Put kid upside down while doing Heimlich on her/him

Question

I understand the Heimlich procedure I should do if my kid ( 4 years ) is choking, but I want to know if is a good idea to put her upside down while doing it?

Would not gravity + my contstant pushing dislodge whatever is blocking her air conducts?

Answer 1

First, don't hold your 4 year old child upside down when performing abdominal thrusts for choking.

This is what you (and any bystander) should do for a choking child (Note that intervention for a choking child is appropriate for any individual to perform, though one should obtain consent from a parent if they are there. You do not need to be a healthcare provider to do this)

Current guidelines on pediatric basic life support can be found here.

For any individual experiencing foreign body airway obstruction, if they are able to cough or make a sound, do not attempt abdominal thrusts or back blows. For a child or infant this is particularly important because these interventions can convert a partial airway obstruction to a full airway obstruction.

IF AND ONLY IF THEY ARE UNABLE TO MAKE A SOUND you have a full airway obstruction. This is where you intervene. Children over 1 (e.g., the 4 year old in the OP) should receive abdominal thrusts, aka the Heimlich maneuver. Current recommendations (current today, 12/10/2018) do not include alternating abdominal thrusts with back blows.

Correct technique for abdominal thrusts for a child are described in this red cross pamphlet. Note that the algorithm in this pamphlet is outdated (it recommends alternating back blows and abdominal thrusts), but the photos demonstrating the abdominal thrust technique are useful (and correct). Don't hold your child upside down or hold them up in the air. Do get down on your knee (see the picture below) if you need to in order to put your hands in the correct position (just above the child's abdomen) and perform the thrust without lifting them off the ground.

ABDOMINAL THRUSTS:

• Place a fist with the thumb side against the middle of the child's abdomen, just above the navel.

• Cover your fist with your other hand

• Give quick, upward abdominal thrusts

There is a case where care of a foreign body airway obstruction involves holding a child at a downward angle. This is ONLY for infants (0-1 year old).

Infants (0-1 year) should receive back blows alternating with chest compressions. The reason you provide chest compressions for airway obstruction in infants is because airway obstruction and respiratory failure of an infant quickly leads to cardiac arrest. The technique is described well (with pictures) in this red cross pamphlet. Note again that this particular pamphlet has outdated recommendations for older children (recommending alternating back flows and abdominal thrusts), but the infant technique is current:

CONSCIOUS CHOKING--INFANT

Cannot Cough, Cry or Breathe

• 1. GIVE 5 BACK BLOWS: Give firm back blows with the heel of one hand between the infant's shoulder blades

• 2. GIVE 5 CHEST THRUSTS: Place two or three fingers in the center of the infant's chest just below the nipple line and compress the breastbone about 1 1/2 inches. TIP: Support the head and neck securely when giving back blows and chest thrusts. keep the head lower than the chest.

• 3. CONTINUE CARE: Continue sets of 5 back blows and 5 chest thrusts until the:

     • Object is forced out

     • Infant can cough forcefully, cry or breathe

     • Infant becomes unconscious

WHAT TO DO NEXT: If infant becomes unconscious--CALL 9 -1 -1, if not already done. Carefully lower the infant onto a firm, flat surface, and give CARE for an unconscious choking infant, beginning with looking for an object (PANEL 6, Step 3).