How to do the Heimlich maneuver: step-by-step guide for adults, children, and infants (2026)

If someone is choking right now, skip to the steps below. Call 911 first if anyone else is with you.

The 30-second version

For a choking adult or child over age 1 who cannot speak, cough, or breathe:

1. Call 911. If someone else is nearby, they call while you act. If you’re alone, put your phone on speaker and start.
2. Give 5 back blows. Heel of your hand, firm, between the shoulder blades.
3. Give 5 abdominal thrusts. This is the Heimlich maneuver. Fist above the navel, inward and upward.
4. Alternate 5 and 5 until the object comes out or the person goes limp.
5. If they become unresponsive, lower them to the floor and start CPR.

For infants under 12 months, swap the abdominal thrusts for chest thrusts. Never do abdominal thrusts on a baby.

That’s the whole protocol. The rest of this page explains how to do each part correctly, what changed in the guidelines in late 2025, and the mistakes that cost people seconds they don’t have.

What changed in 2025 (and why older instructions you’ve seen are out of date)

For decades, American guidance was split. The Red Cross taught back blows first. The American Heart Association taught abdominal thrusts alone, a holdover from Dr. Henry Heimlich’s own lobbying in the 1980s, when he called back blows “death blows.”

That split is over. The 2025 AHA Guidelines for CPR and Emergency Cardiovascular Care, published October 22, 2025 in Circulation, were the first full revision of resuscitation guidance since 2020, and they changed the choking protocol for everyone. Conscious children and adults now get five back blows followed by five abdominal thrusts, alternating until the object is out or the person becomes unresponsive.

Why the change? Observational studies of real adult and pediatric choking incidents found that back blows cleared airways more often and caused fewer injuries than abdominal thrusts on their own. Starting with back blows also makes the protocol consistent across every age group, which makes it easier to remember when you’re panicking.

The infant protocol was updated too: five back blows alternating with five chest thrusts using the heel of one hand. Abdominal thrusts are still not recommended for infants because of the risk of injury.

If you learned “just do the Heimlich” or took a CPR class before late 2025, this is the update you need.

How to tell if someone is actually choking

This matters more than people expect. A person who is coughing hard is moving air, and coughing is more effective than anything you can do with your hands. Interfering can turn a partial blockage into a complete one.

Leave them alone and encourage them to keep coughing if they can:

• Cough forcefully
• Speak, even a few words
• Breathe, even noisily

Act immediately if they:

• Can’t speak or make any sound
• Have a weak, silent, or ineffective cough
• Make high-pitched wheezing noises, or nothing at all
• Clutch their throat (the universal choking sign)
• Look panicked, with wide eyes
• Turn dusky, blue, or gray around the lips and fingernails
• Go limp

The dangerous thing about real choking is how quiet it is. Nobody gasps dramatically. A person with a fully blocked airway makes almost no sound, which is why choking deaths happen at busy dinner tables while everyone keeps talking. If someone stands up abruptly and leaves the table during a meal, follow them.

In children, look for a child who has stopped making noise and isn’t coughing. Dr. Benny Joyner Jr., one of the authors of the 2025 guidelines, points to a child turning blue and not coughing or making sounds as the warning sign parents should know.

Also Read: 75 Self Care Ideas for Women (Sorted by How Much Time You Have)

Step-by-step: the Heimlich maneuver on an adult or child over 1

Step 1: Get 911 on the way

Call 911 immediately. If two people are present, one calls and one helps. If you’re alone with the person, dial, hit speaker, set the phone down, and start the back blows. Don’t stop to explain. The dispatcher can hear you and will send help.

Why call even if you expect to clear it? Because a person can rebound and then deteriorate, and because objects sometimes move deeper instead of out.

Step 2: Five back blows

• Stand slightly behind and to the side of the person.
• Support their chest with one hand and lean them forward, so the object falls out of the mouth rather than back down the airway. This part gets skipped constantly, and it matters.
• With the heel of your other hand, deliver 5 sharp, distinct blows between the shoulder blades.
• Hit hard. Each blow is a separate attempt to dislodge the object, not a rhythmic pat.

Check after each blow. If the object comes out, stop.

Step 3: Five abdominal thrusts (the Heimlich maneuver)

• Stand behind them. For a child, kneel so you’re at their height.
• Wrap both arms around their waist.
• Make a fist with one hand. Place the thumb side of that fist against their abdomen, just above the navel and well below the breastbone.
• Grab your fist with your other hand.
• Pull sharply inward and upward, like you’re trying to lift them off the ground. Each thrust is a distinct J-shaped motion, not a squeeze.
• Repeat 5 times, checking between each.

The force is deliberate. You’re driving the diaphragm up to compress the lungs and fire the trapped air out like a cough. Timid thrusts do nothing. Adults have survived choking with a cracked rib and have not survived polite technique.

Step 4: Alternate until it’s over

Keep alternating five back blows and five abdominal thrusts until the object is expelled or the person becomes unresponsive. Don’t count cycles, don’t pause to reassess for long, and don’t stop because it’s been a while. Bystanders have cleared airways on the twelfth cycle.

