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Airway foreign bodies in children

Author
Fadel E Ruiz, MD
Section Editors
George B Mallory, MD
Susan B Torrey, MD
Deputy Editor
Alison G Hoppin, MD

INTRODUCTION

Tracheobronchial foreign body aspiration (FBA) is a potentially life-threatening event because it can block respiration by obstructing the airway, thereby impairing oxygenation and ventilation. FBA in children may be suspected on the basis of a choking episode if such an episode is witnessed by an adult or remembered by the child. In contrast, the clinical presentation of unwitnessed FBA may be subtle, and diagnosis requires careful review of the history, clinical assessment, and the judicious use of radiography and bronchoscopy.

Aspiration of foreign bodies in children will be reviewed here. A discussion of foreign body aspiration in adults and older children is presented separately. (See "Airway foreign bodies in adults".)

EPIDEMIOLOGY

FBA is a common cause of mortality and morbidity in children, especially in those younger than two years of age. During 2000, ingestion or aspiration of a foreign body (FB) was responsible for more than 17,000 emergency department visits in children younger than 14 years in the United States [1].

Before the 20th century, aspiration of an FB had a 24 percent mortality rate. With the development of modern bronchoscopy techniques, mortality has fallen dramatically [2]. Nonetheless, in the United States, FBA was responsible for about 4,800 deaths in 2013, or about 1 death per 100,000 children 0 to 4 years [3]. Death caused by suffocation following FBA is the fifth most common cause of unintentional-injury mortality in the United States, and the leading cause of unintentional-injury mortality in children younger than one year [4]. In a review of the Nationwide Inpatient Sample (NIS) from 2009 to 2011 of all cases with pediatric FBA in the United States, the combined rate of death or anoxic brain injury was around 4 percent, and the annual associated inpatient cost was close to $13 million [5].

Approximately 80 percent of pediatric FBA episodes occur in children younger than three years, with the peak incidence between one and two years of age [6-13]. At this age, most children are able to stand, are apt to explore their world via the oral route, and have the fine motor skills to put a small object into their mouths, but they do not yet have molars to chew food adequately. Additional predisposing factors to FBA in this age group include access to improper foods or small objects, activity while eating, and older siblings (who may place food or objects into the mouths of infants or toddlers). Young children are also particularly vulnerable to FBA because of the smaller diameter of their airway, which is prone to obstruction [14]. In older children and adults, neurologic disorders [15], loss of consciousness, and alcohol or sedative abuse predispose to FBA [16]. Most case series in children report a male predominance, with a sex ratio ranging from 1.5:1 to 2.4:1 [6,11,17]. (See "Airway foreign bodies in adults".)

                    

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Literature review current through: Nov 2016. | This topic last updated: Wed Apr 06 00:00:00 GMT 2016.
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