Airway foreign bodies in children

Dr Henry Knipe et al.

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

Plain radiograph
  • 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
CT
  • can be useful in assessment of missed or retained foreign body after initial bronchoscopy 3

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. 

Complications
  • oesophageal foreign body
    • flat foreign bodies (e.g. coins) tend to lie a coronal plane in the oesophagus 4
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Article Information

rID: 27886
Systems: Chest, Paediatrics
Sections: Pathology, Gamuts
Synonyms or Alternate Spellings:
  • Paediatric foreign body aspiration
  • Foreign body aspiration in children
  • Inhaled foreign body in children

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