Foreign Body Aspiration (Inhalation) • Can be a life-threatening emergency
• An aspirated/inhaled solid or semisolid object may lodge in the larynx or trachea
• If the object is large enough to cause nearly complete obstruction of the airway, asphyxia
may rapidly cause death
• Although there has been a decrease in childhood deaths from asphyxiation by ingested
objects, the incidence has not changed significantly
• Lesser degrees of obstruction can result in less severe signs and symptoms
• Chronic debilitating symptoms with recurrent infections might occur with delayed
extraction, or the patient may remain asymptomatic
• The actual aspiration event may or may not be identified, although it is often not
immediately appreciated
• Diagnosis is often missed initially, especially in children where the history may be vague
and the patient cannot verbalize the events
• Geographic location, access to certain objects in the particular environment and dietary
habits affect the frequency that various objects are aspirated (e.g. fish bones)
• Male-to-female ratio is 2:1 in foreign body aspiration
• Children, especially those aged 1 to 3 years, are at higher risk due to:
o Incomplete chewing of food
o Increasing independence
o Lessening of close parental supervision as they become older
o Increasing activity and curiosity
o Hand-mouth interactions.
Commonly Aspirated Foreign Bodies • Food
• Nuts
• Legumes (beans, peas)
• Coins
• Popcorn
• Small metallic objects
• Safety pins
• Broken toys
• Pins
• Nails.
Clinical Presentation of Foreign Body Aspiration • Foreign body aspiration can result in a spectrum of presentations, from minimal
symptoms, often unobserved, to respiratory compromise, failure and death
• A positive history must never be ignored and negative history may be misleading
• Once aspirated, objects may subsequently change position or migrate distally, particularly
after unsuccessful removal attempts or if the object fragments
o The object itself might cause obstruction
o Vegetable material may swell over time and worsening the obstruction
• Organic foreign bodies, such as oily nuts induce inflammation and oedema
• Local inflammation, oedema, ulceration, and granulation tissue formation may contribute
to airway obstruction
o Tracheoesophageal fistulas may result
• Distal to the obstruction, air trapping may occur, leading to local emphysema, atelectasis,
pneumonia, and the possibility of abscess or bronchiectasis
• Likelihood of complications increases after 24 to 48 hours, making removal of the foreign
body imperative
• Symptoms and signs include:
o Cough
o Fever
o Haemoptysis
o Difficulty breathing/dyspnoea
o Chest pain
o History of a choking episode is not always obtained or may have initially been
ignored or misdiagnosed
o Stridor
o Wheeze, or diminished breathing sounds
o If obstruction is severe, cyanosis.
Three Stages of Symptoms • Initial event
o Violent paroxysms of coughing, choking, gagging, and possibly airway obstruction
occur immediately when the foreign body is aspirated
• Asymptomatic interval
o The foreign body becomes lodged, reflexes fatigue, and the immediate irritating
symptoms subside
• Complications
o Obstruction, erosion, or infection develops to again direct attention to the presence of
a foreign body.
Management of a Child Who Has Aspirated a Foreign Body 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 infant over and give five chest thrusts with two fingers, one
finger breadth below nipple level in midline
• If obstruction persists, check infant’s mouth for any obstruction which can be removed
• If necessary, repeat sequence with back slaps again
• Refer all patients whose foreign bodies require expert removal.
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 sternum, place the other
hand over the fist and pull upwards into the abdomen, repeat this Heimlich manoeuvre
five times
• If obstruction persists, check the child’s mouth for any obstruction which can be removed
• If necessary, repeat sequence with back slaps again
• Refer all patients whose foreign bodies require expert removal
Note: Acute choking, with respiratory failure associated with foreign body obstruction, may
be successfully treated at the scene with the Heimlich manoeuvre, back blows, and abdominal
thrusts.
References • Beattie, J., & Carachi, R. (2005). Practical Paediatric Problems (International student
Edition) London: Hodder Arnold.
• Behrman, R.E., & Kliegman, R.M. (2002). Nelson Essentials of Paediatrics. (4th ed.)
Pennsylvania: Saunders Company.
• Coovadia, H.M., et al. (2001). Paediatrics and Child Health: A Manual for Health
Professionals in the Third World. (4th ed.). Cape Town, South Africa: Oxford University
Press.
• MOHSW, WHO & UNICEF (2000). IMCI: Management of the Child with a Serious
Infection or Severe Malnutrition, Guidelines for Care at the First-referral Level. Dar es
Salaam, Tanzania: Ministry of Health and Social Welfare.
• Stanfield, P., & Bwibo, N. (2005). Child Health: A Manual for Medical and Health
Workers in Health Centres and Rural Hospitals. (3rd ed.) Nairobi: AMREF.
• Swai, M., et al. (2009). KCMC Paediatric Management Schedule. (7th ed.) Moshi,
Tanzania: Kilimanjaro Christian Medical Centre.
• Swash, M., & Glynn, M. (2007). Hutchinson’s Clinical Methods. (22nd ed.) USA:
Saunders.
• WHO (2005). Pocket Book of Hospital Care for Children: Guidelines for the
Management of Common Illnesses with Limited Resources. Geneva.