Dealing with Breathing Problems

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This leaflet is created from first aid advice provided by St John Ambulance, the nation's leading first aid charity. This advice is no substitute for first aid training - find a training course near you.

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

Young children are more likely to choke than adults, because they often put small objects in their mouths that they may breathe in and get stuck.

If a child or baby is choking they'll get upset quickly and you need to act fast to clear what's stuck. If they can't cough or make any noise, it's serious.

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'll lose responsiveness. Before this happens you can help - see the links at the bottom of the page.

If they do lose responsiveness, their throat muscles could relax and open the airway enough for you to give rescue breaths - be prepared to give rescue breaths and chest compressions if this happens.

Your baby may be choking if they suddenly become distressed, have noisy breathing, if they are unable to cry or cough. In some cases they may not be able to make any noise or breathe.

What you need to do

Step 1 of 4: Slap it out

  • Sit down and lay them face down along your thigh supporting their head.
  • Supporting the baby's head, give up to five sharp blows between their shoulder blades with the heel of your hand.
Choking slap it out baby

Step 2 of 4: Check

  • Then check their mouth to see if there's anything in there and if there is: if you can, pick the object out carefully with your fingertips - take care not to push it further in.
Choking check for blockage baby

Step 3 of 4: Squeeze it out

  • If the back blows fail to clear the blockage, give up to five chest thrusts.
  • With the baby laid face up along the length of your thigh, put two fingers just below the level of their nipples and push downwards up to five times. Check their mouth and carefully pick the object out.
Choking squeeze it out baby

Step 4 of 4: Call for help

  • If they're still choking, call 999 or 112 for an ambulance.
  • Once you've called an ambulance, continue steps 2 and 3 (back blows and chest thrusts) until what's in there has cleared, help arrives, or they become unresponsive.
  • If they become unresponsive at any stage, open their airway and check their breathing.
  • If they're not breathing, start CPR (cardiopulmonary resuscitation - chest compressions and rescue breaths) to try to release whatever's stuck in there - follow the instructions for treating a baby who is unresponsive and not breathing.

What to look for

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.

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

What you need to do

Help clear their throat with these three steps.

Step 1 of 4: 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.

Step 2 of 4: Slap it out

  • If coughing doesn't work, help the casualty 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.
Choking - slap it out

Step 3 of 4: Squeeze it out

  • If back blows don't work, give up to five abdominal thrusts. Stand behind them.
  • Link your hands between their tummy button and the bottom of their chest, with your lower hand clenched in a fist.
  • Pull sharply inwards and upwards.
Choking - squeeze it out

Step 4 of 4: Call for help

  • If they're still choking, call 999 or 112 for medical help.
  • Once you've called, continue steps 2 and 3 - back blows and abdominal thrusts - until what's in there has cleared, help arrives or they become unresponsive.
  • If they become unresponsive at any stage, open their airway and check their breathing.
  • If they're not breathing, start chest compressions and rescue breaths (CPR - cardiopulmonary resuscitation) to try to release whatever's stuck in there. Follow the instructions for treating someone who's unresponsive and not breathing.

In an asthma attack, the muscles of the air passages in the lungs go into spasm. This makes the airways narrower, making it difficult to breathe.

Sometimes something specific can trigger an attack, such as an allergy, a cold, or cigarette smoke. At other times, someone may have a sudden attack with no obvious trigger.

People with asthma usually deal with their own attacks by using a blue reliever inhaler at the first sign of an attack. But if someone doesn't have an inhaler, or the attack is severe, you may need to help.

What to look for

If you think someone is having an asthma attack, these are the five key things to look for:

  1. Difficulty breathing or speaking.
  2. Wheezing.
  3. Coughing.
  4. Distress.
  5. Grey-blue tinge to the lips, earlobes and nailbeds (known as cyanosis).

What you need to do

  • First, reassure them and ask them to breathe slowly and deeply which will help them control their breathing.
  • Then help them use their reliever inhaler straight away. This should relieve the attack.
  • Next, sit them down in a comfortable position.
  • If it doesn't get better within a few minutes, it may be a severe attack. Get them to take one or two puffs of their inhaler every two minutes, until they've had 10 puffs.
  • If the attack is severe and they are getting worse or becoming exhausted, or if this is their first attack, then call 999/112 for an ambulance.
  • Help them to keep using their inhaler if they need to. Keep checking their breathing, pulse and level of response.
  • If they lose responsiveness at any point, open their airway, check their breathing and prepare to treat someone who's become unresponsive.

Hyperventilation is excessive breathing, normally caused by extreme anxiety, and can happen at the same time as a panic attack.

When someone is hyperventilating they breathe unnaturally fast or deep. This makes the blood lose more carbon dioxide than usual, which can make them feel weak and dizzy. As they begin to breathe normally again, they should feel better.

It is very rare for children to suffer from hyperventilation, so if you think a child is hyperventilating you should try looking for other reasons why they could be showing these symptoms.

What to look for

These are the six key things to look for:

  1. Unnaturally fast deep breathing.
  2. Attention-seeking behaviour or anxiety.
  3. Dizziness.
  4. Feeling faint.
  5. Trembling or tingling in the hands.
  6. Muscle cramps in the hands and feet.

What you need to do

  1. Speak to them firmly, but be kind and reassuring.
  2. Take them somewhere that's quiet, as this can help them control their breathing again. If you can't do this, ask any bystanders to leave or turn away.
  3. Encourage the casualty to see their doctor about how they can learn to prevent and control hyperventilation in the future.
  4. If you are unsure of their symptoms or if they are not improving, call 999 or 112 for medical help.

Note: these hints are no substitute for thorough knowledge of first aid. St John Ambulance holds first aid courses throughout the country.

 

Adapted from the St John Ambulance leaflets: choking - adults, choking advice for parents (child and baby)asthma attack and hyperventilation. Copyright for this leaflet is with St John Ambulance.

Original Author:
St John Ambulance
Current Version:
Peer Reviewer:
St John Ambulance
Document ID:
28664 (v2)
Last Checked:
21/11/2016
Next Review:
21/11/2019
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