Foreign Body Aspiration

Essential Information

Aspiration of foods or small objects into the airway is a leading cause of death in infants, toddlers, and preschoolers

Common foods include hot dogs, whole grapes, nuts, candies, seeds, popcorn, chewing gum, meat/cheese chunks, peanut butter, and raw vegetables

Common objects include coins, buttons, small toys, balloons, hair accessories, rubber bands, marbles, and pen caps. Of note, button batteries and magnets are especially problematic objects in aspirations/ingestions

Risk factors for aspiration

Children under 3 years of age are at highest risk:

Narrow airways, natural curiosity, underdeveloped swallow, distractible

Children with developmental delay, altered level of consciousness, or dysphagia

Certain foreign body characteristics lead to difficulty with clearance from the airway (e.g., similar to size of the airway, cylindrical, compressible)

Clinical Presentation

Signs and symptoms are highly variable

Usually witnessed aspiration or choking, but not always

Laryngotracheal foreign body: more likely to present with severe respiratory distress, stridor, and hoarseness

Bronchial foreign body: more likely to present with cough, tachypnea, and focal wheeze or decreased air entry. Can also be asymptomatic or have delayed presentation with fever

Foreign body aspirations can mimic other common illnesses: asthma, bronchiolitis, croup, pneumonia

Natural history

Variable courses that depend on location and degree of obstruction. However, without intervention, outcomes carry significant morbidity. Spontaneous clearance with resolution is uncommon

Large laryngotracheal foreign bodies can result in asphyxiation and death

Undiagnosed cases of bronchial foreign bodies can lead to recurrent focal pneumonias, pulmonary abscesses, and bronchiectasis. Similarly, they may present as an “asthmatic with a persistent, focal wheeze”

Diagnosis and Evaluation

History and physical examination are critical for timely diagnosis. Focal pulmonary examination findings should prompt further investigation

Role of testing

Posteroanterior (PA) and lateral chest radiographs

May detect radiopaque objects

Enlarged lung lobe may indicate object with ball valve effect

Atelectatic lung lobe may indicate complete airway obstruction

Findings may be nonspecific

Although historically performed for further evaluation, lateral decubitus chest radiographs may not add significant value

Include neck and abdomen films for foreign body ingestions

Early rigid bronchoscopy for reasonable concern, even if negative radiographs

In cases with low acuity/low suspicion

Flexible bronchoscopy can rule out distal objects

Typically diagnostic, but not therapeutic


In life-threatening cases first, per basic life support guidelines

Abdominal thrusts (Heimlich maneuver) in older children

Back blows/chest thrusts in infants

Supportive therapy: continuous monitoring, supplemental oxygen

Emergent rigid bronchoscopy with foreign body removal may be necessary if compatible history, examination, or radiographic findings.

May consider antibiotics if clinical presentation is consistent with concurrent infection

Preventive policies

Educate parents: developmentally appropriate toys, safe infant/toddler foods

Federal legislation: warnings on packages with small parts, size regulations for toys for young children

AAP recommendations

<5 years, no gum or hard candy

Raw vegetables and fruit cut into small pieces

Supervise children when eating

Children should sit when eating

Caregivers should know rescue maneuvers

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