Choking is when your airway gets blocked and you can’t breathe properly.

Everyone has a small risk of choking, but this may be higher if you have a swallowing difficulty – known as dysphagia. It happens rarely but can be very frightening for the person and anyone with them if it does happen.

When someone chokes, the airway can either be partly or fully blocked. If it’s a mild blockage, they should be able to clear it themselves by coughing.

If it’s a severe blockage, they won’t be able to cough so without anyone’s help they will lose consciousness.

The risk of choking can be higher if:

• the swallowing problem is more severe
• there are dental problems which make chewing difficult
• you eat too fast, overfill your mouth or find it hard to concentrate
• you are not sitting in a good upright position to eat
• you are feeling drowsy
• speech and language swallowing recommendations are not followed, for example, you are given a solid diet when a pureed diet has been advised.

If there is a choking risk, it is important you have someone with you at meal and snack times and you do not eat alone.

It is helpful for families and carers to know what to do if someone chokes, so share this information with
them and keep it somewhere handy, just in case.

What to do if you think an adult is choking

If you think someone is choking, ask them: ‘Are you choking?’ to check they’re not suffering from something else.

Can they speak, cry, cough or breathe? If they can, they should be able to clear their throat on their own by coughing, so encourage them to cough.

Watch them closely in case the choking becomes severe and they need more help.

If they can’t cough or make any noise, it’s serious.

What you need to do if they are chocking

Step one of four: Cough it out

Encourage them to cough. If this doesn't clear the obstruction, support their upper body with one hand and help them lean forward.

If they are in a wheelchair, make sure the brakes are on.

Step two of four: Slap it out

If coughing doesn’t work, help the person bend forward.

Use the heel of your hand to give up to five sharp back blows between their shoulder blades.

Check their mouth to see if there’s anything in there and if there is, get them to pick it out.

Step three of four: Squeeze it out

If back blows don’t work, give up to five abdominal thrusts.

Stand behind them. Link your hands between their belly button and the bottom of their chest, with your lower hand clenched in a fist. Pull sharply inwards and upwards.

If they are in a wheelchair you may need to take the arm rests off to do this.

Step four of four: Call for help

If they’re still choking, call 999 for medical help.

Once you’ve called 999, continue steps two and three – back blows and abdominal thrusts – until what’s in there has cleared, help arrives or they become unresponsive.

If they become unconscious, support the person to lie down and check their breathing.

If they’re not breathing, begin CPR if you can or with the guidance of the 999 operator.

If the blockage is cleared, get the person checked over by a doctor afterwards in case of complications, such as internal abdominal injuries or secondary aspiration.

References: Resuscitation Council (UK) 2010 Guidelines: Adult Basic Life Support; Adult Choking
Algorithm NHS Choices webpage ‘What should I do if someone is choking?’ 2015