Unconscious Child Choking

In this lesson, you'll learn how to help a choking victim who is an unconscious child. Just as with our last fictional choking scenario, this victim went unconscious while you were trying to help them.

Much of this lesson will look exactly like the unconscious adult choking lesson that you just finished. However, keep in mind that we learn through repetition and you can always expect a nugget or two (or seven) that wasn't in the last lesson.

How to Provide Care

As always, the first thing you want to do is make sure the scene is safe and that your gloves are on, and that you have your rescue shield handy.

• Help lower the child to the ground or floor, so they don't sustain a trauma from a hard fall. Pay extra attention to supporting their head and neck.
• Call 911 and activate EMS if you haven't already done so. Enlist the help of a bystander if one is available.
• Locate the area over the heart to begin chest compressions.

• Stand or kneel directly over the victim's chest. Lock your elbows and use only your upper body weight to supply the force for the chest compressions, and count as you perform them.
• Conduct compressions that go 1/3 the depth of the victim's chest and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second.
• Perform 30 chest compressions.

Remember, once you perform a chest compression, make sure you allow for full recoil of the chest cavity. You want to allow the chest to come all the way back to the neutral position before performing another compression.

• Lift the victim's chin and tilt his or her head back slightly.
• Look inside their mouth. See if any obstructions came loose from the chest compressions. If you see something, sweep it out using your finger. If you don't, continue with the following steps.
• Grab the rescue shield and place it over the victim's mouth and nose.
• Pinch the victim's nose and open their mouth.
• Deliver a rescue breath and watch for the victim's chest to rise. If the chest doesn't rise, reposition the head and chin and try again. If the second breath also doesn't result in a chest rise, go right back into your 30 chest compressions.
• Look in their mouth again after the 30 chest compressions. If you see an object, sweep it out and try two more rescue breaths.
• If the rescue breaths go in this time – causing the chest to rise and fall – reassess the victim for signs of breathing normally and/or responsiveness.

Remember, we're assuming your chest compressions were able to dislodge the obstruction and you got it out of the victim's mouth. At this point, either they're breathing normally and becoming more responsive, or they're not. If not, continue to perform 30 compression to two rescue breaths.

Continue to perform CPR until EMS arrives, an AED is located, someone equally trained relieves you, or the victim becomes responsive and begins breathing normally again.

A Few Common Random Questions that (may) Pertain to Choking Victims

What are the differences between child CPR and adult CPR?

There are three distinct differences to be aware of.

Opening the Airway

While the same head tilt maneuver is applied to children as it is for adults, make sure there is less hypertension in a child's neck compared to adults. To do that, simply tilt the head back only slightly past neutral. Your goal is a chin angle that's less pronounced and more perpendicular to the ground.

Remember, with infants, that tilt is even less pronounced, as in neutral or slightly sniffing. With infants, it's more about distancing the chin from the chest, due to a neck that's still in the stubby stage.

Performing Compressions

The compressions you perform on a child are very similar to those you would perform on an adult. The only difference is in the compression depth. While adult CPR has a depth of 2-2.4 inches, when administering CPR on a child, two inches will usually be the maximum depth. And in very small children, it's better to perform compressions using just one hand.

But since human beings tend to come in many different sizes, stick to your 1/3 the depth of the chest and you'll never be wrong.

Using AEDs

As you recently learned, AEDs work the same regardless of age. However, the pads themselves, as well as pad placement, will vary based on the size of the victim.

If your cardiac arrest victim weighs more than 55 pounds, continue using the adult AED pads. If the victim weighs less than 55 pounds, use pediatric AED pads if available. And yes, you'll have to guess when it comes to their weight.

How well do compressions work for dislodging an obstruction?

Just because your choking victim went unconscious, there's no reason to panic, as chest compressions work surprisingly well for removing airway obstructions. Performing those compression perfectly will also help.

If the victim begins breathing again but it's not “normal breathing”, what are some signs I can look for?

Just as there are many reasons why a person would experience respiratory or airway issues, there are also numerous signs and symptoms that can alert you to a problem, including:

• The person is unable to speak, can only speak a few words, or has a hoarse-sounding voice
• excessive use of abdominal muscles to breathe
• muscles between the ribs pull in on inhalation
• pursed lips breathing
• nasal flaring
• fatigue

Adequate breathing means that respiratory rate – 12-20 for adults, 15-30 for children, 25-50 for infants – depth and effort are all normal.