Choking First Aid: Back Blows and Heimlich Maneuver Steps

Last reviewed: 28 October 2026 · 8 sources (listed at the end). Educational content only. Part of the Jaan Bachayega India series.

Quick answer: Ask “Are you choking?” If they can speak or cough strongly, let them keep coughing and stay close. If they cannot speak, cough or breathe, it is severe choking: get someone to call 108 or 112 and start straight away. Give 5 back blows between the shoulder blades, then 5 abdominal thrusts (the Heimlich maneuver), and repeat until the food comes out. If they become unconscious, call 112 and start CPR.

What usually happens around a choking person: people panic, someone runs to get water, someone tries to pull the food out with a finger. Water does not help a person who cannot breathe, and a finger pushed blindly into the throat can push the food deeper. The two moves that help are simple, and anyone can learn them in one minute.

How to tell someone is choking

Choking happens when food or an object blocks the airway. In adults it is usually food. The American Red Cross lists these signs:

Holding the throat with one or both hands.
A panicked, confused or surprised look.
A weak cough or no cough at all.
High pitched squeaking sounds while trying to breathe, or no sound at all.
Unable to speak or cry.
Skin that turns pale or bluish.

Mild or severe? Ask first

Ask clearly: “Are you choking?”

Mild choking: they can speak, cough strongly and breathe. Encourage them to keep coughing. Coughing is the body’s own best way to clear the airway. Stay with them and watch closely, because mild choking can quickly become severe.
Severe choking: they cannot speak, cannot cough or can only cough weakly, and cannot breathe. They need your help right now.

Severe choking: what to do, step by step

These steps are for adults and children over 1 year. Babies under 1 need a different method, explained further below.

Step 1: Get help on the way

Point at one person and say: “Call 108 or 112. Tell them someone is choking.” Do not wait for the call to finish before you start helping. The 2025 American Heart Association guidelines say calling an ambulance quickly is essential in severe choking, because many people need more than one attempt, and some need help that only the ambulance team or a hospital can give.

Step 2: Give 5 back blows

Support their chest with one hand and help them lean well forward, so that anything that comes loose falls out of the mouth rather than going further down.
With the heel of your other hand, give up to 5 sharp blows between the shoulder blades.
Check the mouth after each blow. If you can see the food, and it is easy to pick out, remove it.

Step 3: Give 5 abdominal thrusts (the Heimlich maneuver)

If the back blows have not cleared it:

Stand behind them and put both arms around their waist.
Make a fist with one hand and place it between the belly button and the bottom of the chest, just above the navel.
Hold the fist with your other hand.
Pull sharply inwards and upwards, up to 5 times.
Check the mouth after each thrust.

Step 4: Keep repeating the cycle

Keep going: 5 back blows, then 5 abdominal thrusts, again and again, until the food comes out, help arrives, or the person becomes unconscious. This is the order in the 2025 American Heart Association guidelines, which also note that back blows were linked with fewer injuries than abdominal thrusts in one large study. St John Ambulance in the UK teaches the same order.

If they become unconscious: start CPR

This is the most important section. If the person collapses and stops responding, gently lower them to the floor. Call 112, put the phone on speaker and start CPR straight away. The 2025 American Heart Association guidelines say to start CPR with chest compressions as soon as a choking person is unconscious.

Lay them flat on their back on a firm surface.
Hand position: put the heel of one hand in the middle of the chest, put the other hand on top and interlock your fingers.
Push hard and fast: keep your arms straight, press down about 5 to 6 cm, let the chest come back up, and repeat at 100 to 120 times a minute.
Look in the mouth before any rescue breath. If you can see the food, remove it. Do not search blindly with your finger.
Not trained in rescue breaths? Keep giving chest compressions without stopping. The ambulance call taker can guide you.
Do not stop until the ambulance team takes over or the person starts breathing normally. If an AED (defibrillator) is nearby, send someone to bring it.

These are the short steps. Read the complete CPR guide for every step, using an AED, and CPR for children and babies.

What not to do

Do not put a finger in blindly to pull the food out. The American Heart Association says a blind finger sweep can make the blockage worse. Remove food only if you can clearly see it and easily pick it out.
Do not give water. A person who cannot breathe cannot swallow safely, and water will not push the food down. This is practical advice, not a quotation from a guideline.
Do not give back blows while they sit upright. Help them lean forward first, as St John Ambulance teaches.
Do not leave them alone, even if they seem to be coughing well.
Do not rely on anti choking suction devices sold online. The 2025 American Heart Association guidelines say there is not enough evidence that they work better than back blows and abdominal thrusts, or that they are safe.

