The risk of foreign body aspiration in children can be reduced with proper education of the general population

Foreign Body Aspiration Complicated by Pneumothorax in Children: HCUP-KID Perspective

OBJECTIVE

Children with airway foreign bodies (AFB) occasionally have pneumothorax complicating their course. We aimed to compare the clinical course of these children to those without this complication.

METHODS

Data was obtained from the 2016 Kids' Inpatient Database of Healthcare Cost Utilization Project. ICD-10 code of T17XXXX was used to locate records. They were grouped based on the presence of preoperative pneumothorax, postoperative pneumothorax, or none. Variables included demographics, AFB type, AFB location, length of stay (LOS), pneumothorax treatment modality, mortality, hospital setting, primary payor, and total charges.

RESULTS

A total of 4165 children with AFB were identified, 57.8% male and 42.2% female. Of these 75 (1.8%) patients presented with preoperative pneumothorax, 29 (0.7%) with postoperative pneumothorax, and 4061 (97.5%) with no pneumothorax. The preoperative pneumothorax patients were older than the postoperative pneumothorax and unaffected AFB patients (mean age = 9.5 [95% CI 7.7-11.3] vs 8.2 [95% CI 5.4-11.1] vs 5.5 [95% CI 5.3-5.7]; P < .001). Preoperative pneumothorax patients incurred higher total charges than the other groups (mean US = $939K [95% Cl 673K-1,204K] vs $599K [95% Cl 377K-821K] vs $228K [95% Cl 211K-244K]; P < .001), had a longer LOS in days (mean = 37.7 [95% Cl 28.7-46.7] vs 31.6 [95% Cl 16.9-46.2] vs 15.8 [95% CI 15.0-16.7]; P < .001), and had a higher mortality rate (16% vs 0% vs 3.7%, P < .001).

CONCLUSION

Pneumothorax can significantly impact a child's hospital course, and preoperative pneumothorax should alert clinicians to the potential for increased mortality risk.

Foreign body aspirations in childhood: A retrospective review

OBJECTIVE

The aim of this study was to examine the childhood-age foreign body aspiration (FBA) retrospectively by focusing on symptoms, types, home interventions, hospitalization and complications.

METHOD

All patients between 0-18 years admitted to pediatric surgical clinic and diagnosed with FBA were examined retrospectively from January 2021 to January 2022.

RESULTS

The study group consisted of 163 patients and their mean age was 17.8±12.7 months (1 months to 6 years). FBA events included aspiration of food (78%), coins (10%), batteries (3.7%), parts of toys (4%), buttons (2.4%) and other (2%). First aid treatment to children was performed at home by mothers (61%). Types of first aid treatment performed by mothers included tapping the back (31%); cleaning inside the mouth (24%); trying to remove the foreign body with fingers (12%), pushing the foreign body forward (5.9%) and forcing the child to vomit (9.5%) respectively.

CONCLUSIONS

FBA is a potential life-threatening health problem during childhood. When the age of majority of patients being under one year old and prevalence of food in FBA types are taken into consideration, safe-feeding practices of mothers, feeding position and training about the safe-environment are the basic steps of prevention strategies.

PRACTICE IMPLICATIONS

One of the most useful ways of preventing FBA cases is to provide planned and continuing education to parents, care givers and all the individuals responsible for the care of the child in order to increase their knowledge and practice levels.

Parental Knowledge and Practices Related to Foreign Body Aspiration in Children in Makkah, Saudi Arabia

Background Foreign body aspiration (FBA) is a life-threatening event and one of the most common causes of mortality in children. As it has different clinical presentations, parental knowledge is essential for early management to prevent complications. Objectives This study was designed to assess the knowledge and practices relating to FBA in children among parents living in Makkah city, Saudi Arabia. Methods An online questionnaire was designed using Google Forms (Google LLC, Mountain View, California, United States) and distributed in October 2022 among parents living in Makkah city. After data collection, an appropriate statistical analysis was conducted. Results A total of 1087 parents enrolled in this study; 63.9% were women and the majority were married 93%. Additionally, 52% of the parents had at least three children. Moreover, 17.6% had an experience of a child having aspirated a foreign body once. The Internet was the most popular source of information on FBA (43.5%). Furthermore, the parents had poor levels of knowledge and practices related to FBA (65.4% and 78.6%, respectively). Conclusion This study reported that parental levels of knowledge of FBA and FBA practices were inadequate. There is a need to increase awareness, which will lead to better outcomes.

