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Choking

Choking is the coughing spasm and sputtering that happen when liquids or solids get into the windpipe. A child's cough reflex will clear the windpipe of liquid within 10 to 30 seconds.  If the child is coughing or gagging, it means their airway is only partially blocked. If that's the case, let them continue to cough as this is the most effective way to dislodge a blockage.  Don't give your child anything to drink because fluids may take up space needed for the passage of air.

Complete blockage occurs when solid food (for example, a piece of hot dog) or a foreign object (such as a small toy) gets stuck. (It can also occur with severe croup, or in the case of an allergic reaction to food or an insect bite.) If this happens a child is unable to breathe, cry, cough or speak. They may make odd noises or no sound at all while opening their mouth. Their skin may turn bright red or blue.  The child will be in a state of panic and, if the obstruction isn't removed in 1 or 2 minutes, the child will pass out.

Having recently witnessed the horror of my little girl of almost 2 and a half choking on her cough medicine, I experienced the panic of this situation, attributed mainly to not knowing what I should do to help her.  Although I attended a First Aid course in my daughter's first year, I did not immediately recall what I was supposed to do and hence I have subsequently spent a bit of time 'googling', as a refresher.  Instead of reinventing the wheel, the guidance I have shared here is courtesy of http://www.cpnonline.org/CRS/CRS/pa_choking_hhg.htm, http://londonmumsmagazine.com/2013/how-to-do-cpr-on-a-child (an illustrated guide with training video),   http://www.babycenter.com/0_infant-first-aid-for-choking-and-cpr-an-illustrated-guide_9298.bc and http://www.babycenter.com/0_first-aid-for-choking-and-cpr-an-illustrated-guide-for-child_11241.bc, and I would strongly recommend further reading from these links, if you can find the time in your busy mummy schedules.

Having said this, however, I can not emphasize enough the importance of attending a First Aid Course, especially for mothers with babies/small children, to understand what to do in the event of an emergency.  This guidance is certainly not intended as a substitute, but rather as a very brief introduction, in the interim period whilst you're waiting to attend a course.  It would be extremely advantageous for your child's caregiver (if you are at work during the day) to attend a First Aid Course. - Zimbabas

What to Do If Your Child is Choking on Solid Food or a Foreign Object
If breathing stops, you will need to administer First Aid, as follows:

A Child Over 1 Year Old

  • Give high abdominal thrusts by grasping the child from behind, just below the lower ribs but above the navel, in bear-hug fashion.
  • Make a fist with one hand and fold the other hand over it.
  • Give a sudden upward and backward jerk (at a 45-degree angle) to try to squeeze all the air out of the chest and pop the lodged object out of the windpipe.
  • Repeat this upward thrust 10 times in rapid succession, until the object comes out.
  • If the child is too heavy for you to suspend from your arms, lay him on his back on the floor. Put your hands on both sides of the abdomen, just below the ribs, and apply sudden, strong bursts of upward pressure.

A Child Under 1 Year Old

  • Place him or her facedown in a 60-degree incline over your knees or on your forearm.
  • Deliver 5 blows with your hand to their back between the shoulder blades in rapid succession.
  • If breathing has not resumed, lay the child on the floor and apply 5 rapid chest compressions (chest thrusts) over the lower third of the breast bone (sternum) using 2 fingers. Alternate back blows and chest thrusts. Repeat until the object comes out.

Reason to avoid abdominal thrusts under the age of 1 year: Risk of liver or spleen laceration

If the child or infant passes out, you will need to give mouth-to-mouth breathing.

  • Quickly open the mouth and look inside to see if there is any object that can be removed with a sweep of your finger (usually there is not).
  • Then begin mouth-to-mouth breathing. Air can usually be forced past the foreign object temporarily until help arrives.
  • If mouth-to-mouth breathing doesn't move the chest, repeat the abdominal thrusts or chest compressions.

Call an ambulance IMMEDIATELY in all cases of choking on a solid object.  If you are alone with the child, give two minutes of care before calling an ambulance.

In general, choking on liquids is temporary and harmless, however, if your child chokes on a liquid and turns blue, becomes limp, or passes out, call an ambulance immediately (or if alone with the child, after giving two minutes of care).

A Brief Introduction to Mouth-to-Mouth (Cardio Pulmonary Resuscitation or CPR)

  • Open the airway - Place 2 fingers under their chin and one on their forehead and tilt the head back.
  • Check for breathing - Look, listen, feel their breath on your cheek.  If they are not breathing, tilt the head and lift the chin, then give 5 rescue breaths.  Seal your mouth around their mouth and blow into them like a balloon, making sure their chest rises each time.  To circulate the oxygenated blood, push hard and fast on the centre of the chest, right between the nipples.  Push down by a third of the depth of their chest, ideally with one hand.  At a rate of 120 beats per minute.  After about 30 compressions, give them 2 more short sharp breaths and then continue with the compressions.  Keep going!  If you're by yourself, you should perform 1-2 minute's CPR before phoning for an ambulance.
  • (If doing compressions on a baby, you will need to use two fingers instead of the heel of your hand).