Foreign body aspiration in childhood

We studied 149 children aged seven months to 13 years (mean age 2.9 +/- 0.2 years) who had aspirated foreign bodies for age, sex, and type of foreign body. Symptoms, physical findings, chest x-ray, and fluoroscopy were compared with different sites of enlodgement. Positive history was obtained in 135 (91%). In 133 children, the diagnosis was made on admission. Frequent symptoms were cough (80%) and cyanosis (27%) following aspiration, while prevalent emergency department symptoms were cough (33%) and dyspnea (30%). Common physical findings on admission were decreased breath sounds (65%), tachypnea (43%), and fever (36%). Admission chest radiographs revealed emphysema (43%) and infiltrates or atelectasis (29%). Forty-one children (27%) were asymptomatic, and 43 children had normal chest x-ray. Fluoroscopy showed inspiratory mediastinal shift in 57%. Bronchoscopy performed within 48 hours of admission was successful in removing the foreign material in 88% of the children. Food particles were the most common type of foreign body. Hoarseness and stridor were significantly more common in upper airway enlodgement (P less than 0.01). Decreased breath sounds were significantly more common among children with lower airway enlodgement (P less than 0.001). A delay in diagnosis of longer than three weeks was associated with equivocal history of aspiration (P less than 0.05), and with significantly more wheezing (P less than 0.02) and atelectasis (P less than 0.01). Our study reemphasizes the importance of integrating various diagnostic tools in order to accurately evaluate and manage these children.