Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Ineffective cough or unconsciousness
A silent child unable to breathe, cry or cough effectively has complete or near-complete foreign-body airway obstruction and can progress to cardiac arrest within minutes.
Action: Shout for help and call emergency services. If conscious, alternate up to 5 back blows with 5 chest thrusts in an infant or 5 abdominal thrusts in a child; reassess after each cycle. If unconscious, open the airway, remove only a clearly visible object, give 5 rescue breaths and start paediatric CPR. Do not perform blind finger sweeps; arrange hospital assessment even after apparent relief.
Synopsis
Treat complete airway obstruction immediately, recognise partial or occult aspiration after choking, understand that normal examination and radiography do not exclude it, and obtain urgent specialist rigid bronchoscopy when clinical suspicion remains.
With an effective cough, encourage coughing and watch continuously; do not strike a child who can still move air effectively.
With an ineffective cough in a conscious infant, alternate 5 back blows and 5 chest thrusts. In a child older than 1 year, alternate 5 back blows and 5 abdominal thrusts.
If unconscious, begin paediatric basic life support with 5 rescue breaths and CPR. Look in the mouth before breaths and remove only a visible object; never sweep blindly.
Key red flags
Ineffective or silent cough, inability to cry or speak, cyanosis or reduced consciousness requires the RCUK choking sequence immediately.
Investigation priorities
01
First-line: inspiratory and air-trapping chest radiographsFirst stepFirst line
Find radiopaque material, unilateral hyperinflation, collapse or mediastinal shift in a stable child.
02
Reference standard: rigid bronchoscopyReference standard
Directly identify and remove a central airway foreign body while controlling the airway.
Management branches
Effective coughEncourage and observe
A choking child remains able to cough loudly and breathe.
Encourage coughing and keep the child under continuous observation.
Do not give blind sweeps, drinks or back blows while cough remains effective.
Stable aspirationRefer for definitive bronchoscopy
Choking history or focal signs persist after the immediate crisis.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.