Baby Choking vs Gagging: Back Blows, Infant CPR and Choking Hazards

Gagging versus choking

• Gagging is noisy and normal, especially when starting solids. The baby coughs, sputters, turns red, maybe spits food forward. Stay calm, let them work it out, and don't reach in.
• Choking is a blocked airway. Signs: silent or unable to cry, cough or breathe; a weak, ineffective cough; high-pitched noises; panicked look; lips or face turning blue or gray.
• If the child is coughing hard, let them keep coughing and watch closely.

Choking baby under 1 year (awake)

1. Shout for help and have someone call 911, or put your phone on speaker and call.
2. Lay the baby face down along your forearm, head lower than chest, supporting the jaw. Give 5 firm back blows between the shoulder blades with the heel of your hand.
3. Turn the baby face up on your other forearm or thigh, head low. Give 5 quick chest thrusts on the center of the breastbone, just below the nipple line, about 1.5 inches (4 cm) deep. The 2025 guidelines use the heel of one hand or two thumbs with hands circling the chest, not the old two-finger method.
4. Keep alternating 5 back blows and 5 chest thrusts until the object comes out or the baby becomes unresponsive.
5. Never do abdominal thrusts on a baby under 1, and never hold a baby upside down by the feet.

Choking child over 1 year (awake)

• The 2025 AHA and AAP guidelines changed this: alternate 5 back blows with 5 abdominal thrusts (older guidance used thrusts alone).
• Back blows: support the chest with one arm, lean the child forward, and give 5 firm blows between the shoulder blades with the heel of your hand.
• Abdominal thrusts: stand or kneel behind the child, a fist just above the belly button, other hand over it, 5 quick inward-and-upward pushes.
• Keep alternating until the object comes out or the child becomes unresponsive.

If the child becomes unresponsive

• Lay them on a firm, flat surface and start CPR: 30 chest compressions, then 2 gentle breaths, repeating, at 100-120 compressions a minute. Press about 1.5 inches (4 cm) for a baby, about 2 inches (5 cm) for a child. Alone with no phone? Do 2 minutes of CPR, then call 911.
• Before giving breaths, look in the mouth and remove an object only if you can see it. No blind finger sweeps; they can push it deeper.
• Keep going until help arrives or the child breathes. Even after recovering, they need a doctor's check.

Common choking hazards

• Foods: whole grapes and cherry tomatoes, whole nuts and seeds, popcorn, hot dogs and sausages in rounds, hard raw vegetables and apple, hard or sticky candy, globs of nut butter, marshmallows, chunks of meat or cheese. The AAP advises skipping the riskiest ones (nuts, popcorn, hard candy, hot dog rounds) until at least 4.
• Objects: coins, small toy parts, marbles, pen caps, balloons and balloon pieces (a leading cause of toy choking deaths), button batteries, small magnets and water beads.
• If it fits through a toilet paper tube, it's small enough to choke a young child.

Safer food shapes

• Soft foods that squash between your thumb and finger: finger-length strips at first, small pieces once the pincer grasp arrives.
• Quarter grapes and cherry tomatoes lengthwise; cut hot dogs lengthwise into thin strips; grate or cook hard vegetables and apple until soft; spread nut butter thinly.
• Always seated upright and watched, never in a moving car or while crawling or walking. See the starting solids and babyproofing guides.

Take a class

Reading is no substitute for practice. Infant and child CPR classes from the American Red Cross or the American Heart Association take a few hours, some are partly online, and they teach the newest technique. Grandparents and sitters should take one too.

Call 911 now if

• A child can't cough, cry, breathe or talk, or is turning blue or gray.
• A child is unresponsive: start CPR.
• A button battery or magnet may have been swallowed or put in the nose or ear: go to the ER now, even if the child seems fine. Don't make them vomit; call Poison Control (1-800-222-1222) on the way for advice.