First aid for chocking and CPR

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First-Aid for Choking and CPR:

Reviewed by emergency services experts at the American Red Cross, July 2006.

We'd all like to think that we'll never be put in the position of having to save our child's life, but it could happen. Children choke on toys, fall off bikes and play equipment, and wade into deceptively deep water. If your preschooler is ever choking or suddenly lifeless, you'll want to know what to do.
We've compiled this step-by-step guide to explain the basics of first aid for choking and CPR, but please don't rely on it as your sole source of information.

Set aside a few hours to take a child CPR course to learn and practice the proper techniques. These techniques differ depending on the age of the child, and doing them improperly can be harmful.

Find a class in your area by contacting your local chapter of the American Red Cross. (You can find the phone number in the white pages.)

The following instructions are for children age 1 and older. To find out what to do when a baby under age 1 is choking or needs CPR, see our illustrated guide to infant CPR.


Choking

• Step 1: Assess the situation quickly

If your preschooler is suddenly unable to cry, cough, or speak, something is probably blocking her airway, and you'll need to help her get it out. She may make odd noises or no sound at all while opening her mouth, and her skin may turn bright red or blue.

If she's coughing or gagging, her airway is only partially blocked. In this case, encourage her to cough. Coughing is the most effective way to dislodge a blockage.

If your child cannot clear her airway by coughing up the object, ask someone to call 911 or the local emergency number and begin back blows and chest thrusts (see step 2, below).

If you're alone with your preschooler, give two minutes of care, then call 911.

On the other hand, if you suspect that your child's airway is closed off because her throat has swollen shut, call 911 immediately. Your child may be having an allergic reaction to something she ate or to an insect bite, for example, or she may have an infection, like croup.

Also call right away if your preschooler is at high risk for heart problems.

• Step 2: Try to dislodge the object with back blows and abdominal thrusts.

If your child is conscious but can't cough, talk, or breathe, or she's beginning to turn blue, stand or kneel behind her. Provide support by placing one arm diagonally across her chest and lean her forward.

Firmly strike your preschooler between the shoulder blades with the heel of your other hand. Give five of these back blows.

Then wrap your arms around your child's waist. Make a fist with one hand and place the thumb side against the middle of your child's abdomen, just above the navel and well below the lower tip of her breastbone.

Grab your fist with your other hand and give five quick, inward thrusts into the abdomen. (Each back blow and abdominal thrust should be a separate and distinct attempt to dislodge the obstruction.)

Continue alternating five back blows and five abdominal thrusts until the object is dislodged, your preschooler can breathe or cough forcefully, or she becomes unconscious.

If your child becomes unconscious, she'll need CPR (see full instructions below).

Place your child on her back. Place the heel of one hand on her sternum (breastbone) at the center of her chest. Place your other hand directly on top of the first hand. Try to keep your fingers off her chest by interlacing them or holding them upward.

Give 30 compressions by pushing your child's sternum down a third to half the depth of her chest. Allow the chest to return to its normal position before starting the next compression.

Open your child's mouth and look for an object. If you see something, remove it with your fingers.

Next give her two rescue breaths. If the breaths don't go in (you don't see her chest rise), repeat the cycle of giving 30 compressions, checking for the object, and trying to give two rescue breaths until the object is removed, your child starts to breathe on her own, or emergency medical personnel arrive and take over.

If you're alone, give your child two minutes of care before stopping to call for help.


How to Give CPR

What is CPR?

CPR stands for cardiopulmonary resuscitation. This is the lifesaving measure you can take to save your preschooler's life if she shows no signs of life (breathing or movement).

CPR uses chest compressions and breaths to circulate blood that contains oxygen to the brain and other vital organs until emergency medical personnel arrive. Keeping oxygenated blood circulating can help prevent brain damage, which can occur within a few minutes, and death.

Giving CPR isn't hard to do. Follow these steps:

• Step 1: Check your child's condition.

Gently tap on your preschooler's shoulder and call out. If she doesn't respond, have someone call 911 or the local emergency number. Swiftly but gently place your child on her back on a firm surface.

Make sure she isn't bleeding severely. If she is, take measures to stop the bleeding by applying pressure to the area. Don't administer CPR until the bleeding is under control.

• Step 2: Open your child's airway.

Tilt your preschooler's head back with one hand and lift her chin up slightly with the other. This will open her airway.

Check for signs of life (movement and breathing) for no more than ten seconds. To check her breathing, put your head down close to your child's mouth, facing her feet.

Look to see whether her chest is rising, and listen for breathing sounds. If she's breathing, you should be able to feel her breath on your cheek.

• Step 3: Give her two gentle breaths.

If your child isn't breathing, give her two breaths, each lasting just one second. Pinch your child's nose shut, place your mouth over hers, and exhale into her lungs until you see her chest rise.

If her chest doesn't rise, her airway is blocked. Give her first aid for choking, above.

If the breaths go in, give your preschooler two breaths in a row, pausing between rescue breaths to let the air flow back out.

• Step 4: Give her 30 chest compressions.

Place the heel of one of your hands on your preschooler's sternum (breastbone) at the center of her chest. Place your other hand directly on top of the first hand. Try to keep your fingers off her chest by interlacing them or holding them upward.

To give a chest compression, push your child's sternum down a third to half the depth of her chest. Allow the chest to return to its normal position before starting the next compression.

Give your child 30 chest compressions at the rate of 100 per minute. Then give her two rescue breaths (step 3, above).

• Step 5: Repeat compressions and breaths.

Repeat the sequence of 30 chest compressions and two breaths. If you're alone with your preschooler, call 911 or the local emergency number after you've given care for two minutes. Continue the cycle of chest compressions and rescue breaths until you find signs of life or help arrives.

Even if your preschooler resumes breathing before medical assistance arrives, she'll need to be checked by a doctor to make sure that her airway is completely clear and that she hasn't sustained any internal injuries.