Foreign Body Aspiration among Children: Risk and Management

Abstract

Introduction: Delay in diagnosis and treatment of foreign body aspiration, especially if treatment involves bronchoscopy by specialists, can have serious consequences and can even lead to the death of children. This review aimed to discuss the risks and management of foreign body aspiration among children.
Methods: A systematic search of the Ovid MEDLINE, Ovid Embase, PubMed, Web of Science, and CINAHL databases was conducted to identify all studies that described clinical prediction models (CPMs) for diagnosing foreign body aspiration (FBA) in children. We also reviewed methods for removing foreign bodies and the outcomes for each patient. The following information was collected: demographic data, time interval from the onset of symptoms to presentation at the hospital, presenting symptoms and signs, examination findings, first-line investigations, time interval before bronchoscopy, intraoperative findings, method of foreign body removal, and individual outcome.
Results: There were 10 studies included in this review because they focused on aspirations and ingestions that were either not documented or retrieved in the posterior pharynx. The complication rate for sharp objects increases to greater than 15% to 35% depending on the number, type, and gastrointestinal contact time, compared to a rate of less than or equal to 1% for non-sharp objects. Patients at increased risk of a retained esophageal coin include those who are small, those with underlying esophageal disease such as a stricture. Bronchoscopy may be necessary to diagnose and remove the foreign body and to rule out other common pediatric conditions. Organic foreign bodies, such as nuts and seeds, can cause inflammatory reactions and may cause symptoms like fever and pneumonia. Inorganic foreign bodies, like toy parts and pen caps, may also be aspirated but do not typically cause these types of reactions.

Conclusions: Children are at a high risk of foreign body aspiration due to their narrow airways and other developmental factors. Early diagnosis and removal of inhaled foreign materials can reduce complications and mortality. The type and location of the foreign body can be determined through a chest X-ray and a thorough history.