this slides would help you to understand how to manage foreign body aspiration in pediatric age group.

1. FOREIGN BODY ASPIRATION
IN CHILDREN
PREPARED BY:
NOOR HADI
WASIT UNIVERSITY COLLEGE OF MEDICINE
IRAQ
20-4-2017

2. Epidemiology
 Ages affected
 Age <3 years old: 50%
 Age <10 years old: 95%
incidence
 Age : 6months -3years
 Sex : male > female

3. Etiology
children comprise the most common age group for foreign body aspiration because of the
following:
 They tend to put objects in their mouth more frequently.
 They lack molars for proper grinding of food.
 They tend to be running or playing at the time of aspiration.
 They lack coordination of swallowing and glottis closure.
 Children often examine even nonfood substances with their mouth.
 Even immobile infants may aspirate foreign bodies, despite not having the ability to crawl and
find things or the ability to pick up objects and put them in the mouth.

4. What are the usual foreign bodies ?

5. Location of Impacted Foreign Bodies
 Larynx 1-5%
 Trachea 5-15%
 L Main Bronchus 30-35%
 R Main Bronchus 30-40%
 L Lobar Bronchus 5-15%
 R Lobar Bronchus 5-15%

6. presentation
 Often, the child presents after a sudden episode of coughing or choking while eating with
subsequent wheezing, or stridor.
 Laryngeal Foreign Body; Hoarseness ,Croupy cough ,Aphonia ,Hemoptysis ,Dyspnea
with wheezing and Cyanosis
 Tracheal Foreign Body; Asthmatic wheeze
 Bronchial Foreign Body; Initially: cough, blood-streaked sputum.
 Asymptomatic , signs of asphyxia and wheezing
 A fever may be present. If the child has been febrile, it is important to consider the
possibility that the object may be contaminated or chemically irritating.
 The most tragic cases occur when acute aspiration causes total or near-total occlusion of the
airway, resulting in death or hypoxic brain damage.
 The more difficult cases are those in which aspiration is not witnessed or is unrecognized and,
therefore, is unsuspected.
 The child may present with persistent or recurrent cough, wheezing, persistent or
recurrent pneumonia, lung abscess, focal bronchiectasis, or hemoptysis.

7. Physical examination:
 Decrease breath sound distally to F. B .
 Unilateral wheezing
 Tachypnea
 Inability to speak
 Limited chest expansion
 Impaired percussion note
 Signs of resp. distress
 Sounds are inspiratory if the material is in the extra thoracic trachea. If the lesion is in the
intra thoracic trachea, noises are symmetric but sound more prominent in the central airways.
These sounds are a coarse wheeze (sometimes referred to as expiratory stridor) heard with the
same intensity all over the chest.
 Once the foreign body passes the carina, the breath sounds are usually asymmetric.
 In bronchial foreign body there is limited expansion, decreased vocal fremitus, impaired or
hyper resonant percussion and diminished breath sounds.
 Similarly, a lack of findings upon physical examination does not preclude the possibility of an
airway foreign body

8. Differential Diagnoses
 Pediatric Asthma
 Pediatric Bronchitis
 Aspiration Pneumonitis and Pneumonia
 Atelectasis
 Bacterial Pneumonia
 Emphysema
 Lung Abscess
 Respiratory Failure
 Tuberculosis

9. Investigations
(a) Plain Chest X-ray(CXR): 80% of laryngotracheal
FB and 15-28% of bronchial FB can have normal
CXR.
 Nonetheless, plain X-rays in inspiration and
expiration are useful.

11. (b) Fluoroscopy: Fluoroscopy being a dynamic method of evaluation is more
sensitive than plain X-ray.
 It is most useful when radiolucent FB is suspected and plain X-ray is
inconclusive.
 In the above situations, fluoroscopy would show phasic mediastinal shift.
 Mediastinal shift during inspiration indicates the side of FB.
 In suspected chronic FB aspiration, investigations like CT
scan, and contrast study may be required.

12. Management
(a) Infants : 4 back blows with head held low followed by 4 chest compressions.
Visualize the pharynx with jaw lift, if FB is seen, extract (avoid blind finger
sweeps).
If above measures fail, give rescue breathing, then repeat the above procedure.(b) Children above 1 year (Heimlich manoeuvre): 6-10 abdominal
thrusts, visualize pharynx, if FB is seen, extract.
If failed, give rescue breathing, then repeat the above procedure.
 However, these measures should not be instituted in a child who is able
to speak or cry or is breathing.

15. If above measures fail:
 urgent cricothyrotomy
 tracheostomy.
 Endotracheal intubation with smaller size tube.

16. Bronchoscopy
 Once stabilized the child is kept nil orally.
 Oxygen should be administered in cases with respiratory distress.
 Dehydration and acid-base disturbances should be corrected before bronchoscopy.
 Team efforts ; ENT senior surgeon and anaesthesiologist
 Rigid bronchoscopes are the best.
 No medications are needed. If significant swelling is observed in the airway or if granulation
tissue is present, a corticosteroid (eg, prednisolone, prednisone) may be administered. Unless
airway secretions are infected, antibiotics are not helpful or necessary.
Chronic bronchial FB may require:
 thoracotomy or lobectomy.

17. Complications Of Retained
Foreign Bodies
 Hemoptysis
 Bronchiectasis
 Bronchial stenosis
 Pneumomediastinum/pneumothorax
 Persistent/recurrent pneumonias
 Acute/recurrent respiratory distress or failure
 Death

18. Thank you