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:
- Unilateral absence of breath sounds
- Localized wheeze
- Stridor
- Bloody sputum
Red flags
- Persistent wheeze unresponsive to ventolin
- Persistent atelectasis
- Recurrent or persistent pneumonia
- Persistent cough with no explanation
Family History– siblings <5 years old will force feed baby
Imaging
- CXR (ask for inspiration/expiration films)
- Radio-opaque objects
- Evidence of air-trapping on expiration (ball-valve mechanism)
- Segmental collapse (complete collapse)
- Lobar consolidation
- Trachea shifts to unaffected side
- FB usually enter right lung (right main stem bronchus – more continuous with trachea)
- 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