FOREIGN BODY ASPIRATION

1. FOREIGN BODY ASPIRATION

2. Introduction • Children are fond of putting objects into various body orifices due to curiosity. • Foreign bodies in some of the areas may be life threatening . • The lodgement of foreign bodies of all sizes,shapes and varieties in the ear and upper respiratory tract commonly affected in childhood.

3. Objects causing obstruction • Dry vegetable matters, seeds and nuts • Piece of carrot or popcorn • Coins, zip or buttons • Food particles like grapes, cookies, meat, apple etc.. • Latex baloon

4. Common areas of obstruction

5. Foreign bodies in the respiratory tract • Aspiration of foreign bodies into the respiratory tract is quite common in children. About 75% cases seeds, nuts and other vegetable matters are inhaled in airway. • Inert materials like glass beads, plastic piece, stone, screw etc can also aspirated. • Problem is common in male toddlers. • Child may present with acute airway obstruction.

6. Clinical features • Child with foreign body in nose- nasal obstruction, sneezing, discomfort, and sero-sanguinous discharge. • Foreign body in Larynx- Sudden choking, aphonia, stridor, violent inspiratory effort and even sudden death in case of complete obstruction. • Foreign body in Trachea- spasodic paroxysmal coughing, wheezing, hoarseness, hemoptysis, cyanosis and dyspnoea

7. Foreign body in bronchus- Tachypnea, cough and wheezing. Prolonged impaction may lead to pneumonitis and bronchiectasis. • Complications of long standing foreign bodies in the respiratory tract may present with repeated pneumonia, lung abscess, atelectasis, and emphysema.

8. Diagnosis • Clinical features • Plain chest X-Ray • Diagnostic cum therapeutic bronchoscopy

9. Emergency Management At Home setting- Thumping over back, groping fingers in Pharynx, Back blows, Chest thrust, Heimlich maneuver At hospital – • bronchoscopy • After bronchoscopy some children may require humidification, parenteral steroids, antibiotic and chest physiotherapy. • Tracheotomy may be required when large vegetable foreign body swells up and difficult t remove through larynx or in case of laryngeal obstruction. • Thoractotomy and bronnchotomy in case of large impacted long standing foreign body in bronchus

10. Foreign body in Alimentary tract • The majority ingested foreign bodies pass through stool spontaneously; some may require endoscopic or surgical removal. • Commonly ingested foreign bodies are – coins, button, cell, key, safety pin, rings, bolus of hair, cotton etc.

11. Clinical features: • May be similar to foreign bodies in respiratory tract but coughing is not severe and minimal choking and gagging. • Dysphagia, drooling, retrosternal / epigastric discomfort if foreign body is in esophagus. • If foreign body passes beyond esophagus it remains asymptomatic. • Impaction of foreign body in GIT may present with features of intestinal obstruction, peritonitis etc .

12. Diagnosis • X-Ray • Esophagoscopy • Barium studies • USG

13. TREATMENT • If foreign body is in esophagus- Eating bulk of mashed potatoes or banana may help • Endoscopy • Smooth surface foreign body in esophagus can be removed using Foley’s catheter. • Surgical removal • Normal diet with adequate roughage and water • Observe for untoward symptoms • Check for passage of foreign body in stool

14. Foreign body in eyes • Dust, sand , wood, glass etc may get embedded or enlodged into the eye • May injure cornea, conjunctiva, sclera r eye ball • Symptoms- pain, lacrimation, foreign body sensation, photophobia, redness, itching and swelling. • Severe infection may occur within hours in wood and plant foreign body

15. Management • Instruct to avoid rubbing • If foreign body is not embedded can remove with corner of clean cloth or blinking eyelids under clean water • Embedded foreign body – irrigation, cotton tip applicator, magnet • Surgical removal • Antibiotic therapy • Aseptic eye care • Follow up

16. Foreign body in ear • Pain • Discomfort • Redness • Swelling • Discharge

17. Measures to be taken: • Gentle suction can be used. • Ear irrigation except organic materials • insects – mineral oil or lignocain • Antibiotic ear drops • In smaller children sedation is required

18. Modified tweezer or forceps is used to reach and grab the object with the help of otoscope.

19. Foreign bodies in the nose • Most of the time asymptomatic • Pain or difficulty in breathing • Nasal bleed • Nausea/vomiting • If it gets moved towards respiratory tract • Choking, wheezing • Difficulty in breathing • Inability to talk

20. Management • Removal under controlled condition in a cooperative manner. • Gentle suction ( commonly used technique) • Systemic antibiotic nasal drops • Easily grasped and removed using crocodile or Tilley's forceps

21. Prevention • Health education to the parents • Provision of soft toys/ play materials • Do not leave minute particles at child’s vicinity • Not eating while exercising • Remind to chew food properly • Remove seeds from fruits • Do not give peanuts etc.. to the child

22. Reference • Hockenberry, Wilson, Judie. Wong’s essentials of pediatric Nursing. South India Edition. Elsevier publication. • Dorothy R Marlow, Barbara A Redding, Raman Kalia. Marlow’s textbook of pediatric Nursing. Harcourt Brace & Company Asia Pte Ltd. • ParulDatta. Pediatric Nursing. 4th edition. Jaypee Publishers. New Delhi.

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