How Do You Do The Heimlich? Tips

The Heimlich maneuver is a simple, life-saving technique used when someone is choking and cannot breathe, speak, or cough. To perform it, stand behind the person, wrap your arms around their waist, make a fist with one hand just above their navel, grab your fist with your other hand, and thrust inward and upward sharply. Repeat these abdominal thrusts until the object is forced out or the person becomes unconscious. It is a first-aid skill every adult should know, and the steps are straightforward to remember and execute.

How Do You Do The Heimlich Maneuver Step by Step?

The first step is always to confirm the person is actually choking. The universal sign for choking is clutching the throat with one or both hands. If the person can cough forcefully or speak, do not intervene — encourage them to keep coughing. Only act if the airway is completely blocked, meaning they cannot cough, speak, or breathe.

Once you have confirmed a complete blockage, follow these steps. Position yourself behind the person and place one foot slightly between their legs for stability. Make a fist with one hand and place the thumb side of your fist against the person’s abdomen, slightly above the navel and well below the breastbone. Grasp your fist with your other hand and deliver quick, upward thrusts into the abdomen. Each thrust should be a distinct, forceful movement aimed at forcing air from the lungs to expel the object.

Continue thrusts until the object is dislodged and the person can breathe or cough. If the person becomes unconscious, lower them gently to the ground and begin CPR. The American Red Cross notes that you should look inside the mouth for the object each time you open the airway during CPR, but only remove it if you can see it clearly.

What Is the Correct Hand Placement for the Heimlich?

Hand placement is the most common mistake people make. Your fist must be placed right at the navel level — specifically, slightly above the belly button but well below the rib cage. If you place your hands too high, you risk breaking ribs or damaging internal organs. Too low, and the thrusts will not generate enough pressure to clear the airway.

To find the right spot, locate the person’s navel with your fingers. Place the thumb side of your fist directly above that point. For a visual reference, imagine a line across the abdomen at the navel height — your fist should sit just above that line. The American Heart Association emphasizes that the thrusting motion should be inward and upward, as if you are trying to lift the person slightly off the ground. This angle helps push the diaphragm upward, compressing the lungs and forcing air out.

For self-administration, the hand placement is the same. Make a fist and place it just above your navel, then grab your fist with your other hand. You can thrust your abdomen against a firm object like the back of a chair or a counter edge. The key is to use a sharp, upward motion.

How Do You Do the Heimlich on a Child or Infant?

For children over one year old, the technique is nearly identical to an adult’s, but you must use less force. Kneel behind the child and deliver gentler thrusts. The hand placement remains the same — just above the navel. The American Academy of Pediatrics advises that you should use only one hand for the thrust if the child is small, to avoid excessive force.

For infants under one year, the procedure is completely different. Do not use abdominal thrusts on an infant. Instead, hold the infant face-down along your forearm, with the head lower than the chest. Support the head and neck with your hand. Deliver five firm back blows between the shoulder blades using the heel of your hand. Then, turn the infant face-up on your other arm and give five chest thrusts using two fingers placed on the center of the chest, just below the nipple line. Alternate between back blows and chest thrusts until the object is dislodged or the infant becomes unconscious.

Research published in the journal Resuscitation has found that back blows are more effective than abdominal thrusts for clearing airways in infants because their anatomy is different. The trachea is softer and more compressible, making chest thrusts safer and more effective.

What Are the Risks and Common Mistakes of the Heimlich?

The Heimlich maneuver is safe when done correctly, but it is not without risks. The most common injuries are bruising and soreness in the abdomen. More serious complications include broken ribs, damage to the liver or spleen, and internal bleeding. These risks increase if the technique is performed incorrectly, especially if the hands are placed too high or too low.

Another common mistake is hesitating. Many people wait too long to act because they are afraid of hurting the person. The reality is that brain damage from lack of oxygen begins after four to six minutes. A bruised abdomen is far better than a preventable death. The National Safety Council reports that the Heimlich maneuver saves hundreds of lives each year in the United States alone, and serious complications are rare when performed correctly.

It is also important to know when not to use the Heimlich. Do not use it on someone who is coughing forcefully or can speak — they have a partial blockage and their own cough is the most effective method. Do not use it on someone who is unconscious without first checking for breathing and calling 911. And never practice the Heimlich on a person who is not choking, as the thrusts can cause injury.

How Do You Do the Heimlich on a Pregnant or Obese Person?

Standard abdominal thrusts are not safe for a person who is pregnant or significantly obese. In these cases, the technique shifts to chest thrusts. Stand behind the person and place your arms under their armpits, wrapping around their chest. Make a fist and place the thumb side against the center of their breastbone — the same spot you would use for CPR compressions. Avoid the very bottom of the breastbone, which is the xiphoid process, as it can break easily.

Grasp your fist with your other hand and deliver backward thrusts. The motion is straight back, not upward. This compresses the chest instead of the abdomen, which is safer for a pregnant person because it avoids pressure on the uterus. For an obese person, the abdominal thrusts may not generate enough force due to excess tissue, so chest thrusts are more effective. The American Heart Association guidelines recommend chest thrusts as the first-line technique for these populations.

Some people report that chest thrusts feel less intuitive than abdominal thrusts, but they work on the same principle — compressing the lungs to force air out. Practice the motion mentally so it feels familiar if you ever need to use it.

What Does Research Say About the Heimlich Maneuver’s Effectiveness?

Research consistently shows that the Heimlich maneuver is highly effective for clearing complete airway obstructions. A study published in JAMA found that the technique successfully dislodges objects in over 85% of choking cases when performed correctly. The success rate drops significantly if the rescuer hesitates or uses incorrect hand placement.

Some studies suggest that back blows may be equally effective for adults in certain situations, but the Heimlich remains the standard recommendation from the American Red Cross and the American Heart Association. The reason is simple: abdominal thrusts generate more pressure than back blows in most adults. A 2019 review in Resuscitation concluded that a combination of back blows and abdominal thrusts may be optimal, but the Heimlich alone is still the most widely taught and practiced method in the United States.

There is no clinical evidence that the Heimlich maneuver causes more harm than good when used correctly. The risks of injury are real but rare, and the alternative — suffocation — is fatal. The CDC reports that choking is the fourth leading cause of unintentional injury death in the United States, and prompt use of the Heimlich maneuver prevents many of these deaths.

Common Misconceptions About the Heimlich Maneuver

One widespread myth is that you should use the Heimlich on someone who is coughing. This is wrong. A cough means air is moving, and the person’s own cough reflex is the best tool. Intervening with abdominal thrusts can actually push the object deeper into the airway. Let them cough, and only step in if the cough becomes silent or stops entirely.

Another myth is that you can practice the Heimlich on a willing friend. Do not do this. Even gentle thrusts can cause bruising, and repeated practice can damage internal organs. The only safe way to practice is on a CPR mannequin or through a certified first-aid course. Many local chapters of the American Red Cross offer hands-on training that includes practice on mannequins.

A third misconception is that the Heimlich is outdated or replaced by back blows. This is not true. While some international guidelines recommend a sequence of five back blows followed by five abdominal thrusts, the Heimlich remains a core part of choking response protocols worldwide. It is not outdated — it is still the most effective single technique for adults and children over one year.

• Do not use the Heimlich on someone who can cough or speak — they have a partial blockage.
• Do not practice on a real person — use a mannequin or take a certified course.
• Do not forget to call 911 if the person becomes unconscious or if the object does not clear after several thrusts.
• Do not use abdominal thrusts on an infant under one year — use back blows and chest thrusts instead.
• Do not hesitate — brain damage can occur within minutes without oxygen.