If someone is choking and can't speak, for anyone aged 1 or over stand behind them and give 5 back blows and 5 abdominal thrusts, and if they collapse, start CPR

In a real emergency, call 911 first, then read this.

Cost

Free. Learn the move from one viewing: make a fist with one hand above the navel, wrap the other hand around it, and thrust quickly inward and upward.

What you get

Original text from the U.S. National Library of Medicine: first ask "are you choking, can you speak?" "Do nothing if they can cough hard or speak," since coughing itself often brings the object out. If they can't speak, "repeat 5 back blows followed by 5 abdominal thrusts until the object comes out or the person loses consciousness." "If they lose consciousness, begin CPR," and have someone call the emergency number at the same time. For pregnant women and obese people, do chest thrusts instead. The 2025 first aid guidelines of the International Red Cross state not to put a finger into the mouth to dig blindly, since this may push the object deeper; only a solid object you can see should be taken out with a finger

Notes

Don't reach into the mouth for something you can't see, because it may push it deeper. Don't hit the back of someone who can still cough. The main beneficiaries are the family members you eat with. The teaching in China is the same: the Fujian Red Cross emergency first-aid training center (福建省红十字应急救护培训中心) says that for children aged 1 and over and for adults, the Red Cross system in China has always taught a cycle of 5 back blows and 5 abdominal thrusts. Many old tutorials online teach only abdominal thrusts, and that is the old version. For a child under 1 year old, don't press the belly; press the chest instead, see §13.43 (choking infant).

Evidence grade

B : Supported by research but without a precise number, or based on small or single studies.

Sources

1. US National Library of Medicine, MedlinePlus. Choking – adult or child over 1 year. https://medlineplus.gov/ency/article/000047.htm
2. Fuzhou Municipal Health Commission (2026). The Heimlich Maneuver Has Been Updated [in Chinese]: "For children over 1 year old and adults: changed from the old single abdominal thrust to a cycle of '5 back blows + 5 abdominal thrusts'" "Red Cross first aid training in China has always taught the cycle of '5 back blows + 5 abdominal thrusts'". https://www.fuzhou.gov.cn/zgfzzt/swjw/fzwj/jkkp/202601/t20260108_5268351.htm
3. International Federation of Red Cross and Red Crescent Societies (2025). International First Aid, Resuscitation and Education Guidelines 2025, page 238: "First aid providers should not use a blind finger sweep in people with a foreign-body airway obstruction as this may push the object further down the person's airway". https://www.ifrc.org/sites/default/files/2026-03/IFRC%20International%20First%20Aid,%20Resuscitation%20and%20Education%20Guidelines%202025.pdf

Translated from the Chinese original. Original book, section 13, tip 26. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer