Choking: How Many Back Blows to Give

Everyone · Explainer · Updated October 1, 2026 · LearnLife Editorial

What Are Back Blows and Why Are They Used for Choking?

Back blows are a lifesaving first aid technique used to help someone who is choking on a blocked airway. When a person is choking, an object such as food or a small item blocks their throat or windpipe, preventing air from reaching the lungs. Back blows involve delivering firm, controlled strikes with the heel of your hand to the upper back, specifically between the shoulder blades. The goal is to create a sudden burst of pressure inside the chest that forces the object out of the airway.

This method works by mimicking the force of a strong cough, which is the body’s natural way to clear an obstruction. Because a choking person may not be able to cough effectively, back blows provide an extra push to expel the blockage. Back blows are recommended as one of the first responses to choking before moving to abdominal thrusts, especially if the person is conscious and able to sit or stand. They are simple, quick to perform, and require no special equipment.

For example, if a friend suddenly clutches their throat and cannot speak or breathe while eating, giving back blows is an immediate step you can take to help. Position them slightly forward, then use the heel of your hand to strike firmly but carefully between their shoulder blades up to five times.

How Exactly Do You Give Back Blows? Step-by-Step Instructions

Giving back blows correctly is crucial for their effectiveness and safety. Here is a detailed step-by-step guide:

1. Assess the situation: Confirm the person is choking—signs include inability to talk, difficulty breathing, coughing weakly or not at all, and clutching the throat.
2. Ask for permission: If the person is conscious, ask if they are choking and if you can help.
3. Position the person: Have them lean slightly forward. This helps the object move upward and out rather than deeper into the airway.
4. Support the person: Stand or kneel behind them, supporting their chest with one hand if needed to steady them.
5. Locate the target area: Use the heel of your other hand to strike firmly between the shoulder blades, aiming for the middle of the upper back.
6. Deliver up to five sharp back blows: Use enough force to create a sudden jolt but not so hard you cause injury.
7. Observe the response: After each back blow, check if the object is expelled or if the person can breathe or cough.

For example, if you are helping an adult choking on a grape, position them leaning forward, then give one back blow, wait briefly, then continue up to five back blows. If the grape does not come out, prepare to give abdominal thrusts.

Why Is It Important to Give Only Up to Five Back Blows?

Limiting back blows to five strikes is important to balance effectiveness with safety and timely escalation to other methods. Giving fewer than five back blows may not create enough force to clear the airway. On the other hand, delivering more than five back blows risks delaying the use of abdominal thrusts, which can sometimes work better if back blows fail.

Five back blows are enough to generate the necessary pressure and jolt to expel the blockage for most choking incidents. After this, if the airway remains blocked, the rescuer should immediately switch to abdominal thrusts. This stepwise approach is designed to maximize the chance of clearing the airway quickly without unnecessary delay or harm.

For instance, if you give six or seven back blows but the object remains stuck, valuable time is lost without trying abdominal thrusts. Conversely, if you give only two back blows and then switch, you may miss the opportunity to clear the airway with simpler means first.

What Are Abdominal Thrusts and How Do They Complement Back Blows?

Abdominal thrusts, also known as the Heimlich maneuver, involve applying upward pressure just above the navel to force air out of the lungs and push the object from the airway. This method is usually performed after five back blows fail to clear the obstruction.

Here is how to perform abdominal thrusts after back blows:

1. Stand behind the person and wrap your arms around their waist.
2. Make a fist with one hand, placing the thumb side against their abdomen, slightly above the navel but below the ribcage.
3. Grasp your fist with the other hand.
4. Deliver quick, upward thrusts into the abdomen, pulling sharply inward and upward.
5. Repeat up to five times or until the object is expelled.

The key difference is that back blows rely on a sharp strike to the back, while abdominal thrusts apply upward pressure from the front. Both create pressure changes in the chest and airway but in different ways. Alternating five back blows and five abdominal thrusts continues until the airway is clear or the person becomes unconscious.

For example, if a person is choking on a peanut and back blows don’t work, switching to abdominal thrusts can be lifesaving. These two techniques together cover more options for clearing the blockage.

What Should You Do If Back Blows and Abdominal Thrusts Don’t Work?

If the person is still choking after five back blows and five abdominal thrusts, or if they lose consciousness, call 911 or emergency services immediately if you haven’t already. Continue the cycle of back blows and abdominal thrusts until help arrives or the person can breathe.

If the person becomes unconscious, gently lower them to the ground and begin CPR if you are trained:

• Start chest compressions to try to circulate blood and air.
• Check the mouth for any visible object before giving rescue breaths.
• Continue CPR until emergency responders take over or the person wakes.

For example, if an adult collapses after unsuccessful back blows and abdominal thrusts, calling 911 and starting CPR can be critical. Prompt emergency help and CPR improve survival chances.

What Are Common Mistakes to Avoid When Giving Back Blows?

Several mistakes can reduce the effectiveness of back blows or cause harm:

• Striking too low: Hits should be between the shoulder blades, not on the ribs or lower back.
• Using open palm slaps: Use the heel of a closed hand for a firm, focused blow.
• Delivering weak blows: The strikes need to be firm and brisk to generate enough pressure.
• Not leaning the person forward: Keeping the person upright or leaning slightly forward prevents the object from blocking the airway further.
• Delaying abdominal thrusts: If back blows do not work after five tries, do not hesitate to switch.
• Ignoring signs of worsening: If the person loses consciousness or stops breathing, call 911 and begin CPR.

Avoid these errors by practicing proper technique and staying calm. For example, if someone is choking and you accidentally slap their ribs lightly, the object may remain stuck, and the person could become more distressed.

How Can You Learn and Practice Back Blows Safely?

Learning back blows in a controlled environment, such as a first aid class, helps build confidence and skill. Many organizations offer hands-on training with mannequins to simulate choking scenarios safely.

Tips to practice safely include:

• Use a training doll designed for choking rescue practice.
• Practice hand placement and force on a pillow or soft surface to get a feel for the correct pressure.
• Review instructional videos from trusted sources like the American Red Cross.
• Teach family members or coworkers, so multiple people are prepared.
• Refresh knowledge regularly, as skills can fade over time.

For example, in a class, you might practice five back blows on a mannequin, followed by abdominal thrusts, learning to switch quickly between methods. This prepares you to respond calmly and effectively in real emergencies.

Frequently asked questions

How do I know if someone is choking and needs back blows?

Signs include inability to talk or breathe, weak or no coughing, clutching the throat, and panicked or distressed appearance. If they can cough forcefully, encourage them to keep coughing first.

Can I give back blows if the choking person is a child or infant?

For children over one year old, back blows are appropriate but gentler than for adults. For infants under one year, use a combination of back slaps and chest thrusts specifically designed for their size.

What if the choking person is pregnant or obese?

In these cases, back blows are still given the same way. For abdominal thrusts, use chest thrusts instead, applying pressure on the lower half of the breastbone, as the abdomen may not be accessible.

Can I hurt someone by giving back blows?

Properly performed back blows rarely cause serious injury. Some bruising or soreness can occur, but the risk is minimal compared to the danger of choking.

Should I call 911 before or after giving back blows?

Call 911 immediately if the person cannot breathe or loses consciousness. If you are alone and the person is still conscious, attempt back blows and abdominal thrusts first but call for help as soon as possible.