Step 5: If they become unresponsive, start CPR

Lower them to the floor carefully so they don’t hit their head. Then:

• Start chest compressions immediately. Hard and fast in the center of the chest, about 2 inches deep, 100 to 120 per minute.
• Before giving rescue breaths, look inside the mouth. If you can see the object and can grab it, remove it.
• Do not sweep a finger through the mouth searching blindly for an obstruction. The risk of pushing it deeper outweighs any benefit.
• Continue CPR until EMS arrives or the person starts breathing.

Chest compressions generate pressure similar to an abdominal thrust, so CPR is itself an attempt to move the object.

Choking infants under 12 months

Never use abdominal thrusts on a baby. Their liver and spleen sit low and unprotected, and the force can rupture them.

Back blows:

• Sit down. Lay the infant face down along your forearm, supported on your thigh.
• Support the jaw and head with your hand, keeping the head lower than the chest.
• Deliver 5 firm back blows with the heel of your hand between the shoulder blades.

Chest thrusts:

• Turn the baby face up along your other forearm, head still lower than the body, head and neck supported in your hand.
• Using the heel of one hand on the breastbone just below the nipple line, give 5 quick downward thrusts, about 1.5 inches deep.

Alternate 5 back blows and 5 chest thrusts until the object comes out or the infant becomes unresponsive. If the baby goes limp, start infant CPR and call 911 if you haven’t already.

One note on the 2025 update that many parents missed: the guidelines also changed infant CPR technique. Two fingers on the sternum is no longer recommended, because it doesn’t reliably achieve adequate compression depth. Use the heel of one hand or the two-thumb encircling technique instead.

Special situations

Pregnant people, or anyone you can’t get your arms around

Use chest thrusts instead of abdominal thrusts. Everything else stays the same, including the back blows.

• Stand behind them and place your arms under their armpits, around the chest.
• Place your fist on the center of the breastbone, not on the ribs or the bottom tip of the sternum.
• Pull straight back in sharp thrusts.

This applies to pregnancy and to any situation where the rescuer can’t encircle the abdomen.

Someone in a wheelchair

Lock the wheels. Stand or kneel behind the chair if you can reach around the backrest. If the chair back is too high or solid, move to the side, lean the person forward for back blows, and use chest thrusts from the front or side. Don’t waste time trying to transfer them to the floor while they’re still conscious.

Someone much taller than you

Get them to sit down or kneel. Height differences make abdominal thrusts nearly impossible to perform correctly, and a seated position is easier than fighting gravity.

If you’re choking and alone

You can do this to yourself, and people do it successfully.

• Make a fist, thumb side against your abdomen just above the navel. Grab it with your other hand and thrust inward and upward, hard.
• Better: use a hard edge. Bend over the back of a chair, a countertop, a railing, or a table edge, position it just above your navel, and drive your body down onto it with your full weight. The leverage beats what your own arms can produce.
• Repeat until the object clears.

Get outside or somewhere visible if you can. And remember that text-to-911 is available in many parts of the US: type 911 into the recipient field and send your location and the nature of the emergency. Check whether your county supports it before you need it.

What not to do

These are the errors that show up in case reviews and in emergency department reports.

• Don’t do a blind finger sweep. It converts a partial obstruction into a complete one. Only remove an object you can see and grip.
• Don’t offer water. It can’t wash down a solid object and it risks aspiration.
• Don’t do abdominal thrusts on someone who is coughing forcefully. Let them cough.
• Don’t do abdominal thrusts on an infant. Chest thrusts only.
• Don’t place your fist on the breastbone or the ribs during abdominal thrusts. Above the navel, below the ribcage.
• Don’t stop because you’re worried about hurting them. A broken rib is survivable. Four minutes without oxygen usually isn’t.
• Don’t leave them alone to go get help if you can call instead.
• Don’t assume it’s over when they take one breath. Stay with them.

After the object comes out: why you should still see a doctor

This is where most choking articles stop, and it’s a real gap.

Anyone who received abdominal thrusts should be medically evaluated, even if they feel fine. The force required to clear an airway is enough to cause rib fractures, and in rare cases injuries to the liver, spleen, stomach, or diaphragm. Internal bleeding can present hours later.

Go to an emergency department, or call 911 back, if the person has any of these after the event:

• Ongoing cough, wheezing, or noisy breathing
• Pain when swallowing, or a sensation that something is still stuck
• Chest, abdominal, or back pain
• Hoarseness or voice change lasting more than a few hours
• Fever in the following days, which can signal aspiration pneumonia
• Any period of unresponsiveness, no matter how brief

A partially dislodged object can drop into a lung rather than out of the mouth. The person often feels better immediately and then develops a cough and fever days later. Bronchoscopy retrieves it. Waiting turns it into pneumonia.

Do anti-choking devices work?

Suction devices marketed to families, including LifeVac and Dechoker, are heavily advertised to parents and to care homes. The honest answer is that the evidence is thin and the major bodies have not endorsed them.

The American Heart Association and the American Red Cross do not recommend them, and the American Academy of Pediatrics and ILCOR do not treat them as standard of care. The FDA issued a safety communication about anti-choking devices in April 2024. These devices are registered with the FDA, as all medical device manufacturers must be, but registration is not clearance or approval, and the FDA has not reviewed manufacturer data confirming they are safe or effective as advertised.

