How to Perform the Heimlich Maneuver: Adult, Child, and Infant Steps (2026)

Quick answer: When a relative is choking, the rule reduces to one sentence — if they cough effectively, do not intervene; if they cannot cough effectively, call 112 (or Nova Ambulans for a private-hospital preference) on speakerphone and alternate cycles of 5 back blows with 5 abdominal thrusts (the Heimlich maneuver). The European Resuscitation Council (ERC) 2025 Adult Basic Life Support guideline and the American Heart Association (AHA) 22 October 2025 update both made this change explicit, replacing the earlier abdominal-thrusts-only protocol with a "back blows first" sequence [1]Source: European Resuscitation Council Guidelines 2025: Adult Basic Life Support — Resuscitation (Smyth MA, et al.)[2]Source: Updated CPR guidelines tackle choking response, opioid-related emergencies and a revised chain of survival — American Heart Association. This guide walks through the technique step by step in adults, children older than 1 year, infants, pregnant and severely obese patients, and a person who is alone — and links to our Basic Life Support / CPR pillar for the moment the maneuver fails or the patient becomes unresponsive.

What Is Choking, and When Is the Heimlich Needed?

Choking — clinically, foreign body airway obstruction (FBAO) — happens when food, a nut, a small toy part, or a tablet partially or fully blocks the airway. In adults the trigger is usually food; in children it is grapes, peanuts, sausage slices, and small plastic parts. The Türk Kızılay First Aid Unit's adult guidance notes that adult FBAO "generally occurs while a person is eating or drinking," and that complete obstruction is present when the person "cannot respond, is not coughing or coughs only weakly, is struggling, and cannot breathe" [4]Source: First Aid for Adults — Türk Kızılay First Aid Unit — Türk Kızılay First Aid Unit.

Only one question gates the maneuver: is the cough effective? Effective cough — sound, breath, and verbal response — means hands off; observe. Ineffective cough — silent, cyanotic, no sound, no breath — means immediate maneuver. Holding to that distinction is your strongest protection against pushing the object deeper with a poorly timed thrust.

The scale of sudden in-home crises is large. According to the Türkiye İstatistik Kurumu (TÜİK) Death and Causes of Death Statistics 2024 release, 489,361 total deaths occurred in Türkiye in 2024; respiratory diseases accounted for 15 percent and circulatory diseases for 36 percent of all deaths [9]Source: Death and Causes of Death Statistics, 2024 — Türkiye İstatistik Kurumu — Türkiye İstatistik Kurumu. Airway obstruction is a household-onset crisis that compromises both systems within seconds, and irreversible brain injury begins around the four-minute mark.

In practice three decision branches drive the technique:

• Age and body type: infant (0–1 year), child (1+ year), adult, pregnant, severely obese — each protocol differs.
• Level of consciousness: awake → Heimlich. Unresponsive → switch to CPR.
• Whether you are alone: there is a self-administered Heimlich.

Adult and Child (1+) Heimlich — Step by Step

The European Resuscitation Council 2025 and American Heart Association 2025 guidelines make a stepwise approach the standard. The American Heart Association's 22 October 2025 newsroom update captures the change in one sentence: "New guidance on choking recommends alternating five back blows followed by five abdominal thrusts for conscious children and adults, until the foreign object is expelled or the person becomes unresponsive." [2]Source: Updated CPR guidelines tackle choking response, opioid-related emergencies and a revised chain of survival — American Heart Association That replaces the older abdominal-thrusts-only standard.

Step 1 — Assess the cough and encourage it

If the person can still cough effectively, do not stand behind them, do not slap their back, do not offer water. Just say: "Keep coughing." The Türk Kızılay protocol's complete-obstruction definition kicks in only when the person "cannot respond, is not coughing or coughs only weakly, is struggling, cannot breathe" [4]Source: First Aid for Adults — Türk Kızılay First Aid Unit — Türk Kızılay First Aid Unit. Up to that line, intervention equals harm.

Step 2 — Call 112 or Nova Ambulans

The moment the cough turns ineffective, call 112 on speakerphone; for a private-hospital preference call Nova Ambulans at the same time. The call does not tie up your hands: with the speaker on you can keep working. The ambulance launches while you start the maneuver — both proceed in parallel. For the three pieces of information our crew asks first — onset time, substance/dose, past medical history — see our Until the Ambulance Arrives guide.

Step 3 — Five back blows

Stand to the side of the patient, support the chest with one hand, and lean the patient slightly forward (gravity helps the object clear). With the heel of your other hand, deliver five sharp blows between the shoulder blades, top to bottom. Look after each blow — if the object emerges, stop. If not, move to abdominal thrusts.

