Pediatric Airway Foreign Body Clinical Presentation

  • Author: Michael R Bye, MD; Chief Editor: Michael R Bye, MD   more...
 
Updated: Jul 22, 2011
 

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.[4] 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.[4] 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

  • 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

Michael R Bye, MD  Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

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

Disclosure: Nothing to disclose.

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, Deputy Chief of Clinical Services, Walter Reed 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, and Christian Medical & Dental Society

Disclosure: Nothing to disclose.

Mary E Cataletto, MD  Director of Children's Sleep Services, Winthrop Sleep Disorders Center, Mineola, NY; Professor of Clinical Pediatrics, State University of New York at Stony Brook, Stony Brook, NY

Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians

Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Michael R Bye, MD  Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center

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

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. Feb 2009;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. Mar 2003;23(1):31-7. [Medline].

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

  4. 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. May 2006;70(5):879-84. [Medline].

  5. National Safety Council. Accident Facts. 1992:32.

  6. [Guideline] American Association for Respiratory Care (AARC). Bronchoscopy assisting--2007 revision & update. Respir Care. Jan 2007;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. Nov 2005;40(5):392-7. [Medline].

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

  9. Chung MK, Jeong HS, Ahn KM, et al. Pulmonary recovery after rigid bronchoscopic retrieval of airway foreign body. Laryngoscope. Feb 2007;117(2):303-7. [Medline].

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

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

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

  13. 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].

  14. 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. Jan 2006;41(1):e1-5. [Medline].

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