- If there is upper airway compromise, refer to choking child guideline
- Sudden respiratory arrest and collapse is caused by complete obstruction of the upper airway by an inhaled foreign body.
- There may be a history of choking, gagging or coughing during eating or playing, and sometimes parents will recall seeing the child with something in their mouth before the event.
- Occasionally, children who were not previously suspected to have inhaled a foreign body may present to ED with persistent cough or wheezing.
- Pneumonia not responding to treatment or recurrent pneumonia in the same lobe / segment should raise concerns about an inhaled foreign body.
- Stridor indicates a partial obstruction of the upper airway by an inhaled foreign body
- Clinically there may be asymmetric chest movement and/or asymmetric breath sounds
- A foreign body acting as a ball valve may cause air trapping with subsequent hyperinflation of the particular lung/lobe and deviation of the trachea
- There may be localised wheezing, crackles or decreased breath sounds, or signs of consolidation suggesting collapse of a lobe/segment
- In some children there will be no abnormal findings
- Radiological studies are only indicated if there is doubt regarding the presence of a foreign body.
- Children with history and examination findings suggestive of inhaled foreign body should be referred to the respiratory specialist (refer to Management)
If history and/or examination findings are inconclusive, imaging should be performed as follows:
- In hours: CT chest (request to state “?bronchial foreign body”). This is based on sensitivity and specificity approaching 100% with a radiation dose similar to conventional chest X-Ray.
- After hours: Inspiratory and expiratory PA chest X-Rays, plus a lateral chest X-Ray looking for:
- An opaque foreign body may occasionally be seen. The lateral CXR will confirm its presence in the bronchial tree as opposed to the oesophagus.
- Segmental or lobar collapse
- Difference in lung expansion between the two sides
- Localised hyperinflation or interstitial emphysema may result from a ball valve obstruction
- Be aware that CXR may be normal
For suspected upper airway foreign bodies
- Allow the child to sit upright in the position in which they are most comfortable
- If airway is compromised refer to Choking guideline
- Urgent referral to ENT
Indications for referral to respiratory medicine for suspected lower airway foreign bodies
Cases which meet 2 out of 3 of the following criteria:
- Suggestive history and/or symptoms that could be explained by inhaled FB
- Examination findings compatible with an inhaled FB
- Radiological changes compatible with an inhaled FB
The respiratory team will contact ENT if a bronchoscopy is indicated.
Fast from time of clinical suspicion
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