The Effect of COVID-19 Stay-At-Home Orders on the Rate of Pediatric Foreign Body Ingestions

BACKGROUND

Foreign body ingestions are a common presentation in the emergency department (ED), particularly in young children.

OBJECTIVE

We sought to determine whether the COVID-19 pandemic lockdowns had an effect on the proportion of foreign body ingestions.

METHODS

We performed a retrospective review of the Pediatric Health Information System for patients younger than 19 years who were identified by International Classification of Diseases, Tenth Revision codes for foreign body ingestion. We analyzed patients in the following three groups: young children (younger than 5 years), school-aged children (5-12 years), and adolescents (13 years and older), using an interrupted time series analysis. Our primary outcome was the difference in proportion of foreign body ingestions. We compared 1 year after the declaration of the COVID-19 pandemic (March 13, 2020 to March 31, 2021) with the previous 3 years (March 1, 2017 to March 12, 2020).

RESULTS

Total pediatric ED encounters decreased in the post period (p < 0.01); 4902 patients per year presented for foreign body ingestion pre-COVID-19 shutdown vs. 5235 patients per year post-COVID-19 shutdown. In all three age groups (young children, school-age children, and adolescents), there was a higher proportion of foreign body ingestions post-COVID-19 shutdown (p < 0.01, p < 0.01, and p = 0.028, respectively), driven primarily by the decrease in total ED encounters. In the youngest age group (younger than 5 years), there was also a significant increase in slope for foreign body ingestions post-COVID-19 (p = 0.010).

CONCLUSIONS

The proportion of foreign body ingestions increased after the declaration of the COVID-19 pandemic, primarily driven by an overall decrease in total ED volume.

Child requiring tracheostomy for removal of an airway foreign body at the tracheal bifurcation

Airway foreign bodies are typically removed orally using a rigid bronchoscope. We present a rare case of a foreign body at the tracheal bifurcation that required removal via tracheostomy. A child turned pale while eating nuts and was suspected to have choked on a foreign body. CT revealed a foreign body at the tracheal bifurcation. As his respiratory condition was unstable, tracheal intubation and removal were attempted using a rigid bronchoscope. Tracheal obstruction during oral removal resulted in respiratory failure and bradycardia. Following emergency tracheostomy, the foreign body was removed via the tracheal stoma after his respiratory condition stabilised. The patient was discharged 21 days later without neurological sequelae. To avoid hypoxaemia during airway foreign body removal, as in this case, assessing the size of the upper airway and foreign body is necessary. Tracheostomy and foreign body removal through the tracheal opening should be considered proactively.

Assessing school-based intervention strategies to foster the prevention of choking injuries in children: The results of the CHOP (CHOking Prevention) trial

There are few public health programs aimed at reducing choking injuries, even though choking is one of the leading causes of death among unintentional injuries in young children. We present the results from the CHOP (CHOking Prevention) project community intervention trial, which aimed to compare three different school-based intervention strategies for food choking prevention. The trial enrolled 41 educational facilities, which were randomized to one of three different intervention strategies to inform about prevention of food choking, or to serve as the control group. In strategy A, education was delivered directly to families, whereas in strategy B, education was delivered first to teachers and by them to families, and in strategy C, education was delivered only to healthcare coordinators in each school and by them to teachers and families. All educational interventions were delivered in the schools by experts and certified trainers. The participants were asked about sociodemographic information and completed questionnaires (pre-, post- and follow-up of intervention). Information from the postintervention and follow-up questionnaires was synthesized into four indicators to evaluate the effectiveness of each intervention strategy. Of the 1,426 participants, 298 were involved in strategy A, 474 in strategy B, 491 in strategy C and 163 in the control group. At postintervention, the scores of the indicators in each strategy significantly outperformed those of the control group, with adjusted p < 0.05. At follow-up, the distribution of the indicator scores of each strategy was found to be not significantly different compared to those of the control group (p > 0.05). The results of this study suggest that a sustainable school-based public health intervention mediated by teachers is effective as direct training for families in improving knowledge about food choking injury prevention. Nevertheless, further improvements could be made to increase long-term information retention.

