Eating is an activity of daily living that every person must do — and we rarely consider it dangerous. In 2019, however, more than 5,200 Americans died from choking, with nearly 500 of them from choking on food.

A choking situation can happen to anyone at any time, so you should know the signs of choking and how to help in an emergency.

Choking occurs when a foreign body blocks the airway — either partially or completely and prevents air passage between the upper airway and the windpipe. Choking can happen to people of any age, but it tends to happen more often among the very young and the very old. In the very young, the foreign body is most often food, a toy, a coin, or a battery; in the elderly, it is almost always food.

How to Tell if Someone Is Choking

It takes only four minutes of choking to cause brain injury and possibly death, so every second counts in helping someone who's choking.

The universal sign of choking: Clutching both hands over the windpipe—is the standard way to tell people you're choking. But if someone doesn't know that sign or isn't capable of making it, look for these four other signs:

1. Face and hand signals: Someone choking may look at you with panicked eyes or
   point to their throat to convey that something is wrong.
2. Struggling to breathe: If a person is gagging, wheezing, or coughing, or is unable to breathe or talk at all, they may be choking. Infants may have a weak cry or cough or suddenly go quiet.
3. Bluish lips or skin: A choking person may not get enough oxygen to their blood, so their face, lips, and fingertips may begin to turn blue. This sign may not appear right away, so make sure to look for the first two signs.
4. Passing out: If the choking person is not getting oxygen, they may pass out. You can then check to see if a foreign object is lodged in their windpipe. If you don't see their chest rising and falling, and can't hear them breathing, or if you know there was a foreign object in their throat, you should begin to take steps to unblock their airway.

How to Help Someone Who is Choking (Over Age 1)

Here are the steps you should take for anyone who is choking and is at least 1 year of age. According to the American Red Cross, when the person is conscious but choking and cannot cough, speak, or breathe:

1. First, remain calm.
2. Give the person five back blows: Stand the person up and bend them forward at the waist. Give five sharp back blows between the shoulder blades with the heel of one hand.
3. Give five abdominal thrusts: Make a fist against the middle of the person's abdomen, just above the belly button. Cover your fist with your other hand. Give five quick, upward abdominal thrusts. (This motion is often called referred to as the Heimlich maneuver.)
4. Keep alternating steps 2 and 3: Don't stop aid until the object is forced out, the person can cough forcefully or breathe on their own, or the person becomes unconscious.
5. If the person passes out: Give aid for an unconscious choking person by performing CPR.
6. Call 911.

How to Help When a Baby is Choking (Under Age 1)

UPMC Children's Hospital of Pittsburgh recommends the following steps to clear the airway of a choking baby who is younger than 1 year of age:

1. Remain calm. Sit down with the child in your arms.
2. Supporting the infant's head and neck with one hand, turn the infant's face down toward your thigh. The child's head will need to be lower than their trunk.
3. Forcefully but gently, deliver five back blows with the heel of your hand between the infant's shoulder blades.
4. While still supporting the infant's head and neck with your hand, turn them onto their back with their head lower than their trunk.
5. Using two fingers, deliver five thrusts to the infant's chest with your finger over the breastbone at the nipple line.
6. Repeat five back blows and five chest thrusts until item is dislodged.
7. Call 911.
8. Continue until object is dislodged or until help arrives.

Never stick your finger into a child's throat to dislodge an object. In most cases, this attempt only pushes the item further down the throat.

Tips to Prevent Choking in Children

The American Academy of Pediatrics recommends that parents be very careful when their children begin to eat table foods. Older infants and children under age 4 are at greatest risk for choking on food and small objects. Small foods and round foods are particularly dangerous. The key food culprits of choking in children are:

• Grapes
• Raisins
• Popcorn
• Hard candy
• Chunks of meat
• Hot dogs
• Peanut butter

Make sure all food is cut into very small pieces and teach children to chew their food well.

Small household items are choking hazards, too. Keep small toys, marbles, balloons,
batteries, and coins out of the reach of small children.

Tips to Prevent Choking in Adults

For older adults, choking can become a problem because they produce less saliva in their mouths as they age. Common choking hazards for adults are almost always food. Here are the top foods to watch out for:

• Foods eaten by the handful: Snacks that people pop into their mouths by the handful can easily get sucked into the windpipe. Common culprits are nuts, popcorn, and grapes. Eat smaller bites, chew well, and slow down.
• Small-diameter foods: Foods that can get lodged easily in the throat include hot dogs, grapes, carrots, and hard candy. Make sure to chew your food well and be careful when eating candy.
• Foods with texture: Certain chewy, dry, or thick foods can be hard to swallow. Some challenging foods include bagels, peanut butter, overcooked chicken, and thick hard pretzels. Take smaller bites, chew longer, and drink extra liquids.
• Big bites: Your mom was right. Big bites can be hard to swallow. Top culprits are steaks and stacked sandwiches. Don't bite off or fit more food in your mouth than you can comfortably chew.