Position your fist on the victim's abdomen, in the midline just above the navel and well below the tip of the breastbone (sternum), with the thumb side pressed against the body. Wrap your other hand over the first and pull sharply inward and upward. That landmark — one to two finger-widths above the navel, centered — reflects where the diaphragm sits and where a rapid upward thrust can compress the lungs and expel a lodged object.
The anatomy that dictates the landmark
The Heimlich maneuver works by turning the lungs into a bellows. When you thrust upward beneath the diaphragm, you rapidly compress the air in the lungs against a closed or partially blocked airway. The sudden pressure spike produces a cough-like burst of air meant to carry the foreign body out.
The key structure is the diaphragm, the dome-shaped muscle separating the chest cavity from the abdomen. It attaches along the lower ribs and the lower spine. Just below it sit the liver on the right and the stomach on the left. A thrust delivered at the correct height squeezes the lungs from below, which is why the force is directed up and in, not straight back.
Placement matters because the abdomen is compressible and the rib cage is not. Pushing on the lower sternum risks fracturing ribs or driving the xiphoid process into the liver. Pushing too low near the pelvis wastes force on the intestines and pelvic bones. The narrow midline window between the navel and the breastbone tip is where upward force converts most efficiently into lung pressure.
One plain-language way to picture it: you are trying to squeeze air out of a partly inflated balloon by pushing up on its underside, and the only useful push point is the soft spot just under the rib cage.
Quantified context: force, timing, and survival
Abdominal thrusts generate internal airway pressures high enough to mimic a strong cough. Bench studies and clinical teaching put the peak pressure in the range of roughly 30 to 60 centimeters of water, comparable to or above a forceful voluntary cough. That pressure is what dislodges a plug of food or a small object.
Timing is unforgiving. Brain injury from hypoxia can begin within about 4 to 6 minutes of complete airway obstruction, and irreversible damage or death becomes likely within roughly 10 minutes without relief. This is why the standard sequence moves quickly from encouraging coughing to back blows and abdominal thrusts in a conscious adult.
Choking is a substantial cause of unintentional injury death, especially in older adults and young children. Food is the leading culprit in adults, with meat and bones among the most common objects. Exact annual counts vary by country and reporting system, so treat any single figure with caution.
The demographic reality shapes the technique. Older adults and people with obesity or pregnancy require adjustments, because the standard abdominal landmark may be unsafe or ineffective in those bodies. The mechanism is the same; the delivery point changes.
The time course of a choking response
| Time from obstruction | What is happening | Correct action |
|---|---|---|
| 0–30 seconds | Victim can often still cough or speak | Encourage forceful coughing; do not intervene |
| 30 seconds–2 minutes | Cough weakens, breathing strained, distress rising | Prepare to act; call emergency services |
| 2–4 minutes | Airway nearly or fully blocked; silent distress | Begin back blows and abdominal thrusts |
| 4–6 minutes | Hypoxia advancing; consciousness may waver | Continue thrusts; prepare for collapse |
| 6–10 minutes | Risk of brain injury climbs sharply | Begin CPR if victim becomes unresponsive |
| Beyond 10 minutes | Severe neurological damage or death likely | Emergency care is critical |
The table is a teaching approximation, not a precise clock. Individual tolerance varies with age, lung reserve, and how completely the airway is blocked.
Edge cases that shift the target
Pregnancy and significant abdominal obesity are the two situations that most change the landmark. In a visibly pregnant or markedly obese person, standard abdominal thrusts risk injuring the uterus or fail because the abdomen cannot be compressed effectively. The recommended alternative is chest thrusts, delivered on the lower half of the sternum, which use the same pressure principle from a different point (American Red Cross; American Heart Association).
Infants under one year are handled differently again. For a choking infant, the standard is a sequence of back blows and chest thrusts, not abdominal thrusts, because the infant liver and rib cage are fragile and abdominal compression carries a higher injury risk.
People who are alone must adapt. A solo choking victim can use self-administered abdominal thrusts by pressing their own fist above the navel and thrusting inward and upward, or by leaning over a firm edge such as the back of a chair and driving the upper abdomen against it.
