Foreign Body in Airways

Definition

• Inhalation of an object leading to partial or complete airway obstruction

• Common in children under 4 years due to exploration by mouth and immature chewing/swallowing coordination

• Can be life-threatening if not promptly identified and managed

____________________________________

Suspected Airway Obstruction (Main Bronchus or Higher)

• Signs

  • Sudden onset of coughing, choking, gagging, vomiting, or distress

  • Stridor or wheezing not explained by infection

  • Potential cyanosis if complete obstruction

• Management Steps

  • Open the mouth and attempt to visualise the object for removal with Magill forceps if clearly seen

  • If not visible

    • Give 5 firm back blows between the scapulae

    • Follow with 5 chest compressions as per paediatric CPR guidelines

    • Continue alternating until resolution or professional help arrives

  • Commence CPR immediately if complete obstruction is present with no air movement or cyanosis

____________________________________

Suspected Lower Airway Foreign Body (Distal to Main Bronchus)

• Signs

  • Persistent cough, wheeze, or dyspnoea without typical coryzal symptoms

  • Potential unilateral wheezing or decreased air entry on auscultation

• Management Steps

  • Avoid back blows or chest thrusts in partial lower airway obstruction

  • Sit the child upright for comfort

  • Urgent referral for imaging (chest X-ray) and possible rigid bronchoscopy under general anaesthesia

  • Chest X-ray may show hyperinflation or mediastinal shift if there is a ball-valve effect

____________________________________

Key Points

• Complete obstruction with no effective cough or sound requires immediate CPR

• Radiopaque objects may be visible on X-ray, but organic materials may not show up well

• Delayed diagnosis can present as persistent cough or unilateral wheeze without fever or runny nose

____________________________________

Prevention

• Foods

  • Avoid small, hard foods in children under 4 years, such as peanuts or hard lollies

  • Under 15 months, also avoid raw carrots, apples, or whole nuts

• Eating Behaviour

  • Encourage sitting quietly during meals and offering small pieces

  • Teach children to chew thoroughly before swallowing

• Parental Education

  • Supervise children during eating and play

  • Check toys for small parts or button batteries that can be aspirated

  • Keep plastic bags and small household items out of reach

____________________________________

Notes

• Persistent wheeze or cough without fever or coryzal symptoms should prompt suspicion of a retained foreign body

• Post-removal follow-up is important to rule out pneumonitis or airway injury

• Early recognition and referral can prevent complications such as bronchiectasis or chronic pulmonary infection