Foreign Body aspiration in a Child.

Dr. M.M. Zameer
Consultant Pediatric Laparoscopic and Robotic Surgeon

It was evening about 8 pm, when I got a call from the emergency about a 10 year old girl with difficulty in breathing. She was urgently evaluated and was found to have a suspicion of foreign body in the airway, which means that she must have aspirated a small solid object into her airway which is causing her to have difficulty in breathing.  This is an emergency as anytime she can go into respiratory distress and have a cardiac arrest and succumb.

Yes it is still the covid times. And yes she did come from a containment zone. But all this doesn’t matter as she needed an emergency procedure to relive her. She was taken for the bronchoscopy the same night and a foreign body was found in the airway on bronchoscopy. Usually it is a peanut which can be removed with an instrument. But in this case it was a metal bead which was too big to be held in an instrument and to come out through the vocal cords. The bead was retrieved with the help of a Fogarty catheter upto the trachea and a tracheotomy was done and the Foreign body was retrieved. All this was done wearing full PPE. She recovered well and was discharged in two days.


Foreign-body aspirations are potential life-threatening emergencies and are the leading causes of unintentional injury in children less than one year old. Infants and toddlers are particularly at risk for several reasons: they explore their world by placing objects in their mouths, they are very playful and active when eating, and they do not have developed dentition in order to chew food properly. Delayed diagnosis at any age can lead to significant morbidity and mortality.

Commonly aspirated foods by infants and toddlers include peanuts, sunflower seeds, carrots,  and raisins. In preschoolers, nonfood items such as coins, paper clips, pins, and pen caps are more commonly aspirated.

How do children with Foreign Body aspiration present ?

A sudden onset of coughing and choking in an otherwise healthy child is highly suspicious for aspiration. Symptoms at presentation include cough, stridor, dyspnea, stupor, cyanosis, and respiratory arrest. The classic triad of new-onset cough, wheezing, and asymmetric breath sounds is only seen in 16-40% of cases and is neither sensitive nor specific for foreign-body aspiration. In general, patients with tracheal foreign bodies (main airway) present with dyspnea and are more easily diagnosed. Bronchial foreign bodies (within the airway on either left / right side), which account for 80-90% of aspirations, are more likely to cause decreased breath sounds, and children usually have a delayed diagnosis.

How is the diagnosis of Foreign body aspiration confirmed ?

A Chest X Ray is a very sensitive test for confirming the presence of a FB. Many Fbs are not radiopaque i.e they will not be seen on the Xray. But the effects of the Fb i.e hyperinflation of the lung on the affected side is usually the finding.

In chronic cases, CT chest may be done to confirm the presence of a FB.

The final word of the presence / absence of the Fb is Bronchoscopy i.e looking inside the airway with a scope.

What is the treatment for FB aspiration ?

Those patients without complete airway obstruction or severe respiratory distress should be placed in a quiet room in a position of comfort until rigid bronchoscopy can diagnose and relieve the obstruction. Bronchoscopy should be performed if foreign body aspiration is suspected, even if radiographic studies are normal. This should be performed under general anesthesia in a controlled setting such as the operating room. In patients with respiratory distress, they should be stabilised and taken for bronchoscopy immediately. Delay can lead to severe morbidity (even brain damage) and death.

Important things to remember regarding FB in a child.

Key Words : Foreign Body | Aspiration | Choking | Bronchoscopy

For More Details Contact: email: phone: +91 9741604009