All choking victims should seek medical attention, since complications can arise not only from the incident, but also from the first aid measures taken.

Occasionally, after choking and first aid, an object will enter the lung instead of being expelled. While the victim may appear to improve and breathe normally, in a few days signs and symptoms of a foreign body in the lung will appear, such as wheezing, persistent cough and pneumonia. If this happens, get medical help immediately!

• Inability to breathe or cry
• High-pitched noises
• Ineffective coughs
• Face begins to turn blue

1. Place the baby with his or her back on a hard surface, keeping the back in a straight line, firmly supporting the head and neck. Expose the child's chest.

2. Open the infant's mouth with your thumb and index finger, placing your thumb over the tongue. If the object is visible and loose, remove it.

3. Lift the infant's chin into a neutral position, neither pushed back or forwards. Do not extend the infant's neck backwards as you would in an older child or adult. If a spinal injury is suspected, pull the jaw forward without moving the head or neck. Don't let the mouth close.

4. Place your ear close to the infant's mouth and watch for chest movement. For 5 seconds, look, listen and feel for breathing.

5. If the infant is not breathing, begin rescue breathing. Maintain the head position and cover the mouth and nose tightly with your mouth. Give 2 slow, gentle breaths, each lasting 1 second with a pause in between.

6. If the chest does not rise, begin back blows. Lay the infant face down along your forearm with the child's chest in your hand and the jaw between your thumb and index finger. Use your thigh or lap for support. Keep the infant's head lower than his or her body.

7. Give 5 quick, forceful blows between the child's shoulder blades with the heel of your other hand.

8. Turn the infant over to be face up on your other arm. Use your thigh or lap for support. Keep his or her head lower than the body.

9. Place 2 fingers on the middle of the breastbone just below the nipples.

10. Give 5 quick thrusts down, depressing the breast 1/2 to 1 inch each time. Each thrust is a separate attempt to clear the airway by forcing air out through the child's windpipe.

11. Open the child's mouth with your thumb and index finger, placing your thumb over the tongue. If the object is visible and loose, remove it. Observe the child's breathing. If the infant stops breathing after removing the object, begin standard CPR for infant under 1 year.

12. If the object is not dislodged, give 5 back blows and 5 chest thrusts, and then check for the object. Repeat this sequence until the object is dislodged or help arrives.

13. If the baby starts having convulsions or seizures, refer to first aid for that condition (see convulsion, first aid).

• DO NOT shake the infant in an attempt to remove the foreign object.
• DO NOT begin CPR (if the breathing has stopped) until the airway is cleared.

If a baby experiences choking, you should call immediately for emergency medical assistance. Even if you successfully dislodge the obstruction and the infant seems fine, call the doctor for further instructions.

• Recognize what is age-appropriate for children -- especially when choosing toys. Don't give infants toys that are heavy or fragile or that have batteries or small parts.
• To reduce the risk of choking accidents, make sure young children do not come into contact with buttons, watch batteries, popcorn, coins, grapes or nuts. It is also important to sit with a child while he or she eats. Do not prop bottles, and do not allow a child to crawl around while eating.
• Never tie pacifiers (or anything else) around a baby's neck.
• Start teaching your child the meaning of "Don't touch." The earliest safety lesson is "No!"