Foreign Body Aspiration
• Foreign body aspiration is not witnessed many a time and is also a common occurrence among children with the highest risk in the age group of 6months – 4years
• If the obstruction is severe it can present as a life-threatening event and warrants immediate action towards removal of the foreign body
• If obstruction is partial then there needs to be a high index of suspicion as often it is treated for other causes of these symptoms and can be overlooked by the parents and physicians for some time
Objects that can be aspirated

Most common objects known to be aspirated are
• Peanuts
• Small coins, marbles
• Small parts of toys
• Hard candies, popcorn
• Pieces of raw carrot, pieces of meat
• Paper clips, safety pins, balloon pieces

Symptoms
• The foreign body can be lodged in the larynx (voice box), trachea (windpipe) or the bronchus (the division of windpipe leading into the lungs)
• The signs and symptoms vary depending on the age of the child and the size/type of object aspirated

Common symptoms are
• Choking, coughing, gasping for air, wheezing
• Inability to talk (complete obstruction)
• Stridor (harsh noise upon breathing in), wheezing
• Holding hands up to the throat
• Bluish discoloration of lips
• Without treatment there can be progressive distress, more bluish discoloration(cyanosis), loss of consciousness, fits and cardiorespiratory arrest

Partial Obstruction
• Partial obstructions can cause initial choking followed by a quite phase where there are no other symptoms until a few days to a few weeks till a tissue reaction occurs where the object is lodged and other complications can follow like fever, pneumonia, collapse of lung air sacs in the affected area etc. the child may appear to be having symptoms of croup or pneumonia

First aid

If child is conscious
• Encourage to keep coughing until foreign body is coughed up
• If coughing is ineffective give 5 back blows with the heel of your hand between the shoulder blades with the child leaning slightly forward
• After 5 back blows give 5 abdominal thrusts by wrapping your arms around the child and placing a clenched fist over the upper abdomen between the umbilicus and the tip of the breastbone, clasp the fist with your other hand and pull inwards and upwards in quick successions to mimic a coughing force and action (there exists the serious risk of injury to internal organs if excess pressure used)

If child is unconscious
• Then lay the child on a flat surface and open the mouth to look for the foreign object if seen remove with a finger sweep, if not visualized then do not attempt a blind sweep
• Call for help and start a pediatric basic life support (CPR) by you or anyone around who is trained and arrange for immediate medical assistance

In infants less than a year old
• 5 back blows and 5 chest thrusts (not abdominal thrusts with the infant supported on the forearm or across the lap with the head positioned downwards)
• Chest compression should be administered with 2 fingers in the center of the chest just below the level of the nipples and compress gently to about 1.5 inches depth
• Repeat the sequence until the foreign body is coughed up
• Arrange for immediate medical intervention in the event of a failed attempt or baby’s in worsening distress
• If the infant becomes unconscious begin basic CPR until help arrives

Management
• In the emergency room/hospital, the doctor after stabilizing the child may order for a chest x-ray
• Even if chest x-ray is clear and suspicion is high a bronchoscopy (tube inserted into the airway) can be performed to visualize and remove foreign body
• The child may be admitted for observation and if post-bronchoscopy can be started on antibiotics

Team Ovum Hospitals