Foreign body ingestion during the COVID-19 pandemic: a retrospective single centre review

Introduction

During the COVID-19 pandemic in 2020, there were many changes in the provision of healthcare as well as home and educational environments for children. We noted an apparent increase in the number of children presenting with ingested foreign bodies and due to the potential impact of injury from this, further investigated this phenomenon.

Method

Using a prospective electronic record, data were retrospectively collected for patients referred to our institution with foreign body ingestion from March 2020 to September 2020 and compared with the same period the year prior as a control.

Results

During the 6-month pandemic period of review, it was observed that 2.5 times more children were referred with foreign body ingestion (n=25) in comparison to the control period (n=10). There was also a significant increase in the proportion of button battery and magnet ingestions during the COVID-19 pandemic (p 0.04).

Conclusion

These findings raise concerns of both increased frequency of foreign body ingestion during the COVID-19 pandemic and the nature of ingested foreign bodies linked with significant morbidity. This may relate to the disruption of home and work environments and carries implications for ongoing restrictions. Further awareness of the danger of foreign body ingestion, especially batteries and magnets, is necessary (project ID: 2956).

Parental knowledge and practices toward foreign body aspiration in children in the Al Qassim region of Saudi Arabia

Background:

Foreign body aspiration (FBA) is a perilous condition with a high mortality rate, especially in children less than three years of age.

Aim:

This study aimed to assess parental knowledge and practices toward FBA in children in the Al Qassim region of Saudi Arabia.

Materials and Methods:

This is a descriptive cross-sectional study conducted among Saudi parents at AlQassim region, Saudi Arabia during the period between February 2020 and June 2020. A validated self-administered questionnaire containing 16 questions of knowledge and practices toward FBA was distributed online via various Social Media platforms. Correct answers were coded and scored. Participant responses were grouped based on their score level of knowledge and practices.

Results:

We recruited 385 parents with a mean age of 35.4 (range: 19–59) years, and 59.2% were female and 40.8% were male. The mean ± SD knowledge score was 4.97 (1.42)/8 points and the practice score was 12.4 (2.13)/20 points. Parents with poor and good knowledge were 61.3% and 36.9% and those with poor and good practices were 55.3% and 44.7%, respectively. Female professionals with less children who were more aware of FBA significantly influenced knowledge, while having no incidence of FBA among children and having heard of FBA significantly influenced practices.

Conclusion:

We found that parental knowledge and practices toward FBA were insufficient. Educated females with less children that heard about FBA influenced parental knowledge. Also, having no incidence of FBA among children and being aware about FBA led to a better impact in parental practices.

A child with a foreign body in bronchus misdiagnosed as asthma

Foreign body ingestion should be considered as an important differential in a child with difficult asthma. We report an 11-year-old male child with foreign body aspiration who initially was diagnosed and treated as difficult asthma. Later on, he was diagnosed to have a foreign body in the right bronchus, which was successfully removed by flexible bronchoscopy.

A Case of Pediatric Aspiration of a Metallic Spring

Prolonged retention of a foreign body after aspiration can lead to numerous respiratory complications. We present a case in which an unwitnessed aspiration of a metal spring by a child led to several months of unilateral wheezing and subsequent physical changes in his left mainstem bronchus. The prompt removal of an airway foreign body requires a high index of suspicion by the physician in order to facilitate proper workup to confirm the diagnosis, allow for prompt management, and minimize damage to the airway.

A Serious Game on the First-Aid Procedure in Choking Scenarios: Design and Evaluation Study

Background

Choking is one of the causes of unintentional injury death. Gaining the knowledge of the first-aid procedure that has to be applied in case of choking can increase the chances of survival of persons with choking. Serious games can be a good channel for educating people about choking scenarios and the actions to be taken to save the persons with choking.

Objective

The objective of this study is to present and evaluate the effectiveness of a serious game designed to prevent choking and to promote the first-aid procedure that needs to be applied in case of choking.