The published research is mixed. A 2023 cadaver study found that LifeVac cleared moistened saltines but failed on cashews and whole grapes, while Dechoker removed nothing at all. Both caused swelling and blood pooling in the mouth. The authors advised consumers to keep relying on back blows and abdominal thrusts. A later systematic review catalogued adverse events including perioral bruising, airway swelling, oropharyngeal abrasions, and one esophageal perforation, and flagged the limited and incomplete quality of the underlying data.

Manufacturer registries report high success rates, but most of that data is self-reported by the companies, and randomized trials in real choking emergencies are close to impossible to run.

Where that leaves you: if you own one, it’s a backup after back blows and abdominal thrusts have failed, not a first move. Buying one is not a substitute for knowing the technique. As Dr. Lauren Rice of Tufts Medical Center put it, the money is better spent on prevention and preparation than on a commercial device. They also aren’t intended for infants under 12 months.

Who chokes, and how to prevent it

Choking is the fourth leading cause of unintentional injury death in the US. The National Safety Council recorded 5,923 choking deaths in 2024, and choking rates climb sharply starting around age 71.

That last detail surprises people. Choking is framed as a toddler problem, but the steepest risk curve belongs to older adults, driven by swallowing difficulty, dentures, stroke history, Parkinson’s, and medications that dry the mouth.

For young children:

• Cut round foods lengthwise, then again. Grapes, cherry tomatoes, and hot dogs are the shape of a child’s airway, which is exactly why they’re so dangerous.
• Avoid whole nuts, popcorn, hard candy, chunks of raw carrot, and marshmallows under age 4.
• Insist on sitting down to eat. No walking, running, playing, or lying down with food.
• Watch for coins, button batteries, small toy parts, and balloon fragments. Uninflated and burst balloons are among the deadliest choking objects for children.
• Supervise meals directly. The large majority of fatal choking incidents happen at home, not in restaurants or daycare.

For older adults:

• Take smaller bites and slow down. Sit fully upright and stay upright for 30 minutes after eating.
• Make sure dentures fit. Loose dentures reduce the sensation that tells you food isn’t chewed enough.
• Ask a doctor about a swallowing evaluation after any stroke or new neurological diagnosis, or if coughing during meals becomes routine.
• Avoid eating while distracted or drowsy, and be cautious combining meals with alcohol or sedating medication.

Also Read: What Is Good Health? The 8 Pillars & a Self-Check Guide (2026)

Frequently asked questions

Is the Heimlich maneuver still what it’s called?

The technique is the same, but the official terminology in resuscitation guidance is “abdominal thrusts,” and the broader emergency is called foreign-body airway obstruction. “Heimlich maneuver” remains the term nearly everyone searches for and uses.

Do I do back blows or abdominal thrusts first?

Back blows first, five of them, then five abdominal thrusts, alternating. That is the 2025 AHA recommendation for conscious adults and children over 1.

How hard should I push?

Hard enough to be uncomfortable to watch. Sharp, forceful, and distinct. Under-doing it is the more common failure by a wide margin.

Can I break a rib?

Yes, and it’s an acceptable trade. Ribs heal. Have the person evaluated afterward.

What if the person is unconscious when I find them?

Call 911, start CPR with chest compressions, and check the mouth for a visible object before each set of rescue breaths. No blind sweeps.

Can I do the Heimlich on my dog?

A modified version exists, but the anatomy and technique differ. Contact an emergency veterinarian rather than applying human technique.

Does the person need to go to the hospital if the food came out and they seem fine?

If abdominal thrusts were used, yes, they should be evaluated. If they simply coughed it out on their own with no intervention and have no symptoms, monitoring is usually enough, though any lingering cough or pain warrants a visit.

How long do I have?

Brain injury from oxygen deprivation typically begins within about 4 to 6 minutes. EMS response averages longer than that in most of the country. You are the treatment, not the ambulance.

The only real preparation

Reading this helps. Training helps more. Dr. Katie Dainty, another 2025 guidelines author, made the point that matters: panic is easy, and training is what lets you respond instead of freeze. The AHA and the Red Cross both run short in-person and blended courses, and many hospitals and fire departments offer free community sessions.

Joyner, who used these exact steps on a relative at a family gathering shortly before the guidelines were published, put it plainly: there’s no rocket science to it, and everybody should know this.

This article is for education and is not a substitute for hands-on training, professional medical advice, or emergency care. In an emergency in the US, call 911.

Sources

• 2025 American Heart Association Guidelines for CPR and Emergency Cardiovascular Care, Circulation, October 22, 2025
• American Heart Association, “What to do if someone is choking and when to start CPR,” updated July 2026
• American Heart Association Newsroom, “Updated CPR guidelines tackle choking response, opioid-related emergencies and a revised chain of survival”
• National Safety Council, Injury Facts, choking mortality data
• FDA Safety Communication on anti-choking devices, April 2024
• Journal of Emergency Nursing, systematic review and meta-analysis of antichoking suction devices, 2026