eMedicine Specialties > Pediatrics: General Medicine > Pulmonology

Airway Foreign Body: Follow-up

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
Contributor Information and Disclosures

Updated: May 21, 2009

Follow-up

Further Inpatient Care

  • Endoscopy must be performed by a physician skilled in pediatric airway procedures. Ideally, an anesthesiologist skilled in the treatment of children should also be present in the operating room.
  • Once the foreign body has been removed and the patient is stable, the child may be discharged. This usually occurs the same day as the procedure.

Further Outpatient Care

In one series of 98 foreign body aspirations, 74.5% of the radiographs were normal within one week.9 A longer time until clearing was associated with inflammatory changes on the initial radiograph or direct visualization, a procedure time longer than 50 minutes, and respiratory complications during the removal.

Inpatient & Outpatient Medications

  • If swelling or granulation tissue was observed, a corticosteroid may be administered.
  • Unless airway secretions are infected, antibiotics are not necessary.

Deterrence/Prevention

  • The best therapy is avoidance.
  • Anticipatory guidance should include information about age-appropriate foods and instructing the child to sit at the table until all chewing is complete.
  • Talking while chewing should also be discouraged.

Complications

  • Atelectasis due to prolonged airway obstruction
  • Bronchiectasis due to chronic infection
  • Lung abscess
  • Pneumomediastinum and pneumothorax (rare complications of foreign body removal)

Prognosis

  • Once the foreign material is removed, the prognosis is excellent. The sooner it is removed, the quicker and more complete the recovery.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Missing a foreign body, which delays its removal and increases the chances for complications, increases the risk of legal action.
 


More on Airway Foreign Body

Overview: Airway Foreign Body
Differential Diagnoses & Workup: Airway Foreign Body
Treatment & Medication: Airway Foreign Body
Follow-up: Airway Foreign Body
Multimedia: Airway Foreign Body
References
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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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Further Reading

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Keywords

foreign body aspiration, choking, foreign body esophagus, aspiration of foreign bodies, airway foreign body, tracheal obstruction, asphyxiation, occlusion of the airway, hypoxic brain damage, lung abscess, focal bronchiectasis, hemoptysis, croup, lung abscess, pneumonia, focal bronchiectasis, diagnosis, treatment

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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: Merck Honoraria Speaking and teaching

Medical Editor

Thomas Scanlin, MD, Chief, Division of Pediatric Pulmonary & Cystic Fibrosis, Assistant Professor, Department of Pediatrics, Robert Wood Johnson University Medical Group
Thomas Scanlin, MD is a member of the following medical societies: American Thoracic Society and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

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.

CME Editor

Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital
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: Merck Honoraria Speaking and teaching

 
 
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