Foreign Body Aspiration

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Foreign body aspiration
Foreign body aspiration (FBA) is the third most common cause of accidental death in infants under one year and the fourth most common cause of unintentional death in children under the age of three. The bulk of foreign bodies aspirated in children are of the organic kind, like rubber, and sponges Understand FBA, its diagnosis, symptoms, and management in this article.

What do you mean by foreign body aspiration?

When an object is inhaled and gets stuck in a child’s airway or lungs, it is referred to as ‘foreign body aspiration’. Children naturally investigate their surroundings by looking at, touching, and tasting things around them. Unfortunately, their tendency to put anything other than food in their mouths can be harmful or even fatal.

Food given to children with underdeveloped molars or uncoordinated chewing motions can also cause suffocation. Small children are more prone to aspirating foreign objects into their airways due to the position of their larynx (voice box). Vegetable matter, nuts, and spherical items like grapes are the most often aspirated foreign bodies in kids.

What are the causes of foreign body aspiration?

A person inhales a foreign object into their airways, resulting in foreign body aspiration. The majority of the time, this is done unintentionally eating or when a non-edible object is put in the mouth.

The most commonly aspirated object category is food, with nuts and seeds. Other foods include raisins, grapes, and sweets. Water and other liquids can also be breathed into the airways. Along with food materials, the following non-edible substances are frequently removed from the airways:

  • When inhaled, balloons can be particularly deadly and are responsible for about 29% deaths in children who aspirated foreign bodies
  • Small toys (like marbles)
  • Coins/pins
  • Dental devices like crowns and fillings
Foreign body

What are the signs of foreign body aspiration?

Foreign body aspiration can cause a variety of symptoms, which typically depend on three primary factors:

  • Where the object has landed in the airways: As a lower airway blockage, the bronchi are where most foreign bodies lodge. The severity of obstruction in the airways further up, including those in the larynx or trachea, varies
  • Size and kind of foreign body that was inhaled: This is more important than the size, shape, and hardness of the object
  • When the aspiration happened: If it occurred recently (within the last few days or weeks) or happened earlier

The following immediate signs and symptoms may point to a foreign body aspiration:

  • Choking
  • Coughing
  • Breathing issues
  • Difficulty speaking
  • Striding or wheezing: A specific type of wheeze called stridor frequently makes a loud, single-pitch noise, commonly during inhalation. A wheeze is a high-pitched, persistent sound that is typically made during exhalation
  • Bluish discolouration of the skin

If the obstruction to the airways is severe enough, symptoms appear suddenly, become worse, and eventually lead to loss of consciousness and even death if the object is not removed.

How is foreign body aspiration diagnosed?

The diagnosis of an aspirated foreign body is made using your child’s presenting symptoms, medical history, and chest X-rays. Your child might need to go to the operating room and have an airway examination done under anaesthesia (micro laryngoscopy and bronchoscopy).

If a child has inhaled anything into their airway or lungs, there are three main ways to determine this:

Chest X-ray: Using this method, certain non-food things can be observed in the lungs or airways. On chest X-ray films, the majority of food, vegetable matter, and plastic toys won’t show up

Expiratory and inspiratory phases of X-rays: These X-rays are obtained after the child has breathed in and then exhaled air from their lungs. The inspiratory and expiratory phase films may demonstrate hyperinflation or air-trapping

Bronchoscopy: A bronchoscope is placed through the mouth and used to look into the interior of the airways (under anaesthesia) when there is a strong enough suspicion of aspiration, but the physical examination and X-rays do not provide a conclusive diagnosis. The foreign body can be found and removed using bronchoscopy

What treatment options exist for removing a foreign body?

First aid treatment for foreign body aspiration

The following actions can be taken to assist in getting the object out of someone who is showing symptoms of choking:

  • Encourage your child to cough, as they typically have the ability to cough and remove the blockage themselves if the obstruction is minor
  • Back slaps: Lean your child slightly forward and deliver up to five gentle clean punches to their back, in the region between the shoulder blades, if they cannot cough or their attempts to cough are ineffective. Use your other hand to support their chest while delivering these hits
  • Heimlich manoeuvre: If back blows don’t work, try five or more abdominal thrusts. Wrap your arms around their waist from behind, just above their navel. Make a fist with one hand, cover it with the other, and pull firmly inward and upward

An emergency tracheotomy may be performed in the worst choking situations. In order to perform a tracheotomy, a minor neck incision is made, and a tube is placed through this incision into the trachea.

Non-emergency procedures

Bronchoscopy:

For inhaled objects found in the trachea or bronchi, removal of the foreign body during bronchoscopy is an effective option. The end of a long, thin tube called a bronchoscope has a camera and a light source. A flexible or rigid tube is placed into the person’s airways to access and examine the respiratory tract. Usually, general anaesthesia is used during a bronchoscopy; however, local anaesthesia, sedatives, or both may be used for a more comfortable procedure.

Some surgical tools, such as forceps or a suction pad, can be added to the bronchoscope to enable the removal of the foreign material.

Alternatively, a laryngoscopy procedure may be used if the object is in the larynx.

Surgery

Surgery might be necessary if the inhaled object is especially large, sharp, or challenging to remove.

Tracheostomy: A surgical technique in which a small incision in the front of the neck is made and used to remove the aspirated foreign body from this area

Thoracotomy: This is a surgical operation that opens the chest and allows access to the lungs. This is carried out under general anaesthesia and is often only recommended if bronchoscopy is unsuccessful

How can foreign body aspiration be prevented?

  • Keep your child away from small things that offer a choking risk, such as marbles, buttons, and coins
  • Instruct them to not put things in their mouths, noses, or other body holes
  • Nuts, seeds, tiny fruits, and sweets are high-risk foods that should not be given to children under the age of three
  • Discourage them from talking, laughing, or playing while eating
  • Do not let them exercise or run while eating
  • Never allow them to put anything that isn’t food in their mouth

What distinguishes foreign body ingestion from foreign body aspiration?

Foreign body ingestion happens when a foreign body is swallowed into the digestive tract, as opposed to foreign body aspiration, which happens when a foreign body is aspirated into the airways. The symptoms, prognoses, and complications of the two illnesses are different.

Does foreign body aspiration affect both adults and children?

While it is possible for anyone, regardless of age, to breathe in anything foreign material unintentionally, this is more prevalent in young children under the age of three.

Which foreign body aspiration complication is the most severe?

Serious, consequences including pneumonia, atelectasis (collapse of the lungs), or bronchiectasis (a condition in which the lungs become widened), can arise from retained and undiagnosed foreign materials.

Dr. Keertana
WRITTEN BY

Dr. Keertana

PharmD
A medical writer with a Doctorate in Pharmacy, she writes vividly about medicine and science. Read her contributions and writings about various healthcare topics.

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