Airway foreign bodies in children
Airway foreign bodies in children are potentially fatal and proper recognition is important because delayed diagnosis is common.
Children under the age of four years are at increased risk of foreign body (FB) aspiration with a slight male predominance 1.
Most children (~70%) are witnessed to have a choking event at the time of aspiration. Children may otherwise present with cough, dyspnoea or irritability 2,6.
Most (70-90%) foreign bodies are organic, most commonly seeds and nuts. Inorganic foreign bodies vary dramatically and can include teeth, coins, pins, pens/crayons, etc.
Aspirated foreign bodies have a predominance for the right tracheobronchial tree 6.
- chest x-ray will be normal in ~35% (range 30-40%) of patients 1-2
- unilateral emphysema or atelectasis are the most common findings; only uncommonly will a radio-opaque foreign body be demonstrated 1-2
- can be useful in assessment of missed or retained foreign body after initial bronchoscopy 3
Treatment and prognosis
Bronchoscopy is considered the gold-standard in the diagnosis of tracheobronchial tree foreign bodies 3 with the added benefit of being able to potentially retrieve the foreign body.
- pneumonia or atelectasis
- broncho-oesophageal fistula
- oesophageal foreign body
- flat foreign bodies (e.g. coins) tend to lie a coronal plane in the oesophagus 4
- 1. Passàli D, Lauriello M, Bellussi L et-al. Foreign body inhalation in children: an update. Acta Otorhinolaryngol Ital. 2010;30 (1): 27-32. Free text at pubmed - Pubmed citation
- 2. Chik KK, Miu TY, Chan CW. Foreign body aspiration in Hong Kong Chinese children. Hong Kong Med J. 2009;15 (1): 6-11. Pubmed citation
- 3. Shin SM, Kim WS, Cheon JE et-al. CT in children with suspected residual foreign body in airway after bronchoscopy. AJR Am J Roentgenol. 2009;192 (6): 1744-51. doi:10.2214/AJR.07.3770 - Pubmed citation
- 4. Rotta AT, Wiryawan B. Respiratory emergencies in children. Respir Care. 2003;48 (3): 248-58. Pubmed citation
- 5. Textbook of Pediatric Emergency Medicine. Lippincott Williams & Wilkins. ISBN:1605471593. Read it at Google Books - Find it at Amazon