KNOXVILLE, Tenn. (WATE) — Few sounds are scarier than a child who is choking. It can be life-threatening, so it’s important to know what to do when a child chokes on something.

Children under the age of 4 are at most risk because toddlers and babies put everything in their mouths and their windpipe is much smaller than that of an adult says Dr. Katy Stordahl, a Children’s Hospital Urgent Care physician. However, choking can happen at any age.

When the brain does not receive oxygen for more than four minutes permanent brain damage and death can result.

Food is the most common thing that a child can choke on, especially things like hot dogs, poorly chewed pieces of meat, hard candies, grapes and raw carrots. Coins, balloons and small toys, as well as holiday decorations also pose a choking risk.

Here are some first aid tips for when a child is choking:

  • Call 911 immediately if the child can’t breathe.
  • Heimlich Maneuver
    • Position yourself behind the child and wrap your arms around his waist.
    • Place your thumb side of your fist on the middle of the abdomen, press inward, and up to dislodge the item.
  • Tongue-jaw lift
    • If the child is unconscious, lay them on their back.
    • Place thumb over their tongue and wrap your fingers around their lower jaw which draws the tongue away from the back of the throat. Try to clear the airway.
  • CPR
    • To be used only when a youngster has no pulse, indicating that his heart has stopped beating.

Stordahl says prevention is key. Make sure certain foods and small items are kept away from young children, have children sit down to eat and chew food properly, and never allow children to run or play with anything in their mouths,