Inhaled Foreign Body in Children

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Inhaled foreign body refers to the aspiration of an object into the respiratory tract. This is most commonly seen in young children under five years old, as they tend to explore objects with their mouths. It can be life-threatening, especially if the object lodges in the airway and obstructs breathing.

Aetiology

• Children are naturally inclined to place objects in their mouths, which can lead to inhalation.
• Common inhaled foreign bodies include small toys, food (nuts, seeds, popcorn), and other household items.
• Large objects can obstruct the airway, causing respiratory distress.

Pathophysiology

When an object is inhaled, it can lodge in the larynx, trachea, or bronchi, leading to airway obstruction. Depending on the location, the obstruction may be partial or complete. A partial obstruction may cause symptoms like coughing and wheezing, while a complete obstruction can lead to life-threatening respiratory failure.

Risk Factors

• Age – Most common in children under five.
• Inadequate supervision during feeding or playtime.
• Access to small objects or food items that can be easily inhaled.
• Developmental delays or conditions that affect swallowing coordination.

Signs and Symptoms

• Acute symptoms: Sudden onset of coughing, gagging, choking, or stridor.
• Respiratory distress – including difficulty breathing, cyanosis (bluish skin), or wheezing.
• Unilateral decreased breath sounds, particularly if the foreign body has lodged in a bronchus.
• Persistent cough or recurrent pneumonia if the foreign body is not immediately expelled or diagnosed.

Investigations

• Chest X-ray: May show signs of air trapping or a shift of the mediastinum, particularly if the foreign body is radiopaque.
• CT scan or fluoroscopy: In some cases, more advanced imaging may be required to identify the location of the foreign body.
• Bronchoscopy: Both diagnostic and therapeutic, as it allows direct visualisation of the foreign body and removal.

Management

Management depends on the severity of symptoms and the location of the foreign body.

Immediate Action:

• Basic life support (BLS): If the child is choking, back blows and chest thrusts (infants) or abdominal thrusts (children over one year) should be attempted.
• If the child is unconscious, begin CPR and call for emergency services.

Medical Intervention:

• Bronchoscopy: The primary treatment to remove the foreign body. This procedure is performed under general anaesthesia and is both diagnostic and therapeutic.
• Antibiotics: May be given if there is evidence of secondary infection, particularly in cases where the diagnosis was delayed and pneumonia has developed.
• Oxygen therapy: May be required in cases of significant respiratory distress.

References

1. NICE (2024). Inhaled Foreign Body: Paediatric Emergency Guidelines. Available at: NICE
2. British Medical Journal (2023). Foreign Body Aspiration in Children. Available at: BMJ
3. NHS (2023). Inhaled Foreign Bodies in Children. Available at: NHS