Stand
behind the child. With your arms around his or her
waist, form a fist with one hand and place it, thumb
side in, between the ribs and waistline. Grab your
fist with your other hand. Keeping your arms off
the child's rib cage, give four quick inward and
upward thrusts. You may have to repeat this several
times until the obstructing object is coughed out.
