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Now we are going to have a look at infant choking. The first thing we need to look at with infant choking is the actual psychological effect it will have on the parent, the bystander, or even the paramedic that arrives on the scene. Children are small, children are cute, children tend to deteriorate very, very quickly and get horrible colours. Their oxygen saturation drops very, very quickly. They have cyanosis, their blue colouration comes in quickly, and consequently, it is a very frightening situation for anybody dealing with a child.

So first thing, that is important that you understand. You have got to remain calm. You have got to try and do the best you possibly can because if you panic, everything else fails. Remember also, the tongue is slightly larger and the whole makeup of the baby is slightly different. If we start doing abdominal thrusts on a baby, we can tend to do damage to the abdominal contents, so we do not do abdominal thrusts at all. We do chest compressions or chest thrusts because that is as effective as an abdominal thrust in a child or an adult, but we do not do any damage to the actual abdominal contents. And of course, things like peritonitis and septicaemia.

One of the really good things also about a child of this size is that we can easily use posture, gravity to help us. One of the best positions and simplest positions to do is to lay the baby down your forearm with your thumb and forefinger in the corners of the mouth to open the mouth up. That way, we have got posture, we have got gravity, we are opening the mouth, and we are allowing any liquids to flow clear off the actual airway itself. Very rarely is it solids that this child will have a problem with because they are not eating solids. And the only way a solid is going to get into their airway is if somebody has tried to put it there or somebody has tried to feed the child with inappropriate food, which again is pretty rare.

But the position we are talking about basically is with the child down your forearm, leg on either side of your arm, and your thumb and forefinger into the mouth. In that position, the leg is trapped between your body and your arm, keeping the patient on your arm. The airway is opened by the two fingers in the corner of the mouth. And we can then pat the back, but we can also clear away any mucus that is coming clear of the airway with a tissue, a cloth, anything we have appropriate. And we have also got gravity because the head of the child is down. Anything that is liquid or mucus you find will drop from the airway itself. We can pat the back, we can clear the airway, we can keep the mouth open, we have got them in the recovery position, modified, because they are face down, put the head down and feet up is the recovery position for a child of this size, and we have got control of the patient on our forearm. This position allows us to manage to clear an airway very effectively.

If that has not worked, the child goes over onto their back, their airway goes into sniffing the morning air position, so it is slightly open. If we go too far or not far enough, remember the airway is much smaller, it is much more supple, and it is much easier to block. We keep the airway and the sniffing the morning air position. If there is anything in there that we can flick out or wipe away, that is great, and we then go on with two fingers onto the chest compressions which will give us enough air being pushed from the lungs, out through the airway itself, to hopefully dislodge or blow clear the blockage itself. Again, if that has not worked, we can go back on the arm with the back slaps and the mouth kept open. And we repeat until the airway is clear, patent and working, and the patient starts to recover. A good sign is a crying baby.