Choking

Overview

Choking happens when food, liquid, or an object partly or fully blocks the airway, making it hard or impossible to breathe. A partial blockage may allow some coughing and air movement, while a complete blockage stops breathing entirely and is a medical emergency that can become life-threatening within minutes.

If someone cannot breathe, speak, or cough and may be choking, call your local emergency number immediately and begin first aid such as back blows and abdominal thrusts if you are trained. Choking is most common and most dangerous in young children, who put objects in their mouths, and in older adults, who may have swallowing difficulties.

Common Causes

Choking usually results from something entering the airway instead of the food pipe, or from a problem with swallowing.

• Food: Eating too quickly, large bites, or high-risk foods such as nuts, hard candy, grapes, hot dogs, and popcorn, especially in children.
• Small objects: Toys, coins, buttons, and other items that young children may put in their mouths.
• Swallowing problems: Difficulty swallowing from stroke, neurological disease, or aging.
• Alcohol or sedation: Reduced alertness and impaired reflexes increase the risk.
• Medical conditions: Conditions affecting the throat or esophagus that interfere with normal swallowing.

Associated Symptoms

Recognizing choking quickly is vital. Warning signs include:

• Sudden inability to talk, breathe, or cough
• Clutching the throat (the universal choking sign)
• Panicked or distressed expression
• Noisy, high-pitched, or wheezing breathing, or silent efforts to breathe
• Skin, lips, or nails turning blue or gray
• Loss of consciousness if the airway stays blocked

A person who can cough forcefully and speak still has some air moving and should be encouraged to keep coughing.

Diagnosis & Evaluation

Choking is recognized by its signs and treated immediately rather than waiting for tests. After the emergency, a clinician may evaluate to make sure the airway is clear and to look for any remaining object or injury:

• Examining the mouth and throat
• Imaging such as X-rays to find an object that may have moved into the airway or lungs
• Assessing swallowing if choking keeps happening, especially in older adults or after a stroke

Repeated choking episodes need evaluation for an underlying swallowing problem.

Treatment & Management

Immediate first aid can save a life when the airway is blocked.

• If the person can cough: Encourage forceful coughing and stay with them.
• If they cannot breathe, speak, or cough: Call emergency services and give first aid. For adults and children over one year, alternate back blows and abdominal thrusts (the Heimlich maneuver) until the object comes out or help arrives.
• For infants under one year: Use back blows and chest thrusts instead of abdominal thrusts.
• If the person becomes unresponsive: Begin CPR if you are trained and continue until emergency help takes over.

Anyone who has choked badly should be checked by a clinician afterward, even if they seem to recover.

Self-Care & Prevention

Many choking incidents can be prevented, especially in young children and older adults, with simple precautions:

• Cut food into small pieces: Prepare bite-sized portions, and for young children avoid high-risk foods such as whole grapes, nuts, popcorn, hard candy, and chunks of hot dog.
• Eat mindfully: Chew thoroughly, eat slowly, and avoid talking or laughing with a full mouth.
• Supervise children: Watch young children while they eat and keep small objects, toys with tiny parts, and coins out of reach.
• Sit upright to eat: Eating while sitting up, not lying down, lowers the risk.
• Be cautious with alcohol: Drinking can dull the reflexes that protect the airway.
• Learn first aid: Taking a course in choking first aid and CPR prepares you to act quickly in an emergency.

When to See a Doctor

Choking with an inability to breathe, speak, or cough is an emergency. Call your local emergency number immediately and start first aid. Also seek medical care if:

• An object was swallowed or inhaled, even if breathing returns to normal
• Coughing, wheezing, or chest discomfort continues afterward
• Choking episodes keep happening, especially with meals
• There is ongoing difficulty swallowing or a feeling that something is stuck

Recurrent choking points to a swallowing problem that needs evaluation to prevent future emergencies.

Related Topics

Frequently Asked Questions

References

1. American Red Cross. Choking and CPR first aid.
2. MedlinePlus, U.S. National Library of Medicine.
3. Mayo Clinic. Choking: First aid.
4. American Academy of Pediatrics (AAP).