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Treating Foreign Body Aspiration in Children - An Overview

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Foreign body aspiration is a common problem in children, which needs immediate and prompt management. The article describes it in detail.

Medically reviewed by

Dr. Kaushal Bhavsar

Published At January 11, 2023
Reviewed AtMay 16, 2023

What Is Foreign Body Aspiration?

Foreign body aspiration is a very common problem seen in children. It occurs when the child inhales foreign objects accidentally, which results in blockage of the airway or lungs. It is natural for children to explore things and feel things, taste them and see the new objects around them. When exploring new things, children tend to put non-edible things into their mouths and get obstructed in the airway or the lungs. Immediate and prompt action has to be taken to avoid the prevention of dangerous and life-threatening complications.

It is very important to be cautious while feeding the child in the early stages of life. The child may even choke on the foods we feed them, which results in dangerous or life-threatening complications. If the aspirated foreign body is large in size, it may cause asphyxia (a breathing impairment resulting from reduced oxygen supply) and lead to sudden death. Mostly foreign body aspiration occurs in infants and toddlers under three years of age. It is very important to train the caregiver about the symptoms of foreign body aspiration.

Sometimes, the position of the larynx (voice box) in a child is also a factor in the aspiration of foreign bodies. Mostly, the foods aspirated by the child are vegetable matter, nuts, fruits, and round foods like hotdogs, grapes, etc. Less common are beads, pins, small components of toys, and many other tiny objects.

What Is the Most Common Place for an Aspirated Foreign Body?

Most commonly, the foreign body gets aspirated in the bronchi, which almost 80 to 85 % gets lodged in the bronchi, especially in the right main stem and in the lower lobes of the lung. It also gets obstructed in the larynx or trachea (windpipe).

What Are the Signs and Symptoms of Foreign Body Aspiration?

The signs and symptoms of foreign body aspiration depend on the following factors such as :

  • The location where the foreign body is obstructed.

  • Size of the foreign body.

  • Nature or texture of the foreign body that is aspirated.

  • The time of inhalation, like the time of inhalation and the time of onset of symptoms.

What Are the Immediate Symptoms of Foreign Body Aspiration?

The immediate symptoms include:

  • Severe and prolonged cough.

  • Difficulty speaking.

  • Breathlessness.

  • Choking.

  • Stridor (a high-pitched, abnormal whistling sound).

  • Skin becomes blue.

  • If the object inhaled is bigger in size and gets obstructed in the airway or lungs, resulting in loss of consciousness and asphyxia and may lead to death.

  • In mild to moderate cases, the child exhibiting the symptoms of obstruction needs immediate help from a physician in order to prevent further complications.

What Are the Two Phases of Symptoms of Foreign Body Aspiration?

The two phases of foreign body aspiration include:

  1. Asymptomatic Phase: It is the phase where the child exhibits a few symptoms mentioned above, and later the symptoms are relaxed. The symptoms occur with coughing and difficulty breathing. This phase lasts for a few hours to a few weeks. Over a period of time, the symptoms may reappear, and this is the mild phase of foreign body aspiration.

  2. Symptomatic Phase: The symptomatic phase includes the symptoms like recurrent cough, wheezing or stridor, difficulty in swallowing, and difficulty speaking. Sometimes, it may lead to life-threatening and cause death.

What Are the Causes of Foreign Body Aspiration?

The causes of foreign body aspiration include:

  • Due to the inhalation of a foreign body that is lodged in the airway or the settlement of the foreign body in the bronchi.

  • Mostly, the foreign body aspiration occurs accidentally.

  • Foods are the most commonly aspirated foreign bodies like seeds, nuts, and raisins.

  • Non-edibles, like tiny parts of toys, can also lead to choking or airway obstruction.

  • Sometimes, water may also be inhaled into the airway, leading to choking, coughing, and short breaths.

What Are the Most Common Foreign Bodies That Are Usually Aspirated?

The most common foreign bodies that obstruct the airway are:

  • Small marbles.

  • Coins.

  • Balloons are the most dangerous, and they cause life-threatening complications.

  • Pins.

  • Dental crowns, restorations, and retainers may also aspirate accidentally.

  • Small objects such as pen caps get obstructed and block the airway.

What Are the Risk Factors for Foreign Body Aspiration?

The risk factors for foreign body aspiration include:

  • Children are more prone to foreign body aspiration.

  • Wearing dental crowns, restorations, and dental retainers.

  • Intoxication.

  • Sedation.

  • Neurological disorders such as dementia (memory disorder).

  • Psychological disorders such as bipolar disorder (mood swings ranging from depression to manic behavior) and schizophrenia (a mental disorder that affects a person's ability to think, behave, and feel).

  • Medical conditions that affect swallowing reflexes.

How To Locate the Foreign Body?

Rapid diagnosis is very important to locate the foreign body because a particular blockage in the airways that is restricting breathing can become life-threatening. After noticing the symptoms, if a doctor suspects a significant airway obstruction, emergency treatment is to remove the object without any further need for imaging tests like ultrasound and X-rays, and diagnostic bronchoscopy.

What Are the Treatment Options for Foreign Body Aspiration?

The treatment of foreign body aspiration includes:

  • When someone is showing signs of choking, encouraging the person to cough will clear the blockage on their own.

  • Give sharp blows to the person on the back, and repeat the procedure until the foreign body is thrown out.

  • Abdominal thrusts or Heimlich Maneuver is the procedure done when the blows fail. Stand behind the child and wrap both arms around the waist, pulling sharply inwards and outward.

  • Emergency endotracheal intubation is done if all the above procedures fail.

  • Removal of the foreign body during bronchoscopy is a common and usually successful treatment method for inhaled objects located in the trachea or bronchi.

Conclusion:

Foreign body aspiration is a common problem in children, which needs immediate and prompt management. Foreign body aspiration is a common reason for death in kids for developmental as well as anatomic reasons. Choking is defined as taking in any foreign body causing varying amounts of obstruction to the airway. The obstruction can lead to difficulties with breathing and oxygenation, thus resulting in significant morbidity or mortality.

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Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

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