Methods

In this study, we present a serious game as a set of minigames that reproduces the main steps of the protocol for the first-aid performed in choking. In the proposed game, the player acquires the role of a helper who has to save the person in a choking emergency by applying the main steps of the protocol. Time and score restrictions are imposed to pass each minigame. To test this game, we performed a pilot study with 48 high school students. Different tests were performed to assess the students’ preferences and their knowledge on choking before and after playing the proposed game. The obtained results were analyzed using Mann-Whitney U test when a grade variable was involved and by using Fisher exact test when 2 categorical variables were involved.

Results

The findings of our study showed that the players enjoyed the game. No statistical differences were detected when considering the gender of the player, their preferences for video games, or their previous experience in choking emergencies. By comparing the knowledge of these students before and after playing the game, we found that all the indicators of the knowledge about how to act in case of a choking emergency were improved through this serious game.

Conclusions

The findings of our study show that the proposed game is a good strategy for promoting and teaching first-aid procedures in choking emergencies to nonexperts in this field.

Frequency of Various Foreign Bodies Retrieved from the Airway During Bronchoscopy in Children: A Pediatric Tertiary Care Center Experience

Objective: To determine the frequency of various foreign bodies (FBs) retrieved from the airway during bronchoscopy in children at the National Institute of Child Health (NICH), Karachi, Pakistan.

Study Design: Cross-sectional descriptive study.

Place and Duration: Department of Pediatrics Surgery, NICH, Karachi, Pakistan from June 1, 2017 to November 30, 2017.

Methodology: Patients referred from the ER and Pediatrics Medicine Department, NICH, Karachi with a suspicion of tracheobronchial foreign body aspiration (FBA) was included in the study.

Results: A total of 96 children were studied. There were 71 males (74%) and 25 females (26%). Eighty-seven (90.6%) were below five years and nine (9.4%) were more than five years of age. Mean time interval between FBA and presentation at hospital was 15 h. FB was located primarily in the right main bronchus (54%), followed by left bronchus (40%) and trachea (6%). Betel nut was the most common FB retrieved in 87.5%. Other FBs were whistle 3.1%, peanut 3.1%, seed 1%, and miscellaneous 5.2%.

Conclusions: FBA is more common in male children, mostly below five years of age. During bronchoscopy, it was found that the FB was mostly located in the right main bronchus. Betel nut was found to be the most common FB aspirated.

Risk Management and Recommendations for the Prevention of Fatal Foreign Body Aspiration: Four Cases Aged 1.5 to 3 Years and Mini-Review of the Literature

(1) Background: Foreign body aspiration (FBA) is a significant public health concern among the pediatric population, and fatalities are dramatic for families. It typically involves organic foreign bodies (mainly food) aspirated by children under three years old, usually at home or school. This review aimed to focus on the preventive measures around four actual cases of fatal foreign body aspiration, emphasizing the correct execution of the Heimlich maneuver and cardiopulmonary resuscitation, supervised mealtimes, and high-risk foods. (2) Methods: Four fatal cases of foreign body aspiration in children are presented here. The children were in a free environment, such as school, home, and the countryside, and were in the presence of teachers, parents, and a grandmother who did not supervise the children adequately. A literature review was performed via the MEDLINE database using the key terms: “foreign body aspiration,” “infant choking, 1.5 to 3 years,” “food and foreign body aspiration,” “common household,” “prevention of foreign body aspiration,” “guidelines,” “recommendations,” “training of caregivers (parents, educators),” “resuscitation,” “Heimlich maneuver,” and “disengagement of the upper airways.” We focused on the prevention of foreign body aspiration. (3) Results: a complete postmortem examination was performed. In three cases, the foreign bodies were food (mozzarella cheese, pear, or raw bean), while in one case, the foreign body was a pebble. (4) Conclusions: This review aimed to discuss recent scientific literature and provide a perspective on the benefits of a dedicated approach to the management of fatal foreign body aspiration in children by caregivers who usually have no experience with the best ways of supervising children in a safe environment, especially regarding the correct execution of resuscitation maneuvers, such as the Heimlich maneuver. Recommendation updates could improve healthcare quality in a pediatric setting and reduce medico-legal implications.

Foreign Body injuries in children in India: Recommendations for prevention from a comparative analysis with international experience

OBJECTIVES

This study aims to identify specific patterns of risk in order to contribute to the prevention of Foreign Body (FB) injuries by assessing FB injury characteristics in Indian children.

