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Foreign body aspiration in children--a persistent problem
1Department of Pediatrics, Rawalpindi Medical College, Rawalpindi.
Insights
Foreign body inhalation in children is common, with 1-3 year olds most affected. Early diagnosis via clinical suspicion and bronchoscopy is crucial for successful removal and preventing long-term issues.
Area of Science:
- Pediatric Pulmonology
- Emergency Medicine
- Diagnostic Imaging
Background:
- Foreign body inhalation is a frequent cause of pediatric respiratory distress.
- Timely diagnosis and intervention are critical to prevent severe outcomes.
Purpose of the Study:
- To identify early diagnostic criteria for foreign body inhalation in children.
- To evaluate the management and outcomes of suspected cases.
Main Methods:
- Prospective study of 20 children with suspected foreign body inhalation.
- Diagnosis based on clinical symptoms, radiological findings, and response to treatment.
- Rigid bronchoscopy used for foreign body removal.
Main Results:
- Successful foreign body removal in 18 out of 20 cases using rigid bronchoscopy.
- Children aged 1-3 years were most susceptible; males were at higher risk.
- Common clinical signs included sudden onset respiratory distress, cough, and localized decreased air entry.
- Consolidation, collapse, or emphysema were common radiological findings.
- Betelnut and peanut were the most frequently inhaled foreign bodies.
- Persistent respiratory infections or recurrent distress may indicate undiagnosed foreign body inhalation.
Conclusions:
- High clinical suspicion is essential for early diagnosis and management.
- Public awareness campaigns are needed to prevent foreign body inhalation.
- Prompt bronchoscopic intervention leads to favorable outcomes and reduces morbidity.
Objective:
Cough and respiratory distress due to foreign body inhalation in children is a common problem in our society. This study was planned to identify the criteria for early diagnosis and management in suspected cases of foreign body inhalation.
Setting:
The study was carried out on indoor patients of Paediatrics Department, Rawalpindi General Hospital (RGH) affiliated with Rawalpindi Medical College (RMC), from January, 1995 to December, 1996. Paediatrics Department has 50-bedded general paediatrics ward, 20-bedded neonatal unit (NNU) and 150-200 daily attendance of outpatient department (OPD). It offers primary to tertiary level care to its patients from whole of Rawalpindi Division.
Methods:
This prospective study encompasses profile and immediate outcome of 20 suspected cases of foreign body inhalation. Selection of study subjects and subjection to bronchoscopy was based on symptomatology, clinical and radiological findings and response to treatment. The data with outcome was recorded on a proforma.
Results:
In 18 cases foreign body was removed successfully by rigid bronchoscope with immediate relief of symptoms and normal chest roentgenograms. Most susceptable age for foreign body inhalation was 1-3 years (n = 14) and male children were at higher risk than females (13 vs 7). Valuable clinical features were sudden onset with respiratory distress, cough, choking, localized poor air entry, crepitations or rhonchi in descending order of frequency. Most common finding in chest roentgenogram was consolidation-collapse and/or emphysema in 50% cases. 30% cases (n = 6) with persistent respiratory tract infection inspite of adequate treatment of recurrent episodes of respiratory distress with wheeze turned out as foreign body inhalation and therefore, such cases need re-evaluation. Betelnut was the most common foreign body removed (n = 7) followed by peanut (n = 6). Most frequent site involved was right main bronchus (n = 7) followed by left main bronchus (n = 5).
Conclusion:
Public awareness through mass media needs attention to prevent foreign body inhalation. High index of clinical suspicion is mandatory for early diagnosis and management to prevent fatal outcome and long term morbidity.