Because of their fragility, children and infants must be approached differently than adults when choking, to prevent causing damage that could threaten the life of the child even if the object is dislodged. Only, however, if the infant is under one year of age should the standard Heimlich method be altered entirely to dislodge the blockage. Toddlers and children over one year of age should be approached, albeit very cautiously, with the traditional procedure proscribed for adults (noted elsewhere), taking special care not to damage the ribs, sternum (breastbone) and vital abdominal organs with thrusts.
As with all cases in which the Heimlich maneuver is to be considered, one must approach a choking child or infant with the utmost caution and consideration. If used unnecessarily the maneuver may cause serious injury, especially to a young child, and should be avoided at absolutely all costs, save when it is necessary in a life-or-death situation. While you may fear the worst when a child begins to choke, be sure that you only use the procedure when the child is unable to BREATHE, TALK, or COUGH. These three things must be remembered, as they are indicators of a minor blockage that has already been resolved, or which is not blocking the passageway to such an extent that it is life threatening. If your child is crying, as likely he or she will be after a painful choking incident, they are inhaling enough oxygen to survive, and the Heimlich maneuver must not be performed. Remember this first so that you can keep it in mind when an accident occurs, so that you do not unnecessarily risk injury to the child out of concern for their state. However, do not withhold too much force when exercising the procedure, or you may not be successful. The judgment of how much force is necessary will be up to you depending upon the size and build of the child or infant, and it is, in a truly life-threatening accident, preferable to do minor harm if in turn a life is saved.
Knowing when an infant has a full tracheal (windpipe) blockage is generally more difficult than knowing when, for instance, an older child or adult is experiencing the same, because obviously they cannot perform the same hand signals and are not yet fully facially expressive. As such, one must be able to recognize the infant's panic, and note that the child is in fact not breathing, whether by testing the breath or the movement of the chest. If the infant is conscious, the Heimlich maneuver should be performed as follows:
* Hold baby face-down, head-down with your secondary (left, if right handed) forearm, bracing the child's face with your secondary hand and supporting the weight of the child with your thigh. Support the head in this way, but do not block the mouth or crane the neck excessively, for fear of causing harm to the child.
* With the heel of your dominant hand, give four firm, but careful blows to the infant's back, between the shoulder blades. This may dislodge the object from the trachea.
* If blockage remains and breathing does not resume, turn the infant over so that he or she faces up, with your hand still supporting his or her head and your arm still resting upon your thigh. With two or three fingers of the opposite hand, thrust firmly upward on the lower part of the baby's sternum (breastbone). Do this as many as five times.
* If, after this, you cannot see the object in the infant's mouth, call emergency services (911) immediately and begin infant rescue breathing (as per CPR). If the object is dislodged by the procedure, remove with your fingers and give two rescue breaths to aerate the infant's lungs and help it start breathing on its own. Continue previous procedures (back blows and chest thrusts) until help arrives.
