FOREIGN BODY ASPIRATIONIN CHILDREN

PREPARED BY:

NOOR HADI

WASIT UNIVERSITY \COLLEGE OF MEDICINE

IRAQ

20-4-2017

Epidemiology

Ages affected

Age <3 years old: 50%

Age <10 years old: 95%

incidence

Age : 6months -3years

Sex : male > female

Etiology

children comprise the most common age group for foreign body aspiration because of the following:

They tend to put objects in their mouth more frequently.

They lack molars for proper grinding of food.

They tend to be running or playing at the time of aspiration.

They lack coordination of swallowing and glottis closure.

Children often examine even nonfood substances with their mouth.

Even immobile infants may aspirate foreign bodies, despite not having the ability to crawl and find things or the ability to pick up objects and put them in the mouth.

What are the usual foreign bodies ?

Location of Impacted Foreign Bodies

Larynx 1-5%

Trachea 5-15%

L Main Bronchus 30-35%

R Main Bronchus 30-40%

L Lobar Bronchus 5-15%

R Lobar Bronchus 5-15%

presentation

Often, the child presents after a sudden episode of coughing or choking while eating with subsequent wheezing, or stridor.

Laryngeal Foreign Body; Hoarseness ,Croupy cough ,Aphonia ,Hemoptysis ,Dyspnea with wheezing and Cyanosis

Tracheal Foreign Body; Asthmatic wheeze

Bronchial Foreign Body; Initially: cough, blood-streaked sputum.

Asymptomatic , signs of asphyxia and wheezing

A fever may be present. If the child has been febrile, it is important to consider the possibility that the object may be contaminated or chemically irritating.

The most tragic cases occur when acute aspiration causes total or near-total occlusion of the airway, resulting in death or hypoxic brain damage.

The more difficult cases are those in which aspiration is not witnessed or is unrecognized and, therefore, is unsuspected.

The child may present with persistent or recurrent cough, wheezing, persistent or recurrent pneumonia, lung abscess, focal bronchiectasis, or hemoptysis.

Physical examination:

Decrease breath sound distally to F. B .

Unilateral wheezing

Tachypnea

Inability to speak

Limited chest expansion

Impaired percussion note

Signs of resp. distress

Sounds are inspiratory if the material is in the extra thoracic trachea. If the lesion is in the intra thoracic trachea, noises are symmetric but sound more prominent in the central airways. These sounds are a coarse wheeze (sometimes referred to as expiratory stridor) heard with the same intensity all over the chest.

Once the foreign body passes the carina, the breath sounds are usually asymmetric.

In bronchial foreign body there is limited expansion, decreased vocal fremitus, impaired or hyper resonant percussion and diminished breath sounds.

Similarly, a lack of findings upon physical examination does not preclude the possibility of an airway foreign body

Differential Diagnoses

Pediatric Asthma

Pediatric Bronchitis

Aspiration Pneumonitis and Pneumonia

Atelectasis

Bacterial Pneumonia

Emphysema

Lung Abscess

Respiratory Failure

Tuberculosis

Investigations

(a) Plain Chest X-ray(CXR): 80% of laryngotracheal

FB and 15-28% of bronchial FB can have normal

CXR.

Nonetheless, plain X-rays in inspiration and

expiration are useful.

(b) Fluoroscopy: Fluoroscopy being a dynamic method of evaluation is more

sensitive than plain X-ray.

It is most useful when radiolucent FB is suspected and plain X-ray is

inconclusive.

In the above situations, fluoroscopy would show phasic mediastinal shift.

Mediastinal shift during inspiration indicates the side of FB.

In suspected chronic FB aspiration, investigations like CT

scan, and contrast study may be required.

Management(a) Infants : 4 back blows with head held low followed by 4 chest compressions.

Visualize the pharynx with jaw lift, if FB is seen, extract (avoid blind finger

sweeps).

If above measures fail, give rescue breathing, then repeat the above procedure.(b) Children above 1 year (Heimlich manoeuvre): 6-10 abdominal

thrusts, visualize pharynx, if FB is seen, extract.

If failed, give rescue breathing, then repeat the above procedure.

However, these measures should not be instituted in a child who is able

to speak or cry or is breathing.

If above measures fail:

urgent cricothyrotomy

tracheostomy.

Endotracheal intubation with smaller size tube.

Bronchoscopy Once stabilized the child is kept nil orally.

Oxygen should be administered in cases with respiratory distress.

Dehydration and acid-base disturbances should be corrected before bronchoscopy.

Team efforts ; ENT senior surgeon and anaesthesiologist

Rigid bronchoscopes are the best.

No medications are needed. If significant swelling is observed in the airway or if granulation

tissue is present, a corticosteroid (eg, prednisolone, prednisone) may be administered. Unless

airway secretions are infected, antibiotics are not helpful or necessary.

Chronic bronchial FB may require:

thoracotomy or lobectomy.

Complications Of Retained Foreign Bodies

Hemoptysis

Bronchiectasis

Bronchial stenosis

Pneumomediastinum/pneumothorax

Persistent/recurrent pneumonias

Acute/recurrent respiratory distress or failure

Death

Thank you