Foreign Body Aspiration

Children of young age explore their environment by seeing, touching and tasting objects around them. They would also unfortunately, put non-food objects in their mouths. Also children of 6months to 3 years do not have molars to chew hard objects like nuts etc. These factors with small airways predispose them to foreign body aspiration.

What are the common foreign bodies aspirations we see?
Vegetable foreign bodies like pieces of peanuts, betelnut (supari), almond (badam), kaju, etc are the commonest. Others can be small parts of toys, metallic objects (screws, nuts, etc).

What is the commonest age group where this problem happens?
This problem is seen commonly between the age group of 6 months to 3 years. But they can be found in older children and adolescents as well.

What are the common symptoms of foreign body aspiration in children?
The common symptoms are bouts of cough after eating a food item (peanut, etc), choking (breath hold, turning blue), unexplained difficulty in breathing, wheezing (a whistling sound from the chest). Doctors may find a difference in the breath sounds on both sides of the lungs and a wheezing sound on hearing with a stethoscope.

Can we detect foreign bodies on a Chest X Ray?
Some non-food items (metallic objects like pins, screw, other small metal pieces, etc. ) can be seen in the airway using a conventional radiograph. However, most food, vegetable matter and plastic toys are not radio-opaque, which means they allow Xray radiation to pass through and hence would not appear on chest Xray. Collapse or overinflation of a part of the lung on the Chest Xray suggest presence of a foreign body in the lungs. It should be remembered that many children with foreign body aspirations can have normal chest xrays.

How do we confirm the presence of foreign bodies in the airways?
The only method to confirm or refute the presence of a foreign body in the child’s airway is to perform a flexible bronchoscopy.

Is a CT Scan of Chest or MRI of Chest useful to confirm the presence of foreign body in the airway?
No, they are not useful for many reasons. Firstly, it is difficult to pick up foreign bodies in the airways with both CT and MRI. Secondly, they again would need a bronchoscopy for confirmation in case of a suspicion. Thirdly, both a bronchoscopy and CT Chest/MRI Chest need the child to be sedated.

What are the complications of foreign body aspiration in children?
If large they can be life threatening as they can block the voice box (larynx) or the windpipe (trachea). If small they can lodge in the windpipe or the other smaller airways (bronchi). This can lead to obstruction of a portion of the lung, infections and later can to serious long term damage to the lungs.

How is a foreign body removed from the airway?
Foreign bodies from the airways are removed with a bronchoscope. In most situations a flexible bronchoscopy is used for foreign body removal. This is a simple procedure which can be done under mild sedation in the bronchoscopy room. Flexible bronchoscopy does not require general anesthesia and taking the child to the operating room.

Rigid Bronchoscopy is occasionally required for removal of a foreign body from the child’s airways or windpipes. These situations could be a sharp foreign body like a screw or an old badly stuck foreign body. After inducing anesthesia, a rigid bronchoscope (a thin tube with an attached camera with a ventilation port), is passed into the airway to locate the foreign body. When the foreign body is found, a specially designed forceps with a camera (called optical forceps) is inserted through the bronchoscope to retrieve the foreign body.

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