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Choking + CPR Quick Reference
2025 AHA/AAP Update (Berg/Bray, Circulation, Oct 22, 2025) · Print + Laminate + Fridge
⚠️ Take an in-person infant + child CPR class. This card is a refresher, not a substitute. AHA Heartsaver / Red Cross / hospital-based. Take it BEFORE solids. Skills decay in ~3 months — a 2-minute monthly mannequin drill maintains them (Sutton 2011).
👶 INFANT (Under 1 Year) — 2025 AHA Algorithm
Coughing or crying = airway open. Don't intervene — let them cough. Stay calm and encourage the cough.
Silent · cyanotic · can't cry = airway obstructed. Act NOW:
1. Call 911 (or shout for someone to call) → put it on speaker.
2. Face DOWN on your forearm, head lower than body, jaw supported → 5 firm back blows between the shoulder blades with the heel of your hand.
3. Flip face UP on the opposite forearm → 5 chest thrusts with 2 fingers on the lower half of the breastbone (NOT the abdomen — never abdominal thrusts on an infant under 1).
4. Repeat the 5 + 5 cycles. Check the mouth between rounds — only sweep if you SEE the object.
5. If they become unresponsive → begin CPR: 30 chest compressions (1.5 in deep, 100–120/min) + 2 breaths. Continue until EMS arrives.
🧒 CHILD (1+ Years) — 2025 Algorithm (Back Blows Now First)
Conscious but can't speak or cough:
1. Call 911 (speaker on).
2. NEW Oct 2025: Lean the child slightly forward → 5 firm back blows between the shoulder blades with the heel of your hand.
3. Stand behind → fist above the navel, below the ribs → 5 abdominal thrusts (Heimlich), inward and upward.
4. Alternate 5 back blows + 5 abdominal thrusts until the object is expelled.
5. Unresponsive → CPR: 30 compressions (2 in deep, 100–120/min) + 2 breaths. Don't skip the breaths — most pediatric arrests are respiratory (Naim, JAMA Peds 2017).
Pregnant or obese child: use chest thrusts instead of abdominal. 2020 → 2025 change: previously abdominal-only; back blows now come first.
Choking + CPR Quick Reference · The Dad System · Page 1 of 4
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The Numbers + Staying Ready
Why It Matters · Drill It · Backup Devices
📊 The Numbers
~12,000 ER visits/yr for food choking in U.S. kids under 14 (CDC); more than 50% are under age 4. Hot dogs = ~17% of food-choking deaths (the top food cause); candy and grapes round out the top three. Bystander CPR roughly doubles pediatric survival (Atkins, Circulation 2009).
🧻 Toilet-paper-roll test: if a food or object fits through the tube (~1.25"), it's a choking hazard for a child under 4.
💛 Drill It — Quarterly
Practice beats memory
Practice on an infant CPR mannequin (Annie / AHA Anytime Kit, ~$35). Both parents plus every sitter. Because skills decay in about 3 months, a 2-minute monthly drill on the kitchen floor preserves competency far better than an annual recert (Sutton 2011). The AHA now formally recommends CPR training starting at age 12.
🆘 Anti-Choking Devices (Backup Only)
Use only after 5 + 5 fails
LifeVac (~$70) and DeChoker (~$60) are airway-suction devices. Use them only AFTER 5 back blows + 5 thrusts have failed. The AHA still recommends the standard algorithm first — independent peer-reviewed survival data on these devices is sparse. Treat them as a backup, never a replacement for the algorithm.
⚠️ Silent Choking Is the Real Danger
A truly choking child often makes NO noise. Coughing is GOOD — let them cough it out. Silence, both hands reaching for the throat, and bluish lips mean act now. Don't pat the back from above while they're upright — it can drive the food deeper. Use the algorithm.
Choking + CPR Quick Reference · The Dad System · Page 2 of 4
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Food Cutoffs by Age
What to Avoid · How to Cut · When It's Safe
Under 6 months
Breast milk or formula only. NO solids. NO water. NO juice.
6–12 months
Purées and soft, mashable foods only.
NEVER under 12 mo: whole grapes · hot dog rounds · popcorn · whole nuts · chunks of cheese or meat · honey (botulism) · marshmallows · raw hard veggies.
Safe: mashed banana · avocado · cooked sweet potato · oatmeal · iron-fortified cereal · soft-cooked egg yolk · thinned smooth nut butter (LEAP).
12 months – 4 years
Cut LENGTHWISE (never crosswise): grapes · hot dogs · cheese cubes · cherry tomatoes · chunks of meat · raw carrots.
Avoid entirely under 4: popcorn · whole nuts · hard candy · marshmallows · raisins · gum · chips · raw hard carrots · raw celery · ice cubes · jelly beans · fish bones · whole olives.
Best practices: sit down to eat (no walking or running) · an adult supervises every meal · cut all round foods.
4–5 years
Introduce slowly and supervised: nuts · popcorn · raisins. Still cut grapes lengthwise.
No hard candy or gum unsupervised. Watch for impulsive, fast eating.
5+ years
Most foods are OK. Keep teaching: chew thoroughly · no talking with food in the mouth · sit while eating · no running with food.
Red flags at ANY age: coughing during a meal · needing lots of fluid to swallow · gulping · grabbing food in handfuls.
Choking + CPR Quick Reference · The Dad System · Page 3 of 4
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Cutting Guide + Response Kit
Prep It Right · Build Your Kit · Drill the Schedule
📐 The Cutting Reference
Grapes / cherry tomatoes / olives: halve LENGTHWISE (long axis). NEVER cross-cut into rounds — the round shape is exactly what blocks the airway.
Hot dogs: NEVER under 1. Quarter LENGTHWISE for ages 2–4, skin removed. Skip them entirely under 4 if you can.
Cheese: shredded or in thin slices (not cubes) under 4.
Meat: finely chopped or shredded across the grain. Test softness with your fingers before serving.
👨👧 Drill Schedule
Quarterly: mannequin practice · Monthly: hazard review + 2-min skills refresh · Annually: renew CPR cert and refill / check the anti-choking device.
🛒 Build Your Choking Response Kit
🏆 Infant CPR Mannequin ·
Prestan Pro Infant (~$80) — gold-standard manikin for quarterly drills, both parents plus sitters.
💰 Budget Mannequin ·
VEVOR Infant CPR Manikin (~$30) — same training value at a fraction of the cost.
🏆 Anti-Choking Device ·
LifeVac Home Kit (~$70) — adult + pediatric mask.
Backup only, after 5 + 5 cycles fail.
Choking + CPR Quick Reference · The Dad System · Page 4 of 4