How to Do the Heimlich Maneuver? A Doctor-Reviewed Answer

How to do the Heimlich maneuver depends on the person’s age and whether the airway is fully blocked. For severe choking in a responsive adult or child older than 1 year, abdominal thrusts can help expel the object while emergency help is arranged.

Overview: what the Heimlich maneuver is and when it helps

Most brief coughing spells while eating are harmless and settle quickly on their own. The Heimlich maneuver is not needed for mild choking, especially if the person can still cough, speak, or take breaths. In those situations, the safest first step is usually to encourage coughing and stay close by.

The Heimlich maneuver refers to abdominal thrusts used to help remove an object from the airway in a person with severe choking. It is generally used for responsive adults and children older than 1 year who cannot breathe, talk, or cough effectively. A person with severe airway blockage may clutch the throat, look panicked, make little or no sound, or develop bluish lips or skin.

Because choking can become life-threatening within minutes, it is important to act quickly and call emergency services. The goal is to create enough pressure inside the chest to push the stuck object out of the airway. If the person becomes unresponsive, standard cardiopulmonary resuscitation measures are needed while waiting for emergency help.

How to do the Heimlich maneuver in adults and children over 1

If a person has severe choking, first ask if they are choking if they can respond at all. If they cannot speak or breathe, call emergency services or ask someone nearby to call. Stand behind the person and place one foot slightly forward so balance is steady if they suddenly collapse.

Wrap both arms around the waist. Make a fist with one hand and place the thumb side of the fist just above the belly button and well below the breastbone. Grasp that fist with the other hand and deliver quick inward and upward thrusts into the upper abdomen. Repeat until the object is expelled or the person becomes unresponsive.

If the person is pregnant or has significant obesity and the abdomen cannot be safely compressed, chest thrusts are preferred. In this approach, the rescuer stands behind the person and places hands around the lower half of the breastbone, then gives firm backward thrusts. This avoids pressure on the abdomen while still helping create force to dislodge the blockage.

Children older than 1 year are treated similarly, but thrusts should be gentler and adapted to the child’s size. The rescuer should kneel behind a smaller child if needed to place hands correctly. Even after the object comes out, the child should be watched closely for ongoing cough, breathing difficulty, or distress.

What to do for infants and for choking when alone

Infants younger than 1 year should not receive the Heimlich maneuver. Instead, hold the infant facedown along the forearm with the head supported and lower than the chest, then give 5 firm back blows between the shoulder blades. If the object does not come out, turn the infant faceup and give 5 chest thrusts using two fingers on the breastbone, just below the nipple line.

These two steps are alternated until the airway clears or the infant becomes unresponsive. Emergency help should be called as soon as possible. If the infant stops responding, resuscitation steps are needed right away.

If an adult is choking while alone and cannot call for help immediately, they should try to call emergency services if able, then perform self-abdominal thrusts. This can be done by placing a fist above the belly button and pulling inward and upward with the other hand, or by pressing the upper abdomen forcefully against a firm edge such as the back of a chair or countertop. These actions may help generate enough pressure to expel the object.

How to recognize severe choking and what not to do

The Heimlich maneuver should be used only when choking is severe. Warning signs include inability to speak, silent or ineffective coughing, high-pitched breathing sounds, obvious respiratory distress, and difficulty getting air in. Some people may appear suddenly frightened, grab the throat, or lose consciousness if the blockage is not relieved quickly.

Mild choking is different. If the person can still cough strongly or answer in short phrases, they should usually be encouraged to keep coughing rather than receiving abdominal thrusts. A forceful cough is often the most effective way to clear a partially blocked airway.

It is also important not to put fingers blindly into the mouth to search for an object. Blind finger sweeps can push the object farther down or injure the mouth and throat. An object should be removed only if it is clearly visible and easy to grasp safely.

After severe choking, some people continue to cough or have chest discomfort. Although this may settle, lingering symptoms can occasionally signal irritation, a small retained fragment, or another problem affecting the airway or swallowing, including airway-related lung conditions or an underlying swallowing disorder that deserves medical assessment.

When to seek medical care

Many people recover completely after a brief choking episode, especially if the object is expelled quickly and breathing returns to normal. Still, medical care is important if choking was severe, if the person fainted, or if symptoms do not fully resolve. Ongoing wheezing, noisy breathing, throat pain, chest pain, drooling, vomiting, trouble swallowing, or persistent coughing can mean that the airway or esophagus still needs evaluation.

