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We are now going to have a look at a choking child. A choking child goes from the ages of one to puberty. Puberty, depending on what you are looking at, you are looking between 8 and 12 to be puberty, basically, with a child. Again, the airway is still small, narrow, easily flexible. The tongue is always larger than the average adult's tongue, in comparison to the size of the mouth and the airway itself. So this child, however, will show clear signs of choking. They are more common. This is the age group, really, that tends to be the bigger choking problem because they experiment, they will put things up their nose, in their ears, and they will chew on things to cut teeth and all the rest of it. So they are much more likely to put things in their mouth, their nose and everywhere else, which will create you problems. And if that drops down into the airway, it tends to sit just below the vocal cords, and we then have a problem clearing it.

Again, we have got postural drainage. We can bring that child over our knee, we can bring them up onto a chair or a table to bring them up to a more operational height, a workable height where we can work safely, or we can kneel down behind the patient so we are down to their level. The process itself now moves from chest thrusts to abdominal thrusts because now the abdominal contents are a little bit larger, a little bit more well-formed and well-protected, and there is a little bit of muscling in there now just to stop us doing any major damage. With the head in sniffing the morning air position or neutral alignment, just so the airway is clear, we check the airway. If there is anything we can fetch away or clear or wipe, we will do that at this process.

We will then go to the back slaps, again between the shoulder blades. Nice firm, gentle blows whilst trying to encourage the child to cough. When you cough, the airway expands. When you back-slap, your jaw. Hopefully, the actual blockage, you jaw it free from where it's blocked. So with an expanding airway from a cough and a back-blow, quite often, it will tend to come clear. Again, the child will try and fight against you because they are trying to suck air in, and you want them to actually expel air from the lungs. And we have got to actually encourage it and be quite forceful with this because you are trying to override what the brain is telling the child to do, as it would be with an adult as well.

So to recap then, put the patient in a position where you can work on that patient to the best of your abilities, whether that's up on a chair or whether you kneel down behind them, make sure you can work and that environment is okay and safe for you to do so. But whatever we require, whatever it takes to clear this airway, we must clear this airway. If the patient goes unconscious, we then go into the resus process, which is your five breaths first, then your 30, 2, 30, 2. That airway has got to be cleared. It's either got to go into the lung, and go that way, or it's gotta come out. One way or another, we have to clear this blockage. If we don't, the outcome isn't good. If we do clear this airway, even if we blow the product down into the lung itself, that can be removed at a later date in surgery and at least we have now got air going back into the lungs, allowing the patient to function again.