Management of suspected foreign body aspiration in children1

Abstract

We aimed to establish prevailing consultant opinion on the management of children with a history suggestive of foreign body (FB) aspiration but no clinical or radiological findings. FB aspiration is a common problem in children. Most agree that bronchoscopy should be performed if a child has clinical or radiological signs. With suggestive history but no such signs, the decision is more difficult; both bronchoscopy and neglected FBs have the potential for serious consequences. A postal questionnaire was sent to all British Association of Otolaryngologists and Head and Neck Surgeon (BAO-HNS) consultants. The 563 questionnaires sent elicited a 63% reply rate. With suspected organic FBs, 52% would bronchoscope immediately, 38% would observe, and 10% would discharge. With suspected inorganic FBs, 35% would bronchoscope, 42% would observe, and 23% would discharge. Thus, the majority suggest admission, showing a preference for bronchoscopy with a history of organic FB, and observation if inorganic. Unless justified, it may be unacceptable to discharge these patients.

Tracheobronchial foreign body aspiration in children: how reliable are clinical and radiological signs in the diagnosis?

“…Delay in diagnosis is associated with increased morbidity and mortality 4,7,8 . Children may present with no history of aspiration or with doubtful history with non‐specific symptoms 5,12–15 . Accurate history and a high index of suspicion are therefore needed to prevent delayed diagnosis and the complications.…”

“…Rigid bronchoscopy is often performed for both definite diagnosis and treatment because of the risks of overlooked foreign body aspiration, even when there is a little suspicion or doubtful history 4,8–11 . However, a survey of practice pattern among otolaryngologists reported that when history is doubtful and no clinical signs are present, the decision was more difficult and some otolaryngologists were reluctant to perform a bronchoscopy 12 . Such a surgical technique can be somewhat complex and hazardous, and a procedure that is not meticulously performed can lead to several critical perioperative complications 10 .…”

Management of suspected foreign body aspiration in children

“…There is no debate that ‘missed’ inhaled foreign bodies can have significant medical and legal consequences, and we have discussed this in our paper 2 . Neither is there any debate that children with any clinical or radiological signs should have urgent bronchoscopy.…”

“…We would like to thank Osman et al . for their letter in the June 2003 issue of Clinical Otolaryngology 1 referring to our article entitled ‘Management of suspected foreign body aspiration in children’ from the October 2002 issue 2 . We are pleased that our survey has stimulated debate and are grateful for their contribution.…”

Foreign body aspirations in Infancy: a 20-year experience

“…Laryngeal and subglottic foreign bodies need urgent intervention in the form of tracheostomy or urgent bronchoscopy, whereas foreign bodies in the right or left main bronchus cause comparatively less airway problem 16-19. Rigid bronchoscopy is the recommended procedure in children with suspected FBs.…”