If an infant or child starts choking when you administer the vitamin A dose you should do the following:

For infants:

• Lay the infant on your arm or thigh in a head down position
• Give five blows to the infant's back with heel of hand
• If obstruction persists, turn the infant over and give five chest thrusts with two fingers, one fingerbreadth below nipple level in midline (see Figure 7.3).

For children:

• Give five blows to the child's back with heel of hand with child sitting, kneeling or lying
• If the obstruction persists, go behind the child and pass your arms around the child's body; form a fist with one hand immediately below the child's breast bone (sternum); place the other hand over the fist and pull upwards into the abdomen; repeat this Heimlich manoeuvre five times (see Figure 7.4)
• If the obstruction persists, check the child's mouth for any obstruction, which can be removed
• If necessary, repeat this sequence with backslaps again.

Table 7.4 below is a summary of the different symptoms you might observe as side effects of vitamin A administration, which include overdose and accidental choking. It also describes how you can prevent these from happening and what actions you need to take to overcome these problems if they occur.

Table 7.4 Potential problems of vitamin A administration.