The child may rapidly develop a bluish discoloration of the nail beds and lips. A child who is not breathing can have permanent brain damage in about four minutes, and can die in about six minutes. Generally, if the child is breathing, crying, or coughing, and you have reason to believe he or she has an airway obstruction, you should call emergency medical assistance. This child will need immediate transport to an emergency department in an ambulance with trained personnel. If the child has an airway obstruction and cannot breathe, cough, or cry, first aid procedures, such as the Heimlich maneuver can be lifesaving.
Many programs require that all caregiver staff maintain current certification.
Less common but more serious is the barky, croupy cough. Even worse is the muffled cough, or the absence of cough or breathing, of a choking child who may need your immediate help in order to survive. The ability to cough is life sustaining. By listening carefully, caregivers can get a fairly clear idea of what's going on with the child and determine when medical help is necessary. Share information on coughing with parents so that they understand why coughing occurs, what to watch for, and how to treat the coughs.