What the New AHA Guidelines Mean During Thanksgiving—and Beyond

Thanksgiving brings full plates, busy conversations, and plenty of distractions. But when someone suddenly cannot speak, breathe, or cough effectively, knowing what to do can make all the difference.

The American Heart Association’s 2025 CPR and Emergency Cardiovascular Care Guidelines introduced an important update to the choking response for conscious adults and children. The new sequence is simple:

Five back blows, followed by five abdominal thrusts. Repeat.

Previously, many people were taught to begin with abdominal thrusts alone. The updated guidance now begins with back blows and alternates between the two techniques until the object comes out or the person becomes unresponsive.

Is the Person Really Choking?

Not every cough during dinner requires intervention.

If the person can still speak, breathe, or cough forcefully, encourage them to keep coughing and watch them closely.

Signs of a severe airway obstruction include:

• A weak or absent cough

• Inability to speak or breathe

• Blue or gray skin color

• Confusion or altered mental status

• Loss of responsiveness

If these signs are present, call 911 and begin the choking response. 

The Updated Steps for Adults and Children

For a responsive adult or child with severe choking:

1. Give five firm back blows between the shoulder blades.

2. Give five abdominal thrusts.

3. Continue alternating until the object is expelled or the person becomes unresponsive.

For someone in the later stages of pregnancy—or when you cannot reach around the person’s abdomen—use five chest thrusts instead of abdominal thrusts.

Infants Need a Different Technique

Never perform abdominal thrusts on an infant.

For a responsive choking infant:

1. Give five back blows.

2. Give five chest thrusts using the heel of one hand.

3. Continue until the object comes out or the infant becomes unresponsive. 

What If the Person Becomes Unresponsive?

If the person becomes unresponsive, lower them safely and begin CPR, starting with chest compressions.

Each time you open the airway to give breaths, look inside the mouth. Remove the object only if you can clearly see and reach it. Do not perform a blind finger sweep because this may push the object deeper into the airway. 

The Takeaway

The new sequence is easy to remember:

Adults and children: five back blows, five abdominal thrusts.
Infants: five back blows, five chest thrusts.

Thanksgiving is a good reminder, but choking can happen at any meal, workplace, classroom, or community event. Updated CPR and first-aid training can help you recognize an emergency and act confidently when seconds matter.

This article is for general education and does not replace accredited CPR training, local protocols, or professional medical guidance.

Sources and More Information:

1. American Heart Association. Updated CPR Guidelines Tackle Choking Response, Opioid-Related Emergencies and a Revised Chain of Survival. October 22, 2025. American Heart Association

2. American Heart Association. Highlights of the 2025 American Heart Association Guidelines for CPR and ECC. cpr.heart.org

3. American Heart Association. Adult Foreign-Body Airway Obstruction Algorithm. www.heart.org

4. American Heart Association and American Academy of Pediatrics. 2025 Pediatric Basic Life Support Guidelines. cpr.heart.org