Step 4 — Five abdominal thrusts (Heimlich)

Step behind the patient, place one foot ahead of the other for balance, and wrap your arms around the waist. Make a fist with one hand; place the thumb side of the fist on the soft abdomen between the navel and the lower tip of the breastbone. Grasp the fist with your other hand. Pull sharply inward and upward. Each thrust must be a separate, deliberate motion; repeat five times.

In a 14 May 2025 interview with Anadolu Ajansı following his wife's choking emergency, Hitit University Faculty of Medicine Anesthesiology and Reanimation faculty member Assoc. Prof. Dr. Selçuk Kayır described the technique in plain terms (translated from Turkish): "Step behind the patient whose airway is blocked by a foreign body, make a fist with one hand, place it between the navel and the chest cavity, place the other hand on top, and quickly press inward and upward five to six times." [7]Source: Doctor whose wife was saved by the Heimlich maneuver shares emergency response advice with a colleague — Anadolu Ajansı (Assoc. Prof. Dr. Selçuk Kayır, Hitit University Faculty of Medicine, Anesthesiology and Reanimation)

Step 5 — Repeat the cycle

Continue the five back blows + five abdominal thrusts cycle without changing the order until the object clears or the patient becomes unresponsive. For children (1+ years, under 12), the rescuer crouches to the child's height and applies more controlled, less forceful thrusts than for an adult. For pediatric airway obstruction by age group, see our Pediatric Emergencies: A Parent's Guide.

In Infants (0–1 Year) the Heimlich Is Not Used: 5 Back Blows + 5 Chest Thrusts

Abdominal thrusts are contraindicated in infants — the liver and spleen are relatively large and rib protection is limited. The American Heart Association's 23 October 2025 pediatric update is explicit: "For infants with severe foreign body airway obstruction (FBAO), or choking, repeated cycles of 5 back blows alternating with 5 chest thrusts are recommended. Abdominal thrusts are not recommended in infants." [3]Source: Updated CPR Guidelines Released for Pediatric and Neonatal Emergency Care and Resuscitation — American Heart Association

The infant steps:

• Place the infant face-down along your forearm, head lower than the trunk; support the jaw; brace the forearm on your thigh.
• Deliver 5 back blows between the shoulder blades with the heel of your hand — careful but firm.
• Sandwich the infant between your forearms and turn face-up, head lower than the trunk.
• With two fingers, just below the nipple line on the breastbone, deliver 5 chest thrusts — about 4 cm depth each.
• Repeat the cycle until the object clears or the infant becomes unresponsive.

For an infant, call 112 / Nova Ambulans simultaneously with the maneuver — seconds matter.

Pregnant and Severely Obese Adults: Chest Thrusts Replace Abdominal Thrusts

Abdominal thrusts are unsafe in pregnancy (uterine compression, injury risk) and impractical in severe obesity (the rescuer cannot encircle the abdomen). The European Resuscitation Council 2025 Adult Basic Life Support guideline lists chest thrusts as the equivalent alternative [1]Source: European Resuscitation Council Guidelines 2025: Adult Basic Life Support — Resuscitation (Smyth MA, et al.).

How chest thrusts go:

• The rescuer stands behind and slips both arms under the armpits.
• A fisted hand is placed on the mid-line of the lower half of the breastbone (about the nipple-line level).
• The other hand grasps the fist; pull sharply inward.
• Repeat five times, then alternate with the back-blow cycle.

When 112 takes the call for a pregnant patient, tell the dispatcher there are two patients — mother and fetus — so the equipment loadout and destination hospital can be set accordingly. For higher-acuity pregnancy transport scenarios, see When Is an Intensive Care Ambulance Required?.

Self-Administered Heimlich When You Are Alone

If you are eating alone at home and a piece of food lodges in your throat, hold one rule in mind: call first, thrust second. The U.S. National Library of Medicine's MedlinePlus medical encyclopedia spells out the steps: "If you are alone and choking, call 911 (or your local emergency number) first. Then perform abdominal thrusts on yourself, either with your own fist or by pressing your abdomen against a firm surface such as the back of a chair, the side of a table, or a railing." [5]Source: Heimlich maneuver on self — MedlinePlus Medical Encyclopedia — U.S. National Library of Medicine, MedlinePlus

Practical tips:

• Open the speaker; even if you cannot speak, the call is recorded and dispatchers can route help to your address.
• Pick a chair back whose height meets just above your navel.
• Drop your torso onto the edge in a sharp, deliberate motion; each thrust is its own movement.
• Open the door in advance — if your level of consciousness drops, the response team can enter without delay. For more practical waiting steps, see Guide for Relatives Waiting for the Ambulance.

