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INTRODUCTION

ESSENTIALS OF DIAGNOSIS

  • History of suspected or witnessed ingestion with subsequent choking or coughing.

  • Physical exam including lung auscultation.

  • Respiratory or swallowing symptoms.

  • High level of clinical suspicion.

  • Neck and chest plain films may be diagnostic.

GENERAL CONSIDERATIONS

Foreign body ingestion and aspiration are common reasons that children seek care in the emergency department and represent an important cause of morbidity and mortality in the pediatric population. Aerodigestive tract foreign bodies are the cause of approximately 150 pediatric deaths per year in the United States, and choking causes 40% of accidental deaths in children less than 1 year of age. Foreign bodies remain a diagnostic challenge as presenting symptoms can vary from life-threatening airway compromise to subtle clinical findings in an otherwise comfortable child. A high level of clinical suspicion can prevent delays in diagnosis.

Most aerodigestive tract foreign bodies occur in children under the age of 4 years. The high incidence of aerodigestive foreign bodies in children of this age is related to their increased mobility, the introduction of adult food, a high propensity for placing objects in their mouths, incomplete dentition, and immature coordination of swallow. Other populations at risk for esophageal foreign bodies include psychiatric patients, patients with underlying esophageal or neurological disease, and edentulous adults. Coins are the most commonly ingested foreign body, whereas nuts and seeds are the most commonly aspirated foreign body (Figure 41–1). Although fortunately rare, the aspiration of latex balloons is associated with especially high mortality rates.

Figure 41–1

(A) Peanut lodged at right mainstem bronchus. (B) Peanut held with optical forceps. The foreign body, forceps, and bronchoscope are withdrawn together to limit the risk of dislodging the peanut.

A child with a witnessed ingestion or aspiration episode should be evaluated by a physician. It is important to ask the child’s caregivers about the object or food that may have been ingested, the approximate time of ingestion, and the swallowing and respiratory symptoms the child has experienced since the time of ingestion. A history of premorbid swallowing disorders should also be elicited. When an unusual foreign body is aspirated or ingested, it may also be helpful to have the parents bring in a similar object from home.

Damage to the surrounding aerodigestive tract mucosa may occur and is related to the type of foreign body and the length of time the foreign body has been present. Granulation tissue formation, erosive lesions, and infections can be minimized with early diagnosis and endoscopic removal of the foreign body.

PREVENTION

Foreign body ingestion is a significant public health concern. The Consumer Products Safety Act, passed in 1979, includes criteria for the minimum size of ...

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