In a child with suspected airway obstruction due to choking, what is the recommended initial maneuver?

• A. Check mouth for obstruction with finger sweep
• B. Perform abdominal thrusts on infant
• C. Perform chest compressions immediately
• D. Deliver back blows and chest thrusts

Answer: (D)

Relieving a choking obstruction in a conscious child is handled with external airway clearance techniques rather than starting CPR. The best initial maneuver is to deliver back blows and chest thrusts. The back blows, delivered between the shoulder blades with the heel of the hand, create an upward air movement that can pop the object loose. The chest thrusts then compress the chest to generate air pressure that helps expel the blockage. Perform five back blows followed by five chest thrusts, repeating as needed until the object is expelled or the child can cough, speak, or breathe effectively on their own.

Avoid blindly sweeping the mouth with a finger, which can push the object deeper if you can’t clearly see it. Finger sweeps are only appropriate if you can see the object and can safely remove it. Abdominal thrusts are not used for infants and are generally reserved for older children, while chest compressions are reserved for an unresponsive child, at which point you would start CPR and check the mouth for a visible object to remove if possible.