Being parents to infants or young children alike, it is normal for us to always be concerned to matters regarding our children. Mishaps are a common occurrence and accidents aplenty as your child explores the world.


Today, we focus on how to best handle situations with regards to choking with valuable advice from Dr Azam Mohd Nor, Consultant Paediatrician/ Paediatric Cardiologist from Pantai Hospital Kuala Lumpur, in the event we are unable to obtain immediate medical attention.


Below is a guideline on how to identify, relate and react:


What are the symptoms of choking?

Choking basically means to have difficulty in breathing caused by a constricted or obstructed throat which leads to a lack of air. Symptoms differ according to the age of the child. They commonly tend to gag and cough. In more severe cases, they would have difficulty breathing and the most critical is when the child turns blue in the face as it would mean their airway is totally blocked.


What are the causes of choking?

There are mainly three causes:


1. Gastroesophageal Reflux Disorder also known as GERD. This usually happens to infants where the stomach acid flows back into the tube connecting to the mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of the esophagus.

2. External objects such as eating grapes or peanuts, and other small items such as lego pieces, small toys, etc.

3. Internal factors like swallowing incoordination.


Is it normal to throw up after choking?

Yes, it is. Throwing up is a mechanism to clear the passage and is normal. However, in some cases especially in infants with GERD, throwing up after choking is a cause of alarm as it might lead to aspiration of fluids into the lungs. This is a reason to worry as it might lead to pneumonia and further complicate matters.


What should parents do if a child is choking?

If a child is choking, firstly, make sure their airway is clear. Usually, while a child is choking, they would be coughing violently and this means their body is in the process of dislodging the object naturally. Therefore, parents need to observe that they remove the obstructing object. It is vital to ensure that the child does not turn blue in the face.


Turning blue is an indication that the breathing passage is still blocked and if that is the case, immediate medical help is required. Do NOT attempt to administer CPR with the intention to revive the child as it may further worsen the situation.


What type of first aid to be given in case of choking?


If the object is still lodged, in cases of infants, hold them face down with bottoms higher than their head and proceed to deliver a strong pat or firm back blows between the shoulder blades to make sure whatever that is lodged in their throat is forced out (as per the provided picture). The position of face down with bottom higher than head will cause gravity to assist in dislodging the obstruction.


As for children that are older and can no longer be carried, the Heimlich Maneuver should be administered if the child is choking and not coughing but is gasping for air.


How does one perform the Heimlich Maneuver on an unconscious child?


The Heimlich Maneuver (refer to picture), can only be done on older or larger sized children who can no longer be carried. How to do it is basically to use the ball of your fist and thrust at the position directly below the sternum while pushing the child in a bent forward position.


For an unconscious child, you have to lie them down on their left lateral position i.e. lying down on the left side and thrust them firmly on their back with the flat of your palm until the obstruction is removed.


Should you hit on the back if they are choking?

Only if they are gagging and unable to breathe. If they are already coughing, hitting them on their back is unnecessary as coughing is an indication of a clear airway.


How long does it take to recover from choking?

Usually, just a few minutes as any longer would result in child turning blue in the face.


When should you call a doctor or go to the ER?

In all cases, it is best to seek medical attention after the choking is over to ensure everything is fine.




1. Use appropriate bottle and teat flow.   

2. Do NOT allow the child to feed unattended or unsupervised especially in situations where the baby is left with a bottle and a pillow under their chin propping up the bottle.

3. Do NOT allow your child to consume food without supervision. Ensure that all food given to your child are cut smaller into bite size and avoid giving whole objects or food that easily causes choking e.g grapes,nuts etc.

4. Set ground rules about eating from young, such as advocating proper sitting down while eating, chewing food properly, not speaking with their mouths full, and no playing and lying down while eating.




Dr Azam Mohd Nor, Consultant Paediatrician/ Paediatric Cardiologist from Pantai Hospital Kuala Lumpur feels passionately that awareness coupled with proper education and discipline is very important in order to avoid having a bad situation at hand. It is also best for parents to consider being properly CPR certified and to always seek medical attention after attending to their child in an emergency.