The Choking Guidelines Changed Last Year: The New Sequence Every Parent and Manager Should Know

Excerpt: The choking-response guidance revised in October 2025 calls for alternating five back blows and five abdominal thrusts for a conscious adult or child, and five back blows with five chest thrusts for an infant. Here’s how the updated sequence works, why the back-blow step matters, and what to do if the person becomes unresponsive — from the adult or child five-and-five cycle to the infant chest-thrust variation.

One year ago this week, revised CPR and emergency cardiovascular care guidance set out a clearer sequence for helping a person who is choking. If you learned a different method years ago, it’s worth updating what you remember, and how your family or workplace responds.

Holiday gatherings and family meals are coming up, and choking can happen at home, in a restaurant, at a daycare, or during a break at work. The National Safety Council’s Injury Facts reports 5,923 choking deaths in the United States in 2024 and identifies choking as the fourth leading cause of unintentional injury death. Food is a common cause, adults 65 and older make up the largest share of choking deaths, and young children, especially those under 5, are at particular risk.

I teach practical first aid and CPR/AED skills across San Diego County, Temecula, Murrieta, Menifee, and Lake Elsinore. The main point I want people to leave with is simple: know the age-specific sequence, call 911 for a life-threatening emergency, and be ready to act.

Recognize severe choking and call for help

A person with a severe airway blockage may clutch their throat, look panicked, have a weak or ineffective cough, or no cough, make a high-pitched squeak or go silent, and be unable to speak or cry. Their skin may become pale or blue. If they cannot cough effectively, speak, cry, or breathe, treat it as an emergency.

Call 911, or direct someone specific to call, and follow the dispatcher’s instructions. If the person can cough forcefully, encourage them to keep coughing and watch closely for worsening symptoms. The Red Cross provides separate adult and child choking instructions and infant choking instructions.

Conscious adult or child: alternate five and five

For a conscious adult or child with severe choking, use this sequence. A child here means someone beyond infancy.

1. Give five back blows. Stand slightly behind and to the side. Support the person and lean them forward. Use the heel of one hand to deliver up to five firm blows between the shoulder blades.
2. Give five abdominal thrusts. Stand behind the person and wrap your arms around their waist. Place a fist just above the navel and below the ribs, grasp it with your other hand, and thrust inward and upward.
3. Repeat the cycle. Continue alternating five back blows and five abdominal thrusts until the object comes out, the person can breathe normally, or they become unresponsive.

For a smaller child, kneel behind them as needed to reach safely. Do not use abdominal thrusts on an infant. If the obstruction clears after thrusts, medical evaluation is prudent because thrusts can cause injury even when the person appears better.

Infant: five back blows, then five chest thrusts

For a conscious choking infant, support the head and neck throughout. Keep the infant’s head lower than the chest as you alternate the following:

1. Give five back blows. Position the infant face-down along your forearm, supporting the jaw without pressing the throat. Use the heel of your hand to give five firm blows between the shoulder blades.
2. Give five chest thrusts. Turn the infant face-up while supporting the head and neck, keeping the head lower than the chest. Use the heel of one hand to give five distinct thrusts to the center of the chest.
3. Repeat the cycle. Continue five back blows followed by five chest thrusts until the object comes out or the infant becomes unresponsive.

Never give abdominal thrusts to an infant: they can cause serious injury. Infant skills depend on correct positioning and hand placement, so I encourage caregivers to practice with an infant training mannequin in an instructor-led class.

What changed, and why the sequence matters

The updated guidance makes the five-back-blow, five-abdominal-thrust sequence explicit for a conscious choking adult or child. Earlier guidance for children emphasized abdominal thrusts, and the new sequence provides a clear approach for adults as well. For infants, it specifies five back blows alternating with five chest thrusts; abdominal thrusts are not recommended.

The update also brought adult, child, and infant cardiac-arrest care into a single Chain of Survival, meaning the linked actions that support a person from recognizing an emergency through recovery are now described in one place. It reinforces that CPR includes compressions and breaths, especially for children and infants, whose cardiac emergencies often involve breathing problems.

The guidance encourages community training, awareness campaigns, and instructor-led practice. It also notes that children 12 and older can be taught effective CPR and defibrillation. American Red Cross first aid and CPR/AED programs teach practical response skills, including choking care. HSI certification is available only when a client specifically requests it. I focus on helping people practice, ask questions, and build confidence, not just memorize a list.

Special situations to remember

• Pregnancy or a person too large to reach around: Use chest thrusts instead of abdominal thrusts.
• A person using a wheelchair: If safe and practical, position yourself behind the chair; you may need to kneel to reach the person. Call 911 and follow dispatcher instructions.
• You are choking alone: Call 911 if you can. Give yourself abdominal thrusts, or press your abdomen against a firm object, such as the back of a sturdy chair.
• The person becomes unresponsive: Carefully lower them to a firm, flat surface and begin CPR with chest compressions. Call 911 if no one has already done so. When opening the mouth to give breaths, remove an object only if you can see it. Never do a blind finger sweep: it can push an object farther into the airway.

CPR response for an unresponsive person depends on age and training. In my classes, I teach adult, child, and infant skills using the current Red Cross and HSI program materials.

Practice the skills before an emergency

Only about 41% of people who have an out-of-hospital cardiac arrest receive CPR before EMS arrives, according to CARES data. The Red Cross notes that early bystander CPR can double or triple survival chances. These are population-level figures, not promises about what will happen in an individual emergency. CPR and first aid training do not guarantee survival, and they never replace calling 911.

I offer mobile First Aid, CPR & AED and pediatric training, with hands-on and blended options that combine online learning with an in-person skills session. I travel to your home, school, daycare, office, or organization across San Diego County, Temecula, Murrieta, Menifee, and Lake Elsinore.

Training is by appointment only. To request a class, email me or call (951) 669-4177 and include the specific dates you want for the class, your preferred location, and the course you need. I’ll help you choose a format and build practical skills for responding with greater confidence.

Sources

• American Red Cross: Adult & Child Choking and Infant Choking
• American Red Cross: Guidelines Database, Foreign Body Airway Obstruction
• HSI: First Aid: Choking course
• HSI: First Aid CPR AED Student Book
• National Safety Council Injury Facts: Choking data and deaths by age and cause
• International Liaison Committee on Resuscitation: 2025 International Consensus on First Aid Science With Treatment Recommendations
• CARES: 2024 Metrics Summary