Airway foreign bodies in children

Dr Owen Kang and Dr Henry Knipe et al.

Airway foreign bodies in children are potentially fatal, which is why proper recognition is important. Unfortunately, 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 had 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 predilection for the right tracheobronchial tree 6

  • the patient should be radiographed on expiration: this will exaggerate the differences between the lungs
    • in infants and toddlers, a parent can be asked to push inward and upward on the child's upper abdomen for attaining expiration
    • the normal lung should appear smaller and denser than the affected lung
  • due to the check valve mechanism, where air enters the bronchus around the foreign body but cannot exit, the affected lung will usually appear overinflated and hyperlucent, with concomitant rib flaring and a depressed ipsilateral hemidiaphragm
  • 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

In case there is a high suspicion of foreign body aspiration by an infant or toddler, but the chest X-ray is inconclusive, fluoroscopy may be attempted. The child is imaged in the lateral decubitus position, lying on the presumed affected side. The occluded lung is immobile on inspiration-respiration. 

Can be useful in the assessment of a 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.

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

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

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Cases and figures

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    Case 8: left lung collapse due to ground nut in bronchus
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