METHODS

Single center case series are included in the worldwide registry on Foreign Bodies Injuries www.susysafe.org. Statistical analysis performed on FB injury data (age, medical information, FB anatomical location (ICD) and characteristics, and situational data) from 252 Indian children (0-14 years) was used to identify FB risk patterns.

RESULTS

The study included 252 FB injury cases, out of which 110 occurred in females (43.7%). Most of the reported FB injuries (N = 252) were located in the mouth, esophagus and stomach, or intestines and colon (34.5%), and in the nose (31.3%). The analysis of the median duration of all injuries (i.e., the difference between the reported injury time/date and the reported time/date of arrival at hospital) showed that children with a FB in the airways were those referred to the hospital latest (median of 332.50 min, p-value <0.001). With regards to FB type, the majority of FB objects were non-food items and ingestion of coins accounted for 25% of all FB injuries.

CONCLUSIONS

Cultural differences may exist with regards to the Indian diet being conducive to lower choking food risk for children, and to acceptability and accessibility to objects such as coins and stationery. Such findings should be taken into account when developing primary and secondary prevention strategies aimed at reducing the burden of such injuries in India.

Increasing awareness of food-choking and nutrition in children through education of caregivers: the CHOP community intervention trial study protocol

BACKGROUND

Choking is one of the leading causes of death among unintentional injuries in young children. Food choking represents a considerable public health burden, which might be reduced through increased effective preventative education programs. We present a protocol for a community intervention trial termed CHOP (CHOking Prevention project) that aimed to teach Italian families how to prevent food choking injuries and increase knowledge relating to nutrition.

METHODS

Italian educational facilities were enrolled. Stratified randomization blocked by geographical area was performed. Each stratum was randomized to one of three different intervention strategies or to a control group. Educational intervention was delivered in the schools by experts and certified trainers as per the following three intervention strategies: directly to families (Strategy A); to teaching staff only, who subsequently delivered the same educational intervention to families (Strategy B); to health service staff only, who then delivered the educational intervention to teaching staff, who subsequently delivered the intervention to families (Strategy C). Participants completed a questionnaire about their knowledge on the topics presented during the educational interventions (pre-, post-, and follow-up of intervention). Information from the questionnaires was synthetized into 6 indicators in order to measure how effective each intervention strategy was.

DISCUSSION

The issue of food choking injuries in children is relevant to public health. The protocol we present provides an opportunity to progress towards overcoming such challenges through a working model that can be implemented also in other countries.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03218618. The study was registered on 14 July 2017.

Foreign Body Aspiration in Infants and Older Children: A Comparative Study

BACKGROUND

Foreign body aspiration (FBA) is a major cause of morbidity and mortality in children. It is a preventable event that predominates in preschool age. The signs and symptoms mimic respiratory diseases common in the same age-group. We compared FBA in infants to FBA in older children.

METHODS

Retrospective analysis of all the cases of suspected FBA of children under the age of 18 years hospitalized at one medical center during 2002 to 2016. We analyzed the data according to age: up to 1 year (infants) and 1 to 18 years.

RESULTS

One hundred seventy-five children with suspected FBA were admitted; of whom, 27 (15%) were infants and 148 (85%) were older children (age 1-18 years). For the 2 age groups, adults witnessed 85% and 73%, respectively, of the incidents (P = .4). In the neonate group, 48% presented with normal X-ray findings compared to only 20% in the older group; 15% of the older group had a positive chest X-ray for a foreign body, while none had such in the infants' group (P = .01). For the 2 age groups, the majority of the FBs found were from organic origin. About half of the patients were diagnosed and managed within 24 hours of the aspiration event. In 10%, repeated bronchoscopy was performed due to a retained FB remnant. In a multivariate analysis, signs and symptoms (P < .05), location of the FB (P < .001), and witnessed aspiration (P < .001) were independent prognostic factors for the length of hospitalization.

CONCLUSION

Foreign body aspiration is not uncommon in young infants; the management is challenging due to small airways, the need to use smaller bronchoscopes, and the lack of working channel forces in pediatric bronchoscopes.

Death as a Consequence of Foreign Body Aspiration in Children

Aim:

To analyze the rate of mortality in children with foreign body aspiration (FBA).

