d. If the airway is still blocked, administer modified abdominal thrusts to expel
Abdominal thrusts are preferred for clearing the airway of a child. If
abdominal thrusts cannot be administered due to abdominal injuries, perform
chest thrusts by locating the compression site (paragraph 4-1d) and
administering thrusts with the heel of one hand sufficient to depress the lower
half of the sternum 1 to 1 1/2 inches. Make each thrust separate and
(1) Abdominal thrust--large child. If the child is large, administer abdominal
thrusts using the same procedures as for an adult [paragraph 5-6f(1)].
Abdominal thrust--small child.
(a) If the child is small, position yourself at the child's side. Striding the
casualty's thighs is not recommended for small children. If the child is on a table, you
may prefer to stand at his feet and deliver the thrusts.
(b) Place the heel of your hand that is closest to the child's feet on his
abdomen. The heel should be on the midline slightly above the navel and well below
the rib cage and xiphoid process. Turn your hand so your fingers are straight out and
pointing toward the child's head.
Place the heel of your hand on top of the first hand.
(d) Administer quick, but gentle, inward and upward thrusts.
e. If the obstruction has not been expelled after five thrusts, open his mouth
using jaw-tongue lift [paragraph 5-6c(3)] and look for the obstruction. If you see the
obstruction, perform a finger sweep [paragraphs 5-6c(5), (6), and (7)] and remove the
obstruction. Do not perform a blind finger sweep since you may push the obstruction
deeper into the child's throat.
f. Attempt to administer two ventilations again (paragraph 6-3). If the airway is
still blocked, perform up to five abdominal thrusts and visually check for the obstruction
again. Once the obstruction is removed, perform rescue breathing or CPR (Lesson 6)
as needed if the child does not begin breathing again on his own.