🚨
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.
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.
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
📊
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.
🧻 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.
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.
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.
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
🍇
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.
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).
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.
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.
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.
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
📐
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.
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.
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.
💰 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.
🏆 Safe-Cut Tool · Munchkin Mighty Grip Cutter (~$10) — for grape and hot-dog quartering.
🏆 In-Person CPR Class · AHA Heartsaver Pediatric (~$85) or a hospital course. Take it BEFORE solids. heart.org/cpr-classes-near-me
🏆 In-Person CPR Class · AHA Heartsaver Pediatric (~$85) or a hospital course. Take it BEFORE solids. heart.org/cpr-classes-near-me
Choking + CPR Quick Reference · The Dad System · Page 4 of 4