A less obvious case: a victim who is already unconscious. Once responsiveness is lost, abdominal thrusts stop and CPR begins, because the priority shifts from expelling the object to circulating blood and oxygen.
Red flag: never perform abdominal thrusts on a conscious person who is coughing forcefully or can speak — let the cough work. Red flag: do not use abdominal thrusts on infants under one year. Red flag: use chest thrusts, not abdominal thrusts, for a visibly pregnant or markedly obese victim. Red flag: if the victim becomes unresponsive, stop thrusts and start CPR immediately. Red flag: seek medical evaluation after any successful thrust, because internal injury is possible even when the object comes out.
Misconceptions and the professional caveat
The most common misconception is that the fist goes at the base of the breastbone or directly over the stomach. Both are wrong. The base of the breastbone is bone and cartilage that can fracture or drive the xiphoid into the liver. The stomach itself is not the target; you are compressing the lungs from below, and the stomach is simply nearby.
A second misconception is that abdominal thrusts are the only tool. Modern guidance from major resuscitation bodies pairs them with back blows. The American Red Cross teaches five back blows followed by five abdominal thrusts in adults, alternating until the object clears or the person collapses. The old "Heimlich-only" framing is outdated.
A third misconception is that a hard enough thrust is always better. Excessive force raises the risk of rib fracture, liver laceration, and stomach rupture. Correct placement plus firm, controlled thrusts beats raw force.
Here is the counterintuitive professional caveat: the landmark is a zone, not a point. Rescuers are taught to feel for the navel and place the fist one to two finger-widths above it, but exact anatomy varies with body habitus, prior surgery, and posture. A thin person's diaphragm sits higher relative to the navel than a person with a large abdomen. The "correct" spot is therefore a small target region, and the rescuer's job is to find the compressible midline just under the rib cage rather than hunt for a single inch.
A related caveat: outcomes data for bystander abdominal thrusts are limited and mostly observational. Much of the technique's evidence base comes from mechanism studies and case series rather than large randomized trials, which is ethically unavoidable. That does not weaken the recommendation, but it means the precise pressure and force figures should be read as approximate.
Practical actions and how to reconcile the thresholds
The steps below translate the landmark into action for a conscious adult. They assume a responsive victim with a fully obstructed airway who cannot cough, speak, or breathe.
Confirm severe obstruction. Ask "Are you choking?" If the person cannot answer, cannot cough effectively, or is turning blue, act now. Call for emergency help or have someone else call, and send for an automated external defibrillator if one is nearby. Stand behind the victim and wrap your arms around the waist. Make a fist and place the thumb side against the abdomen, in the midline, just above the navel and well below the breastbone tip. Grasp your fist with your other hand and deliver quick, firm, inward-and-upward thrusts. Repeat in sets, alternating with back blows per your training, until the object clears or the person becomes unresponsive. If the person goes limp, lower them to the ground and begin CPR.
Several thresholds circulate for "how far above the navel" and "how hard." The most defensible reconciliation is this: distance is measured in finger-widths (one to two) rather than inches, because it scales to the victim's body; force is described as firm and controlled rather than in pounds, because rescuer strength and victim size vary too much for a single number. Where sources differ on back-blow-versus-thrust order, follow the sequence you were trained in and keep alternating — the alternation matters more than the exact starting move.
For self-rescue, the same landmark applies to your own fist, or to a firm edge driven against the upper abdomen. After any successful rescue, the victim should be evaluated by a medical professional, since abdominal thrusts can cause internal injury that is not immediately obvious.
Limitations and what this guidance cannot do
This explanation describes a general technique for a general adult. It cannot substitute for hands-on certified training, and it does not cover every body type, medical condition, or situation. The pressure and timing figures are approximations drawn from mechanism studies and resuscitation guidance, not precise prescriptions. Bystander outcomes data remain limited, and the technique's effectiveness depends on correct placement, adequate force, and a partially compressible chest.
This article is general educational information, not a diagnosis, treatment plan, or substitute for professional medical guidance. It does not promise any outcome. For hands-on instruction, seek a certified first-aid or CPR course, and for any choking emergency or suspected internal injury, contact local emergency services or a qualified healthcare professional immediately.