Methods:

We outlined a retrospective review of hospital data of patients between 1971 and 2013. FBA occurring in children 0 year to 14 years was considered for inclusion (patient ages ranged from 0.6 to 15 years, with a median age of 2.2 years). The gender structure within the investigated cases was 75.8% males and 24.2% females. During the study period, 772 patients undergoing rigid bronchoscopy with the diagnosis of FBA were included. Deaths on arrival were excluded.

Results:

Total rate of mortality (for whole investigated period) was 0.785. For last fifteen years of the investigated period the rate of mortality was zero.

Conclusion:

For prevention of foreign body aspiration in children and its mortality should be taken two strategies: non-medical (alterations in product design and public education campaigns) and medical (education of medical staff and improvement of equipment).

Basic choking education to improve parental knowledge

OBJECTIVE

To evaluate the effect of an educational intervention on parental knowledge of choking hazards and prevention.

METHODS

A quasi experimental study was performed utilizing an internet based educational video intervention for parents with a child 6 months to 4 years old presenting to a Pediatric Otolaryngology clinic at a Level 1 pediatric hospital. Following the clinic visit, participants were sent a choking video (intervention) or general safety video (control) with a pretest and posttest knowledge survey (via email). An additional posttest knowledge survey was sent 30 days later as a surrogate measure for knowledge retained over time. Frequencies, chi square test, Independent t-test and McNemar's test were used for statistical analyses.

RESULTS

202 participants viewed the video and completed both the pretest and immediate posttest knowledge survey. Average change in total knowledge scores from the pretest to immediate posttest was statistically significant between the intervention (μ = 1.88, σ = 1.20) and control group (μ = 0.14, σ = 1.05); t (200) = -10.99, P < .001. This finding was consistent when assessing change from the pretest to 30 day posttest between the intervention (μ = 1.41, σ = 1.32) and control group (μ = 0.17, σ = 1.41); t (118) = -4.95, P < .001. A majority of the knowledge questions (5 of 7) showed a significant change in score from the pretest to immediate posttest (P = .001-.027). Additional analyses revealed accuracy on 4 of 7 knowledge questions significantly changed from the pretest to 30 day later posttest (P < .001- .002).

CONCLUSION

The brief educational video overall improved parental knowledge of choking hazards and prevention immediately after the video and 30 days later. Importantly, improved parental knowledge may decrease rates of choking among children.

An Evidence-Based Practical Approach to Pediatric Otolaryngology in the Developing World

Despite humanitarian otolaryngology groups traveling in record numbers to resource-limited areas treating pediatric otolaryngology disease processes and training local providers, there remains a large burden of unmet needs. There is a meager amount of published information that comes from the developing world from an otolaryngology standpoint. As would be expected, the little information that does comes involves some of the most common pediatric otolaryngology diseases and surgical burdens including childhood hearing loss, otitis media, adenotonsillectomies, airway obstructions requiring tracheostomies, foreign body aspirations, and craniomaxillofacial surgeries, including cleft lip and palate.

Foreign body aspiration: a life-threatening situation

Foreign body aspiration is a life-threatening event, especially in children. In Pakistan, foreign body aspiration in children with betel nuts is a common emergency in the perioperative area. Health awareness of parents, teachers, caretakers, and health care providers can play a significant role in reducing the risk of this life-threatening event. This article describes a case report of a 2½ year old boy who presented in the perioperative area with a betel nut aspiration.

Logistic regression analysis of risk factors for prolonged pulmonary recovery in children from aspirated foreign body

OBJECTIVE

Foreign body aspiration is a life-threatening emergency for children. Fried chicken is commonly available all over the world, but no cases have previously been reported addressing this food as a tracheobronchial foreign body. We report an extremely rare case of tracheobronchial aspiration of fried chicken complicated by severe bronchitis and postoperative atelectasis. To clarify predisposing factors related to bronchopulmonary complications, we also reviewed paediatric cases of tracheobronchial foreign bodies treated in our department over the past 14 years.

METHODS

We retrospectively reviewed a total of 77 cases of tracheobronchial foreign bodies from 1988 to 2011. The main outcome measure was duration of hospitalisation, reflecting postoperative therapy. Logistic regression analyses were conducted to determine risk factors for longer hospitalisation.

