Heartsaver Infant Choking Algorithm

Witnessing an infant choke is a terrifying experience for any parent, guardian, or caregiver. Knowing the correct steps to take can make all the difference in a life-threatening emergency. The American Heart Association (AHA) has developed the Heartsaver Infant Choking Algorithm, a clear, step-by-step procedure designed to help you act quickly and effectively.

By learning this vital skill, you can be prepared to save a life when every second counts.

What is the Heartsaver Infant Choking Algorithm?

The Heartsaver Infant Choking Algorithm is a sequence of actions recommended by the American Heart Association for relieving a severe airway obstruction in an infant (a child under one year of age). This procedure is designed for lay rescuers—people who are not healthcare professionals but want to be prepared for emergencies. The algorithm is a crucial component of first-aid and CPR training programs like the AHA’s Heartsaver courses.

Understanding the difference between a mild and severe obstruction is the first critical step.

Mild Choking: The infant can still make sounds, cough, or cry. In this case, you should stay with the infant and encourage them to continue coughing, which is the body’s natural way of clearing the airway. Do not interfere with their attempts to cough.
Severe Choking: The infant cannot breathe, make sounds, or has a very weak, ineffective cough. They may have a panicked look and their skin might start to turn blue. This is a life-threatening emergency that requires immediate action using the Heartsaver Infant Choking Algorithm.

The Step-by-Step Infant Choking Algorithm

If you determine an infant is severely choking, you must act immediately. The following steps outline the correct procedure for a responsive infant.

Step 1: Confirm Severe Choking and Call for Help

First, quickly assess the infant. Are they unable to cry, cough, or breathe? If you see these signs, you have a severe obstruction. Shout for help. If someone is nearby, tell them to call 911 immediately. If you are alone, do not leave the infant. Begin the choking relief procedure and perform two minutes of care before stopping to call 911 yourself.

Step 2: Perform 5 Back Blows

To perform back blows, you need to position the infant safely.

Sit or kneel, holding the infant face-down along your forearm.
Support the infant’s head and jaw with your hand. The head should be lower than the chest.
Rest your forearm on your thigh for stability.
Using the heel of your other hand, deliver five firm back blows between the infant’s shoulder blades.

Each blow should be a separate, distinct attempt to dislodge the object.

Step 3: Perform 5 Chest Thrusts

If the back blows do not clear the airway, you must immediately switch to chest thrusts.

Carefully turn the infant over, so they are now face-up on your other forearm. Keep the head supported.
Ensure the infant’s head remains lower than their chest.
Place two fingers in the center of the infant’s chest, just below the nipple line.
Give five quick, downward chest thrusts, compressing the chest about 1.5 inches (4 cm) deep.

Like the back blows, each thrust is a separate attempt to force the object out.

Step 4: Repeat the Cycle and Check the Mouth

Continue the cycle of 5 back blows followed by 5 chest thrusts until the object is expelled or the infant becomes unresponsive. After each set of back blows and chest thrusts, if the infant is still responsive, quickly look inside their mouth for the object. If you can see the object and can easily remove it with your fingers, do so. Never perform a blind finger sweep, as this could push the object deeper into the airway.

What to Do If the Infant Becomes Unresponsive

If the infant stops responding, becomes limp, or stops breathing, you must change your approach immediately.

Call 911: If you are alone and have not already done so, call 911 now. Place your phone on speaker so you can communicate with the dispatcher while providing care.
Begin CPR: Place the infant on a firm, flat surface.
Chest Compressions: Start CPR with 30 chest compressions. Use two fingers in the center of the chest and push down about 1.5 inches deep at a rate of 100 to 120 compressions per minute.
Check the Airway: Before giving rescue breaths, open the infant’s mouth and look for the object. If you see it, remove it.
Give Rescue Breaths: Tilt the head and give two rescue breaths, each lasting about one second. If the chest does not rise, the airway is still blocked. Reposition the head and try giving breaths again.
Continue the Cycle: Continue the cycle of 30 compressions and 2 breaths, checking for the object before each set of breaths, until the infant starts to breathe on their own or emergency responders arrive.

Learn These Lifesaving Skills with Professional Training

Reading about the Heartsaver Infant Choking Algorithm is an important first step, but hands-on training is essential to build the confidence and muscle memory needed to act effectively in a real emergency. This is where getting certified can make a world of difference.

At Safety Training Seminars, we provide official American Heart Association (AHA) courses, including Heartsaver Pediatric First Aid CPR AED, which covers the infant choking algorithm in detail. Our certified instructors guide you through realistic scenarios using manikins, ensuring you master the techniques for back blows and chest thrusts. As an official AHA Training Center, we offer certification classes for the general public and healthcare providers across more than 70 locations in California. Upon completion of our blended learning course—which includes a short online portion and a brief in-person skills session—you receive your AHA certification card the very same day.

Don’t wait until an emergency happens. Equip yourself with the skills to protect the most vulnerable. Book a certification class with us today and gain the confidence to act when it matters most.