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Pediatric Airway Foreign Body Clinical Presentation

  • Author: Emily Concepcion, DO; Chief Editor: Michael R Bye, MD  more...
 
Updated: Oct 13, 2015
 

History

Often, the child presents after a sudden episode of coughing or choking while eating with subsequent wheezing, coughing, or stridor. However, in numerous cases, the choking episode is not witnessed, and, in many cases, the choking episode is not recalled at the time the history is taken.

The most tragic cases occur when acute aspiration causes total or near-total occlusion of the airway, resulting in death or hypoxic brain damage.

The more difficult cases are those in which aspiration is not witnessed or is unrecognized and, therefore, is unsuspected.

In these situations, the child may present with persistent or recurrent cough, wheezing, persistent or recurrent pneumonia, lung abscess, focal bronchiectasis, or hemoptysis.

If the material is in the subglottic space, symptoms may include stridor, recurrent or persistent croup, and voice changes.

In one series, as many as one third of parents were unaware of the aspiration or remembered an event that occurred more than a week before the presentation.[5] In as many as 25% of cases, aspiration occurred more than one month before presentation. Consequently, a high index of suspicion in addition to the history may be necessary to reach the diagnosis. In another series of 280 foreign body aspirations, 47% were detected more than 24 hours after the aspiration.[5] However, 99% had signs or symptoms or abnormal plain radiographs before the bronchoscopy.

One of the author's cases involved a 9-year-old boy with persistent pneumonia and lung abscess. Upon bronchoscopy, a plastic toy was visualized in his left lower lobe bronchus. Neither he nor his family could recognize the toy and had no idea how long it had been since it might have been aspirated.

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Physical

See the list below:

  • Major findings include new abnormal airway sounds, such as wheezing, stridor, or decreased breath sounds. These sounds are often, but not always, unilateral.
  • Sounds are inspiratory if the material is in the extrathoracic trachea. If the lesion is in the intrathoracic trachea, noises are symmetric but sound more prominent in the central airways. These sounds are a coarse wheeze (sometimes referred to as expiratory stridor) heard with the same intensity all over the chest.
  • Once the foreign body passes the carina, the breath sounds are usually asymmetric. However, remember that the young chest transmits sounds very well, and the stethoscope head is often bigger than the lobes. A lack of asymmetry should not dissuade the observer from considering the diagnosis.
  • Similarly, a lack of findings upon physical examination does not preclude the possibility of an airway foreign body.
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Contributor Information and Disclosures
Author

Emily Concepcion, DO Fellow, Department of Pediatric Pulmonology, State University of New York Downstate Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Charles Callahan, DO Professor, Chief, Department of Pediatrics and Pediatric Pulmonology, Tripler Army Medical Center

Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Chief Editor

Michael R Bye, MD Professor of Clinical Pediatrics, State University of New York at Buffalo School of Medicine; Attending Physician, Pediatric Pulmonary Division, Women's and Children's Hospital of Buffalo

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Michael R Bye, MD Professor of Clinical Pediatrics, State University of New York at Buffalo School of Medicine; Attending Physician, Pediatric Pulmonary Division, Women's and Children's Hospital of Buffalo

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Thomas Scanlin, MD Chief, Division of Pulmonary Medicine and Cystic Fibrosis Center, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School

Thomas Scanlin, MD is a member of the following medical societies: American Association for the Advancement of Science, Society for Pediatric Research, American Society for Biochemistry and Molecular Biology, American Thoracic Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

References
  1. Pak MW, van Hasselt CA. Foreign bodies in children's airways: a challenge to clinicians and regulators. Hong Kong Med J. 2009 Feb. 15(1):4-5. [Medline].

  2. Eren S, Balci AE, Dikici B, et al. Foreign body aspiration in children: experience of 1160 cases. Ann Trop Paediatr. 2003 Mar. 23(1):31-7. [Medline].

  3. National Safety Council. Injury, Death and Fatality Statistics. Available at http://www.nsc.org/news_resources/injury_and_death_statistics/Pages/InjuryDeathStatistics.aspx. Accessed: February 12, 2013.

  4. National Safety Council. Accident Facts. 1992. 32.

  5. Bittencourt PF, Camargos PA, Scheinmann P, de Blic J. Foreign body aspiration: clinical, radiological findings and factors associated with its late removal. Int J Pediatr Otorhinolaryngol. 2006 May. 70(5):879-84. [Medline].

  6. [Guideline] American Association for Respiratory Care (AARC). Bronchoscopy assisting--2007 revision & update. Respir Care. 2007 Jan. 52(1):74-80.

  7. Ramirez-Figueroa JL, Gochicoa-Rangel LG, Ramirez-San Juan DH, Vargas MH. Foreign body removal by flexible fiberoptic bronchoscopy in infants and children. Pediatr Pulmonol. 2005 Nov. 40(5):392-7. [Medline].

  8. Thatte NM, Guglani L, Turner DR, Forbes TJ, Gowda ST. Retrieval of endobronchial foreign bodies in children: involving the cardiac catheterization lab. Pediatrics. 2014 Sep. 134 (3):e865-9. [Medline].

  9. Zaupa P, Saxena AK, Barounig A, Hollwarth ME. Management strategies in foreign-body aspiration. Indian J Pediatr. 2009 Feb. 76(2):157-61. [Medline].

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  11. [Guideline] American Academy of Pediatrics. Prevention of Choking Among Children. J Pediatr. 2010 Feb. 125(3):601-7. [Full Text].

  12. Bloom DC, Christenson TE, Manning SC, et al. Plastic laryngeal foreign bodies in children: a diagnostic challenge. Int J Pediatr Otorhinolaryngol. 2005 May. 69(5):657-62. [Medline].

  13. CDC. Nonfatal choking-related episodes among children--United States, 2001. MMWR Morb Mortal Wkly Rep. 2002 Oct 25. 51(42):945-8. [Medline].

  14. Kim IG, Brummitt WM, Humphry A. Foreign body in the airway: a review of 202 cases. Laryngoscope. 1973 Mar. 83(3):347-54. [Medline].

  15. Mu L, He P, Sun D. Inhalation of foreign bodies in Chinese children: a review of 400 cases. Laryngoscope. 1991 Jun. 101(6 Pt 1):657-60. [Medline].

  16. Svedstrom E, Puhakka H, Kero P. How accurate is chest radiography in the diagnosis of tracheobronchial foreign bodies in children?. Pediatr Radiol. 1989. 19(8):520-2. [Medline].

  17. Tang FL, Chen MZ, Du ZL, Zou CC, Zhao YZ. Fibrobronchoscopic treatment of foreign body aspiration in children: an experience of 5 years in Hangzhou City, China. J Pediatr Surg. 2006 Jan. 41(1):e1-5. [Medline].

  18. Kim IA, Shapiro N, Bhattacharyya N. The national cost burden of bronchial foreign body aspiration in children. Laryngoscope. 2015 May. 125 (5):1221-4. [Medline].

 
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Aspirated foreign body (backing to an earring) lodged in the right main stem bronchus.
 
 
 
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