Age based evaluation of nut aspiration risk

Abstract

Objective To identify an age at which initiation of whole nut into the pediatric diet could be considered safe, by evaluating the age distribution of children undergoing bronchoscopy with removal of nut or seed material from the airway. Method A retrospective chart review over a ten-year period identifying children age 0–18 that have undergone bronchoscopy with retrieval of airway foreign bodies. A statistical analysis of demographic data was carried out to identify age distribution of aspiration events. Results Sixty-four cases of foreign body aspiration were identified, of which 43 (67%) were of organic origin, specifically nuts. A Fisher’s exact test was carried out on the cumulative percentage of organic foreign body aspirations to identify the age distribution of nut aspiration events. A statistically significant decrease in organic foreign body aspirations occurred at approximately 36 months of age (p = 0.004). Conclusion Foreign body aspiration is a leading cause of accidental injury or death in children. Nut and other small organic foreign bodies account for a significant portion of accidental aspiration events, however, no guidelines exist regarding appropriate age of whole nut introduction into the diet. Our study suggests that 90% of pediatric nut aspiration events occur under the age of 36 months. We suggest supervised introduction of whole nuts between the ages of 3 and 4 years. Official guidelines regarding this should be considered by professional pediatric societies. Level of evidence 4

Nuts and Beans Aspiration in Children—Positive Respiratory Virus Does Not Rule Out Foreign Body Aspiration

“…The vast majority of our cohort had aspirations less than 3 years of age, which was in line with other reviews 2 . Thus, it was suggested that nuts in diets should better be introduced after the age of 3 years, under close supervision 2 …”

“…Toddlers are particularly susceptible to aspiration during feed, which could be attributed to their weak protective reflexes, as well as immature chewing and swallowing mechanisms 6 . The vast majority of our cohort had aspirations less than 3 years of age, which was in line with other reviews 2 . Thus, it was suggested that nuts in diets should better be introduced after the age of 3 years, under close supervision 2 …”

“…6 The vast majority of our cohort had aspirations less than 3 years of age, which was in line with other reviews. 2 Thus, it was suggested that nuts in diets should better be introduced after the age of 3 years, under close supervision. 2 Because of the nonspecific presentations, patients are sometimes misdiagnosed as respiratory tract infection or asthma.…”

“…Foreign body aspiration (FBA) is a potentially life-threatening emergency in the pediatric population. Previous studies have shown that small food objects, including nuts and beans, are the common aspirated foreign bodies in preschoolers 1–3 . The diagnosis of FBA can be challenging, because some children present with nonspecific respiratory symptoms only.…”

Scenario Analysis of a Municipality’s Food Purchase to Simultaneously Improve Nutritional Quality and Lower Carbon Emission for Child-Care Centers

“…Nuts must be crushed, ground or served as nut or seed butter (such as peanut butter). It is important to avoid giving whole nuts and similar hard foods to young children to reduce the risk of choking [48].…”