Choking

Which of these most strongly suggests that a toddler eating lunch at nursery is choking rather than simply upset?

• AA runny nose and repeated sneezing throughout the meal
• BA sudden inability to cry, speak or cough effectively✓
• CA loud, prolonged bout of crying with a red face
• DRefusing to open the mouth for the next spoonful

Answer: Choking is suspected when a child suddenly cannot cry, speak or cough properly, especially while eating or playing. Loud crying shows the airway is open, sneezing and a runny nose point to a cold, and refusing food is ordinary toddler behaviour rather than an airway emergency.

A four-year-old chokes on a piece of apple but is coughing loudly and can still take a breath between coughs. What should the first aider do?

• AGive five sharp back blows between the shoulder blades
• BSweep a finger around the mouth to find the piece of apple
• CGive five abdominal thrusts inwards and upwards at once
• DEncourage the child to keep coughing and watch closely✓

Answer: A loud cough with breaths in between is an effective cough, and the child's own coughing is the best way to clear the object, so you encourage it and stay ready to act. Back blows and abdominal thrusts are for an ineffective cough, and a blind finger sweep can push the apple further down.

How should a first aider position a choking baby for back blows?

• AFace down along the forearm, supported on your leg, with the head lower than the chest✓
• BLying flat on the changing mat on their back, with the head turned to one side
• CFace up along the forearm, supported on your leg, with the head held higher than the chest
• DSitting upright on your knee, leaning forward, with the chin resting on your hand

Answer: The baby lies face down along the forearm resting on your thigh, head supported and lower than the chest, so gravity helps and a sharp blow between the shoulder blades can dislodge the object. Face up is the position for chest thrusts, an upright leaning-forward position is used for a child rather than a baby, and lying flat on a mat gives neither gravity nor support.

Five back blows have not cleared the airway of a choking nine-month-old. What should the first aider do next?

• AGive up to five rescue breaths using a mouth-and-nose seal, one per second
• BGive up to five chest thrusts using two thumbs, sharper than compressions✓
• CGive up to five abdominal thrusts using a fist, pulling inwards and upwards
• DGive up to five more back blows using a heavier hand, faster than before

Answer: For an infant the alternative to back blows is chest thrusts, delivered with the baby on their back on your knees using the two-thumb technique and given more sharply than CPR compressions. Abdominal thrusts are never used on a baby because of the risk of internal injury, simply repeating back blows ignores the sequence, and rescue breaths are only started if the baby becomes unconscious.

Where does the first aider place their fist when giving abdominal thrusts to a choking child?

• AJust above the hip bones on the lower abdomen
• BDirectly over the navel in the centre of the abdomen
• CBetween the navel and the bottom of the breastbone✓
• DOver the lower half of the breastbone in the centre

Answer: The clenched fist goes between the navel and the tip of the breastbone and is pulled sharply inwards and upwards to force air out of the lungs. Over the navel itself is too low to work, the lower breastbone is the CPR compression point rather than the thrust point, and the hips are far below the diaphragm.

A choking child remains conscious after back blows and abdominal thrusts, and the object is still lodged. What should the first aider do?

• AMove on to five chest thrusts and then five rescue breaths
• BStart chest compressions at 15:2 while the child is still awake
• CLay the child in the recovery position and wait for the ambulance
• DKeep alternating five back blows with five abdominal thrusts✓

Answer: While the child stays conscious the cycle of five back blows and five abdominal thrusts is repeated, with 999 called if it has not been already, until the obstruction clears. Chest thrusts are the infant technique, CPR starts only when the child becomes unconscious, and the recovery position does nothing to clear a blocked airway.

A childminder can see nothing in a choking baby's mouth but suspects a small toy part is lodged. What does Resuscitation Council UK say about using a finger?

• ASweep repeatedly with a hooked finger until the object is found
• BUse a sweep only after the baby has become unconscious
• CSweep once blindly around the back of the throat to feel for it
• DUse a single sweep only if the object can clearly be seen✓

Answer: A finger sweep is reserved for a clearly visible object and is done once; blind sweeps can push the item deeper, injure the soft tissues and provoke vomiting. Repeated hooking is even more dangerous, and unconsciousness does not make a blind sweep safe, since the next step then is CPR with five rescue breaths.

A choking two-year-old suddenly goes limp and unresponsive in the first aider's arms. What should happen next?

• AStart CPR straight away, beginning with five rescue breaths✓
• BPlace the child in the recovery position, then monitor breathing
• CContinue back blows and abdominal thrusts, now on the floor
• DGive ten firm chest thrusts, then check inside the mouth

Answer: Once a choking child becomes unconscious the guidance is to start CPR immediately with five rescue breaths, which may also move the object. Back blows and thrusts are for a conscious child, the recovery position is for someone who is breathing normally, and ten chest thrusts is not a step in the sequence.

A child's airway clears after two abdominal thrusts and they are now breathing normally and chatting. What should still happen?

• AThe child should be examined by a doctor because thrusts can injure internal organs✓
• BThe child should be kept in the recovery position for a full hour before eating again
• CThe child can go straight back to playing because breathing has fully returned
• DThe child should be given five rescue breaths to make sure the airway is clear

Answer: Abdominal thrusts can damage the abdominal organs, so a child who has received them needs a medical check afterwards even when they seem fine. Returning straight to play skips that check, rescue breaths are for a child who is not breathing, and an hour in the recovery position has no basis in the guidance.

A parent asks a nursery to buy a marketed anti-choking suction device. What is Resuscitation Council UK's position on these devices?

• AIt has banned their use in early years settings registered with Ofsted
• BIt makes no recommendation for or against them because the evidence is insufficient✓
• CIt recommends them as the first step before back blows for every child over 1 year of age
• DIt recommends them for infants only, replacing chest thrusts in the sequence

Answer: Resuscitation Council UK has looked at the evidence for suction anti-choking devices and found it insufficient, so it neither recommends nor advises against them. The devices do not replace back blows for children or chest thrusts for infants in the taught sequence, and there is no Ofsted ban on them.

Which food-preparation step reduces the risk of a young child choking on grapes?

• ACutting grapes lengthways into quarters before serving✓
• BServing the grapes whole but chilled from the fridge
• CServing the grapes with a teaspoon rather than with fingers
• DPeeling the skin off each grape before serving them

Answer: Whole grapes are the right size and shape to plug a small child's airway, so cutting them lengthways into quarters changes the shape and size and stops a whole grape blocking the throat. Chilling, peeling or using a spoon does nothing about the size and shape of a whole grape.

Under the EYFS safer eating guidance, who should always be present in the room while children are eating?

• AThe setting's designated safeguarding lead or their deputy
• BA member of staff holding a current food hygiene certificate
• CA member of staff holding a valid full paediatric first aid certificate✓
• DA member of staff holding an emergency paediatric first aid certificate

Answer: EYFS 3.64 says that while children are eating there should always be a member of staff in the room with a valid full paediatric first aid certificate, so choking can be dealt with immediately. Food hygiene and safeguarding roles are separate requirements, and an emergency paediatric first aid certificate does not satisfy this rule.