In an Anadolu Ajansı interview, Ankara City Hospital Emergency Medicine Department training lead Prof. Dr. Hakan Oğuztürk put the everyday risk into one line (translated from Turkish): "Airway obstruction is a problem we can run into in daily life at any moment. When you know what to do, you can readily save the life of someone who cannot breathe." The same article proposed Heimlich-instruction posters in restaurants and schools.

When the Patient Loses Consciousness: Stop the Heimlich, Start CPR

If the person becomes unresponsive, slumps, or collapses during the maneuver, stop the Heimlich. For an adult, in order:

1. Lower the patient to a firm flat surface on their back.
2. If you have not yet called, dial 112 or Nova Ambulans on speakerphone now.
3. Start cardiopulmonary resuscitation (CPR): in adults, cycles of 30 chest compressions + 2 rescue breaths. Step-by-step instructions, the Look-Listen-Feel breathing assessment, and the Hands-Only CPR option for untrained bystanders are covered in our pillar piece Basic Life Support / CPR — A Bystander's Step-by-Step Guide.
4. With each ventilation, open the mouth and check for the foreign object; if you can see it, remove it in a single motion. If you cannot see it, do not perform a blind finger sweep.

The American Heart Association 2025 update notes that, in an unresponsive choking patient, chest compressions raise intrathoracic pressure and can help dislodge the foreign body — so CPR both maintains circulation and serves as a choking intervention [2]Source: Updated CPR guidelines tackle choking response, opioid-related emergencies and a revised chain of survival — American Heart Association. The European Resuscitation Council 2025 adult protocol prescribes the same transition [1]Source: European Resuscitation Council Guidelines 2025: Adult Basic Life Support — Resuscitation (Smyth MA, et al.).

When the return of spontaneous circulation (ROSC) is achieved, place the patient in the lateral position. The role of the lateral (recovery) position in keeping the airway open, the steps to apply it in a conscious-but-impaired patient, and the situations that require reversing it are covered in our cluster article Recovery Position Step-by-Step.

Five Common Mistakes to Avoid

Combining the warnings emphasized in the Türk Kızılay First Aid Unit's adult-choking page [4]Source: First Aid for Adults — Türk Kızılay First Aid Unit — Türk Kızılay First Aid Unit:

• No blind finger sweeps. Searching for an object you cannot see can drive it backward and tear the mucosa. The Türk Kızılay protocol says: "If you can see and are sure the object is solid, remove it with a single finger sweep; if you are not sure, do not touch it."
• Do not intervene while the person can cough effectively. Slapping the back, fist thrusts, or offering water can convert partial obstruction into complete obstruction.
• Never apply the Heimlich to an infant. Abdominal thrusts are contraindicated under 1 year.
• Do not use the classic Heimlich on a pregnant or severely obese patient. Switch to chest thrusts.
• Do not keep the patient at home even if the object cleared. The Türk Kızılay page warns that "even if the person returns to normal breathing, they should be urgently taken to the nearest health facility because the foreign object may remain in the upper or lower respiratory tract" [4]Source: First Aid for Adults — Türk Kızılay First Aid Unit — Türk Kızılay First Aid Unit. For routing to a private hospital with Nova Ambulans and how regulation shapes call timing, see Difference Between 112 and a Private Ambulance.

Evidence Context: Why Back Blows Are Now First

A 2024 systematic narrative review published in Medicina (Kaunas) — frequently cited for first-aid evidence quality — reports that back blows are "associated with an improved likelihood of FBAO resolution and survival to hospital discharge," while abdominal thrusts had "the highest number of studies reporting potential for trauma" [8]Source: Do We Actually Help Choking Children? The Quality of Evidence on the Effectiveness and Safety of First Aid Rescue Manoeuvres — A Narrative Review — Medicina (Kaunas), 2024 — PubMed identifier 39597012. The 2025 guideline shift to "back blows first" aligns with this evidence base.

On the regulatory side, in Türkiye certified first-aid training providers operate under the First Aid Regulation (T.C. Resmî Gazete 29/7/2015, Issue 29429), supervised by the Ministry of Health; the regulation governs "basic first-aid training of the public" and the certification of trainers, instructors, and first aiders [6]Source: First Aid Regulation — T.C. Resmî Gazete (29 July 2015, Issue 29429) — T.C. Resmî Gazete. The framework also defines first-aider headcount per workplace size — that an adult sees the right intervention at work is regulation-driven, not coincidence.