Urgent care is also needed if the person becomes sleepy, confused, or blue around the lips, or if breathing remains fast or labored. Children, older adults, and people with neurologic disease may need extra caution because swallowing problems can be subtle. Repeated choking episodes should always prompt a medical review rather than home observation alone.

If choking happened after swallowing a bone, battery, magnet, sharp object, or large piece of food, clinicians may recommend immediate assessment even if the object seems to have passed. In some cases, specialists in gastroenterology care or emergency medicine are involved to make sure there is no retained object or internal injury.

How doctors evaluate someone after a choking episode

A doctor starts by asking what happened, what was being eaten or swallowed, how long symptoms lasted, and whether the person lost consciousness. The clinician will ask about coughing, voice changes, throat pain, chest discomfort, fever, and any history of swallowing difficulties, reflux, neurologic conditions, or prior choking episodes. This history helps guide whether the concern is airway blockage, aspiration into the lungs, or a problem in the esophagus.

The physical examination focuses on breathing, oxygen levels, heart rate, and the sounds of the lungs and upper airway. The doctor may look in the mouth and throat, assess the voice, and check for abdominal tenderness if abdominal thrusts were used. In children and frail adults, clinicians are also alert for bruising or discomfort after first-aid maneuvers.

Further tests depend on the symptoms. Imaging such as chest or neck X-rays may be used when a retained object, aspiration, or complications are suspected. If food feels stuck lower down or swallowing remains difficult, endoscopic assessment may be considered, sometimes through endoscopy to look directly at the upper digestive tract. When breathing symptoms continue, doctors may also evaluate for infection, aspiration, or other lung problems such as pneumonia.

Treatment after choking and ways to reduce future risk

Treatment after a choking event depends on whether the object has fully cleared and whether any complications are present. If a piece of food or another item remains lodged, doctors may remove it using specialized tools. Airway specialists or digestive specialists may be involved, and some people need observation if they inhaled food into the lungs or had low oxygen levels during the event.

When swallowing problems are suspected, treatment focuses on the cause. This may include review by ear, nose and throat, neurology, or digestive specialists, and sometimes formal swallow testing. If a narrowing, inflammation, or another esophageal problem is found, a doctor may advise targeted treatment, including treatment for esophageal disorders when appropriate.

Prevention matters, especially for young children, older adults, and anyone with dental, neurologic, or swallowing issues. Helpful steps include eating slowly, cutting food into small pieces, chewing thoroughly, avoiding talking or laughing with food in the mouth, and limiting alcohol if it affects alertness or swallowing coordination.

Children should be supervised during meals and kept away from small objects, nuts, whole grapes, hard candy, and toys with detachable parts unless age-appropriate. Near the end of the care pathway, some families also choose teaching on choking first aid and CPR so they feel prepared. Acibadem International’s multidisciplinary specialists and JCI-accredited hospitals diagnose and treat swallowing, airway, and digestive conditions for international patients when further evaluation is needed.

Frequently asked questions

When should the Heimlich maneuver be used?

It should be used when a responsive adult or child older than 1 year has severe choking and cannot breathe, speak, or cough effectively. If the person can still cough forcefully or talk, encouraging coughing is usually safer than starting abdominal thrusts.

How many thrusts should be given?

Abdominal thrusts are repeated until the object comes out, emergency help takes over, or the person becomes unresponsive. There is no single fixed number, because the response depends on how quickly the airway clears.

Can the Heimlich maneuver hurt someone?

It can sometimes cause soreness, bruising, or, rarely, more serious injury, which is why it should be used only for severe choking. Even so, when a person cannot breathe, the immediate priority is clearing the airway.

What if the person becomes unconscious?

If the person becomes unresponsive, emergency services should be called right away if this has not already happened. CPR should begin according to current first-aid guidance while waiting for professional help.

Is the Heimlich maneuver used for babies?

No. Infants under 1 year need a different approach: alternating back blows and chest thrusts. Abdominal thrusts are not recommended in this age group because they can cause injury.

Should someone see a doctor after choking if they feel better?

Sometimes yes, especially if choking was severe or symptoms return. Medical review is important if there is persistent cough, wheezing, throat pain, chest discomfort, trouble swallowing, fever, or concern that something may still be stuck.

References

• American Heart Association
• American Red Cross
• Mayo Clinic
• National Health Service
• MedlinePlus

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.