Choking (paediatric basic life support)

If there is sudden onset upper airway obstruction with its characteristic signs of acute respiratory distress associated with coughing, gagging, or stridor, inhalation of a foreign body is strongly suspected and immediate action is required to prevent respiratory failure (1).

• majority of choking events in children occur during play or whilst eating when a carer is usually present
• choking caused by a foreign body should be suspected when
  • the onset was very sudden
  • there are no other signs of illness
  • there are clues to alert the rescuer, for example a history of eating or playing with small items immediately prior to the onset of symptoms

Naturally the child would react immediately to the foreign body by coughing in an attempt to expel it. If the cough is absent or ineffective and the object completely obstructs the airway, the child will become asphyxiated rapidly.

• signs of ineffective coughing
  • unable to vocalise
  • quiet or silent cough
  • unable to breathe
  • cyanosis
  • decreasing level of consciousness
• signs of effective coughing
  • crying or verbal response to questions
  • loud cough
  • able to take a breath before coughing
  • fully responsive

Active interventions to relieve choking are therefore required only when coughing becomes ineffective, but they then must be commenced rapidly and confidently (1).

Reference:

1. Resuscitation Council (UK). Resuscitation Guidelines 2010.