In pediatric airway obstruction, what is the initial step when the child is conscious?

• A. Five back blows
• B. Visualize for object
• C. Five chest compressions
• D. Call EMS immediately

Answer: (A)

When a child is conscious and choking, the priority is to relieve the airway obstruction with a quick, noninvasive maneuver that can dislodge the object without compromising breathing. Five back blows are the first action because delivering forceful taps to the back between the shoulder blades uses gravity and vibration to shake the obstructing item loose from the upper airway while the child remains responsive.

To perform this, position the child seated or standing, with the head supported and the body leaning slightly forward. Use the heel of your hand to deliver five firm back blows between the shoulder blades. After each blow, check the mouth for the object and remove it if visible and safe. If the obstruction persists after five back blows, proceed with the next step (typically five abdominal thrusts for a conscious child, alternating with back blows) and continue until the object is expelled or help arrives. If the child becomes unresponsive at any point, start CPR with chest compressions and check the mouth between cycles.