Correct Answer: B. Back blows
In a 2-year-old child with foreign body airway obstruction (FBAO), back blows are the most appropriate immediate first-line intervention. Current pediatric resuscitation guidelines — including those from the Indian Academy of Pediatrics (IAP), the UK Resuscitation Council, and PALS protocols — recommend a combined sequence of 5 back blows followed by 5 abdominal thrusts for conscious children over 1 year of age. Critically, back blows come first in this sequence, making them the most appropriate immediate management when a child is actively choking.
The mechanism of back blows is well-established: a sharp blow delivered between the shoulder blades generates a sudden increase in intrathoracic pressure via a vibratory force transmitted through the chest wall. This pressure wave can dislodge a lodged foreign body (such as a peanut) and propel it out of the airway. Back blows are rapid, non-invasive, and can be performed immediately without any equipment. In a 2-year-old who is conscious and choking, initiating back blows without delay is the correct first action — before escalating to abdominal thrusts if the obstruction persists.
This question specifically tests knowledge of the order of the FBAO algorithm in children >1 year: Back blows → Abdominal thrusts → Repeat cycle → CPR if unresponsive. The "immediate" qualifier in the question stem is the key discriminator pointing to back blows as the answer.
Why other options are wrong
- A. Chest compressions — Indicated only in cardiac arrest (unresponsive, pulseless child). A conscious, choking child does not require CPR. Compressions do not generate directed airflow to expel a foreign body and waste critical time.
- C. Abdominal thrusts — While abdominal thrusts are part of the correct FBAO sequence for children >1 year, they come after back blows, not before. Selecting abdominal thrusts as the immediate first step reflects an incomplete understanding of the correct algorithm order.
- D. Endotracheal intubation — A definitive airway procedure reserved for failed dislodgment or loss of consciousness with complete obstruction. It is invasive, requires equipment and expertise, and is never the immediate first-line step in a conscious, choking child.
Reference: IAP Pediatric Resuscitation Guidelines; UK Resuscitation Council PBLS Algorithm; OP Ghai Essentials of Pediatrics (Resuscitation Chapter)