Near-fatal Food Aspiration in a Young Child With Down Syndrome

To highlight the multifactorial risks of food aspiration in children with Down syndrome (DS), including anatomical, functional, and behavioral vulnerabilities, through a case of near-fatal choking.

We describe a case involving a 4-year-old boy with DS who presented with near-asphyxiation after aspirating a large piece of fried chicken. The patient's medical history, clinical findings, imaging results, and treatment course were reviewed.

The patient exhibited delayed language development, absent protective airway reflexes, impulsive eating behavior, and possible streptococcal tonsillitis. A large food bolus was visualized in the upper airway but could not be removed because of agitation. Spontaneous coughing expelled the object, and the patient recovered fully after a course of antibiotics. Imaging confirmed the obstruction, and group A Streptococcus was detected on a throat swab.

This case underscores the need for proactive feeding and swallowing assessments, especially during transitions to self-feeding in children with DS. Individualized preventive strategies, including caregiver education and early behavioral assessment, are critical to reducing aspiration-related morbidity in this vulnerable population.