After the food comes out

Even if they feel fine, the person should be checked at a hospital. The American Heart Association guidelines advise hospital care after severe choking whether or not the object came out, and abdominal thrusts can, rarely, injure organs inside the belly.

🛒 Be ready at home: Hansaplast Fast Aid Kit, 9 items

Gauze, cotton, bandage, tape and plasters for small injuries at home.

A first aid kit does not help a choking person. Back blows and abdominal thrusts do. Check the contents before you buy.

Special cases

Pregnant women, or someone you cannot get your arms around

In late pregnancy, or when you cannot reach around a person’s belly, abdominal thrusts may not be possible. The American Heart Association guidelines say chest thrusts can be used instead. A hands on first aid course is the best place to learn how.

Babies under 1 year

Babies need a different method. The NHS says to use back blows and chest thrusts for babies under 1, not abdominal thrusts, and to call for help immediately. Children over 1 can be given back blows and abdominal thrusts, as above. Baby choking will get its own guide in this series.

How to lower the risk

The American Red Cross lists eating too fast, talking or laughing with the mouth full, and dentures that do not fit well as things that raise the risk of choking in adults. It also notes that medical conditions affecting chewing or swallowing raise the risk. If an elderly parent has such problems, ask their doctor how to make meals safer.

🛒 If a doctor has advised softer food: Orpat hand blender, 250 W

For mashing dal, vegetables and fruit into a softer texture at home.

Only change the texture of an elderly person’s food if their doctor or a swallowing specialist has advised it. Stay with them while they eat.

For young children, the NHS advises: think about the size, shape and texture of food; do not give hard foods such as boiled sweets or whole nuts; stay with your child while they eat; and encourage them to sit still while eating, because running around with food in the mouth can cause choking.

🛒 Small pieces for small children: Pigeon mini handy chopper

A hand pulled chopper for cutting vegetables and fruit into small pieces quickly.

Small pieces still need supervision. Always stay with your child while they eat, and do not give whole nuts or hard sweets to young children.

The NHS also says to keep small objects such as buttons, coins and small toy parts out of a baby’s reach, and to keep button batteries well away from small children, because they can cause severe internal burns if swallowed.

Share it with your family

Take a screenshot of this box and send it to your family WhatsApp group, especially to anyone who eats out often or looks after children or elderly parents.

Save and send: if someone is choking

Ask: “Are you choking?” Can cough or speak? Let them cough. Stay close.
Cannot speak, cough or breathe? Someone calls 108 / 112.
5 back blows between the shoulder blades, leaning them forward.
5 abdominal thrusts (Heimlich): fist just above the belly button, pull in and up.
Repeat until it comes out.

Unconscious: lower to the floor, call 112 and start CPR.

No finger sweep. No water. Babies under 1: different method. Get checked at hospital afterwards. Emergency numbers: 108 (ambulance, most states) · 112 (national). Health Beats by Biswa

Disclosure: the product links on this page are Amazon affiliate links. If you buy through them, this site may earn a small commission at no extra cost to you. Nothing linked here treats choking. Back blows, abdominal thrusts and calling for help do.

This article is health education, not medical advice, and not a diagnosis for any person. It reflects the author’s own views as a nursing and public health professional and does not represent any employer or institution. The best way to learn these skills is a hands on first aid course.

Sources

American Heart Association: Part 7: Adult Basic Life Support. 2025 American Heart Association Guidelines for CPR and Emergency Cardiovascular Care. Circulation, 2025 (section on foreign body airway obstruction). ahajournals.org
St John Ambulance: Choking, clinically reviewed 28 April 2025. sja.org.uk
St John Ambulance: How to do CPR, clinically reviewed 18 September 2026. sja.org.uk
American Red Cross: Adult and Child Choking, learn first aid. redcross.org
NHS (UK): How to stop a child from choking, reviewed 28 October 2024. nhs.uk
NHS (UK): Baby and toddler safety, reviewed 19 February 2026. nhs.uk
Government of India: 112 India, Emergency Response Support System. 112.gov.in
National Health Mission: ERS / Patient Transport Service (Dial 108 / 102). nhm.gov.in

Choking First Aid: Back Blows and Heimlich Maneuver Steps

How to tell someone is choking

Mild or severe? Ask first