Prevention First

The prevention notes on the Türk Kızılay First Aid Unit's adult page are simple and life-saving:

• Cut food into small pieces; chew thoroughly; do not talk or laugh while eating.
• Watch the meals of relatives over 65, of denture wearers, and of those with stroke history or dysphagia.
• Do not give children whole grapes, peanuts, sausage rounds; cut small, round foods into safe sizes.
• No nuts or hard candies for children under 1 year.
• At least one adult per household should be Basic Life Support (BLS) certified, refreshed every three years; certificate-renewal cycles and tier-1/2/3 first-aider headcounts are defined in the First Aid Regulation [6]Source: First Aid Regulation — T.C. Resmî Gazete (29 July 2015, Issue 29429) — T.C. Resmî Gazete. For the contents of an emergency-ready home kit, see Emergency Kit Guide.

Frequently Asked Questions

At what age can the Heimlich maneuver be used?

In children aged 1 year and older, and in adults. The European Resuscitation Council 2025 and American Heart Association 2025 guidelines recommend, for a patient over 1 year who cannot cough effectively, alternating 5 back blows with 5 abdominal thrusts (Heimlich) [1]Source: European Resuscitation Council Guidelines 2025: Adult Basic Life Support — Resuscitation (Smyth MA, et al.)[2]Source: Updated CPR guidelines tackle choking response, opioid-related emergencies and a revised chain of survival — American Heart Association. In infants 0–1 years, abdominal thrusts are contraindicated — use 5 back blows alternating with 5 chest thrusts instead [3]Source: Updated CPR Guidelines Released for Pediatric and Neonatal Emergency Care and Resuscitation — American Heart Association.

Should I perform the Heimlich if the person can still cough?

No. The Turkish Red Crescent First Aid Unit's adult-choking protocol is explicit: if the person can cough effectively, make sound, and breathe, do not start the maneuver [4]Source: First Aid for Adults — Türk Kızılay First Aid Unit — Türk Kızılay First Aid Unit. Encourage continued coughing, keep the back upright, and watch closely until the object clears or the cough weakens. Performing abdominal thrusts during an effective cough can drive the foreign body deeper.

Are abdominal thrusts unsafe for pregnant or severely obese patients?

Yes — abdominal compression is unsafe, so use chest thrusts instead. Stand behind the patient, slip your arms under the armpits, place a fist on the lower half of the breastbone (mid-sternum), grasp it with your other hand, and pull sharply inward. The European Resuscitation Council 2025 Adult Basic Life Support guideline lists chest thrusts as the equivalent alternative when abdominal thrusts cannot be applied safely [1]Source: European Resuscitation Council Guidelines 2025: Adult Basic Life Support — Resuscitation (Smyth MA, et al.).

How do I perform the Heimlich on myself when I am alone?

As described in the U.S. National Library of Medicine's MedlinePlus first-aid encyclopedia, first call 112 (or Nova Ambulans for a private-hospital preference) on speakerphone, then press the area just above your navel — not the rib cage — onto the firm edge of a chair back, table, or railing; let your body weight drive a quick inward and upward thrust [5]Source: Heimlich maneuver on self — MedlinePlus Medical Encyclopedia — U.S. National Library of Medicine, MedlinePlus. You can also place a fist on the same area and grasp it with your other hand. If your level of consciousness drops, lie down on your back and stay there until help arrives.

What if the patient becomes unresponsive during the maneuver?

Stop the Heimlich, lower the patient to the floor, call 112 or Nova Ambulans if you have not already, and start Basic Life Support / CPR immediately — for adults, cycles of 30 chest compressions + 2 rescue breaths. With each ventilation, open the mouth and remove the foreign object only if you can see it; never perform a blind finger sweep. The American Heart Association 2025 update notes that, in an unresponsive choking patient, chest compressions raise intrathoracic pressure and may help dislodge the obstruction [2]Source: Updated CPR guidelines tackle choking response, opioid-related emergencies and a revised chain of survival — American Heart Association.

Related Articles

• Basic Life Support / CPR — A Bystander's Step-by-Step Guide — What to do when the Heimlich fails or the patient becomes unresponsive.
• Recovery Position Step-by-Step — Keeping the airway open after spontaneous circulation returns.
• Automated External Defibrillator (AED) Use — The next link in the survival chain for an unresponsive patient.
• Pediatric Emergencies: A Parent's Guide — All pediatric emergencies, including age-specific airway obstruction.
• Until the Ambulance Arrives — Practical steps during the 5–15-minute wait.
• Nova Ambulans Medical Board — Editorial oversight of medical content.