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]

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