Paeds · respiratory-sleep-and-airway
Foreign-body aspiration
Also known as Foreign-body aspiration · Inhaled foreign body · Airway foreign body · Aspirated foreign body · Tracheobronchial foreign body · Choking in children
Fellowship guide to foreign-body aspiration in children: the choking toddler and the three clinical phases, why the small paediatric airway and organic objects make aspiration dangerous, the anatomy that sends objects into the right bronchus, the valve mechanisms that produce air trapping or collapse, the crucial teaching that a normal chest radiograph does not exclude aspiration, the choking basic-life-support algorithm, and rigid bronchoscopy as the definitive diagnostic and therapeutic step.
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Target exams
Red flags
- A previously well toddler with a sudden witnessed choking episode followed by cough, stridor or a persistent unilateral wheeze has an inhaled foreign body until proven otherwise, and a normal chest radiograph does not exclude it
- A child who is choking with an ineffective cough, silent efforts, cyanosis or falling consciousness has a critical or complete airway obstruction and needs immediate back blows and thrusts, progressing to resuscitation if they become unconscious
- A laryngeal or tracheal foreign body can cause complete obstruction and asphyxia within minutes, and a mobile tracheal object with an audible slap is immediately life-threatening
- A child with an unexplained persistent focal wheeze, recurrent pneumonia in the same lobe, or a non-resolving lobar collapse has a retained foreign body until endoscopy proves otherwise
- A suspected aspirated or ingested button battery is an emergency because of rapid caustic tissue injury, and needs urgent localisation and removal
Life stages
Care settings
Clinical exam formats
Board mappings
- Foreign-body aspiration
- Foreign-body aspiration: recognition, the choking algorithm and rigid bronchoscopy
- Foreign-body aspiration: the choking child, the missed diagnosis and endoscopic removal
- Short case: the child with a persistent focal wheeze
- Long case: recurrent pneumonia and the retained foreign body
- Foreign-body aspiration: presentation, investigation and management
- Respiratory: the child with a suspected inhaled foreign body
- Respiratory: foreign-body aspiration
- Patient Care: foreign-body aspiration in children
- Medical Expert: foreign-body aspiration
Overview & Definition
A well toddler is eating peanuts on the sofa when he suddenly coughs, splutters and goes briefly blue, then settles and looks completely normal within a minute. That single sequence is the whole of foreign-body aspiration in miniature: a dramatic choking event, a deceptively quiet interval, and a child who is now carrying an inhaled object in the airway. Foreign-body aspiration is the inhalation of any solid or semi-solid object below the vocal cords into the trachea or bronchi, and it is one of the commonest preventable causes of death and serious airway morbidity in early childhood. [1]
The reason it earns a whole topic is that the diagnosis is made by suspicion, not by any single test. The choking history is the most powerful clue there is, yet the event is often unwitnessed, the child looks well by the time they arrive, and the chest radiograph is frequently normal. A clinician who waits for confidence before acting is the clinician who misses the object, and a missed foreign body smoulders on into recurrent pneumonia and bronchiectasis. The skill is to keep the diagnosis alive on a suggestive story and to move to the airway team early. [1] [3]
References12ShowHide
- [1]Salih AM; Alfaki M; Alam-Elhuda DM Airway foreign bodies: A critical review for a common pediatric emergency. World J Emerg Med, 2016.PMID 27006731
- [2]Foltran F; Ballali S; Passali FM; Kern E; Morra B; Passali GC; Berchialla P; Lauriello M; Gregori D Foreign bodies in the airways: a meta-analysis of published papers. Int J Pediatr Otorhinolaryngol, 2012.PMID 22333317
- [3]Sink JR; Kitsko DJ; Georg MW; Winger DG; Simons JP Predictors of Foreign Body Aspiration in Children. Otolaryngol Head Neck Surg, 2016.PMID 27071446
- [4]Fidkowski CW; Zheng H; Firth PG The anesthetic considerations of tracheobronchial foreign bodies in children: a literature review of 12,979 cases. Anesth Analg, 2010.PMID 20802055
- [5]Chapin MM; Rochette LM; Annest JL; Haileyesus T; Conner KA; Smith GA Nonfatal choking on food among children 14 years or younger in the United States, 2001-2009. Pediatrics, 2013.PMID 23897916
- [6]Committee on Injury, Violence, and Poison Prevention Prevention of choking among children. Pediatrics, 2010.PMID 20176668
- [7]Zoizner-Agar G; Merchant S; Wang B; April MM Yield of preoperative findings in pediatric airway foreign bodies - A meta-analysis. Int J Pediatr Otorhinolaryngol, 2020.PMID 33068947
- [8]Safia A; Abd Elhadi U; Bader R; Khater A; Karam M; Bishara T; Massoud S; Merchavy S; Farhat R Flexible versus Rigid Bronchoscopy for Tracheobronchial Foreign Body Removal in Children: A Comparative Systematic Review and Meta-Analysis. J Clin Med, 2024.PMID 39337140
- [9]Keil O; Huzhva Y; Rigterink V; Dennhardt N; Boethig D; Nickel K; Carlens J; Dittrich AM; Grychtol R; Wetzke M; Hansen G; Schwerk N; Schütz K; Beck CE Rigid and Flexible Bronchoscopy for Foreign Body Removal in Children: Complications, Risk Factors and Anesthetic Management. Pediatr Pulmonol, 2025.PMID 40844046
- [10]Kvist O; Garcia JP Has the cat got your tongue, or is something obstructing your throat? A review of imaging of ingested and aspirated foreign bodies in the paediatric population. Pediatr Radiol, 2024.PMID 39419854
- [11]Diamond-Pott H; Shaari DS; Iraj L; O'Sullivan-Bakshi S; Londino A; Wong SJ; Laitman BM Rising Pediatric Button Battery Injuries Despite Safety Efforts: An Analysis of National Injury Data. Laryngoscope, 2026.PMID 42411449
- [12]De Palma A; Brascia D; Fiorella A; Quercia R; Garofalo G; Genualdo M; Pizzuto O; Costantino M; Simone V; De Iaco G; Nex G; Maiolino E; Schiavone M; Signore F; Panza T; Cardinale F Endoscopic removal of tracheobronchial foreign bodies: results on a series of 51 pediatric patients. Pediatr Surg Int, 2020.PMID 32468145