Foreign Body in Child’s Airway!!

Young children can accidentally inhale a substance into their windpipe or airways, leading to blockage of a part of a the airway. This condition is called as foreign body aspiration.

Why is foreign body aspiration more common in children?
Young children especially between the ages of 6 months and 3 years commonly put things into their mouth, including non-food items. In addition children of this age group do not have developed molar teeth to chew hard objects like nuts etc. Although foreign body aspiration is common between the age groups of 6 months and 3 years of age, it can be seen in older children and adolescents as well.

What are the common foreign bodies seen in the child airway?
The most common foreign bodies seen in the child’s airway are vegetable foreign bodies like pieces of peanut, almond or badam, cashew nut or kaju, betel nut or supari etc. In addition to these vegetable foreign bodies a lot of non-food items can be seen in the child’s airway. These items could be small plastic parts like parts of a toy, wrapper of biscuits, piece of concrete etc. Occasionally we find sharp foreign bodies in the airway like screws, nuts, pins etc.

In which part of the airway foreign bodies are usually found?
Foreign bodies can be usually found in any part of the airway, starting from the voice box, also called as the larynx, the windpipe, also called as the trachea, or inside the bronchi on either side of the lung.

What are the common symptoms of foreign body aspiration in children?
When a child aspirates a foreign body, the child would usually have a severe bout of cough associated with choking or turning blue. This is followed by a difficulty in breathing and associated whistling sound from the chest which is called as wheezing. When we examine the chest of the child, we would find that there would be a difference in the breath sounds. The breath sounds are reduced on the side the foreign body is present.

 

Can we detect a foreign body on a Chest Xray or a CT scan?
Vegetable foreign bodies like nuts and plastic foreign bodies cannot be seen on X-rays and CT scan as they are not radio-opaque, which means they allow Xray radiation to pass through. Metallic objects like pins, screw, other small metal pieces can be seen on a Xray. Chest Xray changes that suggest a foreign body in the airway are collapse or overinflation of a part of the lung. Many children with foreign body aspirations can have normal chest xrays. CT scans or MRI of the chest are not very useful for detection of foreign body in the child’s airway. Foreign bodies are difficult to pick up on a CT scan or MRI of the chest. Both CT scan and MRI requires sedation to be given to the child. It should also be remembered that a CT scan gives lot of radiation to the child, equivalent to 400-500 X-rays.

What are the complications of foreign body aspiration in children?
Large foreign bodies can block the voice box (larynx) or the windpipe (trachea) and can endanger a child’s life. Smaller foreign bodies lodge in the windpipe or the other smaller airways (bronchi). This can lead to obstruction of a portion of the lung leading to collapse. This subsequently leads to persistent infection and damage to the lung as well.

How is a foreign body removed from the airway?
Bronchoscopy is the best way to confirm the presence of a foreign body in the child’s airway. Bronchoscopy can be done in 2 ways, either a flexible bronchoscopy or a rigid bronchoscopy. Flexible Bronchoscopy can remove most foreign bodies from the child’s airway like nuts. Flexible bronchoscopy requires minimal amount of sedation and can be done in the bronchoscopy room of the hospital. In case of sharp foreign bodies or foreign bodies which are badly stuck in the airway, rigid bronchoscope is used for removal of the foreign body. Rigid bronchoscopy is done in the operation theatre and requires general anaesthesia.

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