Aspiration and ingestion of foreign bodies in the windpipe and the food pipe are common accidents that occur in childhood. 80% of pediatric foreign body aspirations occur in children between the age of 0 and 3 years, with most incidents occurring between 1 to 3 years of age. Most of the accidents happen at home, however, 40% of such incidents occur without the parents witnessing. A majority of objects aspirated are organic in nature, i.e. food items. Peanuts, plastic toys and button batteries are the most commonly identified objects aspirated by children.
Symptoms
Any symptoms or signs of ingestion or aspiration largely depend on where the lodged object is impacted. In around 75% of the children who have ingested a foreign body in their food pipe, it is lodged at the level of the upper oesophagal sphincter (upper food pipe). On the other hand, a foreign body in the windpipe can cause symptoms like cough, dyspnea, and pneumonia. In fact, any child with recurrent pneumonia should get a foreign body as a differential diagnosis.
How is it diagnosed?
Foreign body ingestion or aspiration can be diagnosed by taking the child’s medical history, performing clinical examination followed by an X-ray of the chest and neck. Sometimes, a CECT may also be needed. A flexible bronchoscopy may also be needed to confirm the diagnosis. In this procedure, a pediatric size bronchoscope is used to visualize the windpipe. This can help confirm the diagnosis. Radiolucent, small, light objects such as bottle caps and can rings often get trapped in the oesophagus and do not show up on X-rays. These should be looked for with a CT and/or endoscopy, depending on how clear the history of ingestion of the object is.
How is it treated?
An Urgent Rigid Bronchoscopy must be performed to remove the foreign body lodged in the wind pipe. A small, pediatric-size rigid bronchoscope is used to remove the foreign body, after putting the patient under anaesthesia. Apart from pediatric surgeons, pediatric anaesthetists also play an important role in this surgery.
On the other hand, a majority of ingested foreign bodies will pass spontaneously. At least 80% of foreign objects pass without the need for intervention. However, some objects will cause damage to the gastrointestinal (GI) tract and/or become lodged.
Children who have swallowed button batteries are at a high risk of oesophageal necrosis and should be urgently referred for the removal of the object. It can be removed by performing a flexible gastroduodenoscopy and special graspers. Although several social media videos show the procedure is carried out using a Foley® catheter, it can sometimes be disastrous. Sometimes, during the Foley catheter removal procedure, the foreign body may block the windpipe, leading to the obstruction of the airway. Damage to the oesophagus and fatal complications may also occur. The Foley catheter removal procedure should never be tried when a sharp foreign body is lodged. The removal of a foreign body lodged in the oesophagus, under direct vision using an endoscope is the safest method and it should be preferred when facilities are available. If a foreign body enters the small intestine, then the child can be observed and intervention would only be necessary when complications like obstruction or perforation arise.
Precautions needed by parents
It is difficult to prevent toddlers from putting things in their mouths. However, basic home safety measures, such as cupboard locks and vigilance about not leaving objects that can be easily ingested, within children's reach, are helpful. The button battery in toys should always be kept screwed and all the old batteries should be discarded. At the beginning of peanut season, older siblings should be counselled against forcefully feeding peanuts to infants or toddlers.
Dr. Shandip Sinha Sr. Consultant
Madhukar Rainbow Children’s Hospital, Malaviya Nagar, Delhi
Published - January 31, 2022 09:36 pm IST
