An approach to… FOREIGN BODY ASPIRATION

 

Toddlers – children who are mobile and can put small objects in their mouths (beads, peanuts)

 

History

-         Choking

-         Chest infection – not responding to treatment

-         Sudden onset unilateral wheeze

-         Persistent cough

-         Hemoptysis

 

Physical exam

-         Asymmetric chest signs:

o       Unilateral absence of breath sounds

o       Localized wheeze

-         Stridor

-         Bloody sputum

 

Red flags

-         Persistent wheeze unresponsive to ventolin

-         Persistent atelectasis

-         Recurrent or persistent pneumonia

-         Persistent cough with no explanation

 

FHx – siblings <5yo will force feed baby

 

Imaging

-         CXR (ask for inspiration/expiration films)

o       Radio-opaque objects

o       Evidence of air-trapping on expiration (ball-valve mechanism)

o       Segmental collapse (complete collapse)

o       Lobar consolidation

o       Trachea shifts to unaffected side

o       FB usually enter right lung (right main stem bronchus – more continuous with trachea)

o       FB may also be in esophagus and compress trachea (look at lateral film)

 

Differential diagnosis

-         URTI

-         Pneumonia

-         Asthma

-         Acute bronchitis

 

Management

-         Heimlich manoeuvre if complete obstruction

-         Rigid bronchoscopy

-         Antibiotic if pneumonia

-         Prevention: educate parents, no nuts/carrots before child has molars, no toys with small parts, no walking with food