RESULTS

Age, sex, and interval between the aspiration episode and bronchoscopy were not significantly associated with longer hospitalisation. Regarding kinds of foreign bodies, higher rates of longer hospitalisation were noted for patients who had aspirated peanut or animal material, as compared to patients who had aspirated non-organic material (odds ratio, 5.80; 95% confidence interval, 1.12-30.43).

CONCLUSIONS

In terms of predicting the risk of pulmonary complications, the type of foreign body aspirated offers a more meaningful factor than the interval between aspiration and operation. Specifically, peanuts or animal material containing oils appear to be associated with a more prolonged pulmonary recovery even after retrieval of the foreign body.

An alternative method of management of pediatric airway foreign bodies in the absence of rigid bronchoscopy

OBJECTIVE

Pediatric airway foreign body aspiration is a life-threatening clinical entity. The standard of care for managing this situation is endoscopic retrieval using rigid bronchoscopy. However in resource-limited settings rigid bronchoscopy may not be available. This retrospective case series describes the successful application of one treatment modality for pediatric airway foreign body.

METHODS

A retrospective review was performed for seven pediatric patients who were treated at Soddo Christian Hospital with a diagnosis of airway foreign body aspiration. All patients were treated in the operating room using general anesthesia, a combination of inhaled halothane and intravenous ketamine. Paralytics were not used in any patient and spontaneous breathing was maintained. Flexible fiberoptic bronchoscopy was initially performed on each patient to confirm the presence of a foreign body and identify the anatomic position with the airway. Using a standard technique, a tracheotomy was performed. If the foreign body was still noted to be distal to the tracheotomy, postural percussion was performed to dislodge the foreign body into the trachea. Once the foreign body was identified at the tracheotomy, it was removed.

RESULTS

All seven patients presented in respiratory distress and were emergently managed in the operating room. The average age was 2.8 years (6 months-8 years of age). The foreign bodies were successfully removed in all patients. There were no mortalities and all patients were successfully discharged from the hospital.

CONCLUSIONS

Pediatric airway foreign body aspiration is a life-threatening clinical entity in any setting, but it presents unique challenges in resource-limited settings where rigid bronchoscopy is not available. This report presents one such treatment modality and utilizes a combination of flexible fiberoptic bronchoscopy and tracheotomy to treat such patients.

Mothers' knowledge about foreign body aspiration in young children

OBJECTIVE

To evaluate parents' knowledge regarding foreign body aspiration (FBA) and determine the factors that are associated with lack of knowledge.

METHODS

An 8-item questionnaire regarding knowledge of FBA was developed and distributed at regular check-ups for children younger than 24 months old.

RESULTS

Out of the 1766 questionnaires distributed, 1603 were recovered and most of them (1539) were answered by mothers. After omitting 49 questionnaires with incomplete data, 1490 questionnaires answered by mothers were analyzed. Only 4.3% [95% CI 3.3-5.3] of mothers did not recognize a small toy as a cause of FBA, while 20.2% [95% CI 18.2-22.2] did not know that peanuts and other nuts can be causes of FBA, and 48.1% [95% CI 45.5-50.6] did not know that they should not give peanuts to a child younger than 3 years old. Regarding clinical signs, 27.7% [95% CI 25.4-30.0] and 41.8% [95% CI 39.3-44.3] of mothers did not know that sudden choking and sudden coughing were symptoms suggesting FBA, respectively. Being a mother with a child younger than 12 months old and being a mother with a first child were independent risk factors for lack of knowledge about FBA, regardless of the age of the mother.

CONCLUSIONS

A substantial number of mothers lack knowledge regarding FBA. To prevent FBA and to make timely diagnoses, parents, especially mothers with children younger than 12 months old and mothers with a first child should be given adequate information.

Toys in the upper aerodigestive tract: new evidence on their risk as emerging from the Susy Safe Study

Foreign body (FB) inhalation, aspiration or ingestion are relatively common events in children. Despite many efforts made in several countries to achieve acceptable safety levels for consumer products devoted to children, small toys or toy parts are still frequently mentioned among risky foreign bodies. The aim of the present study is to characterize the risk of complications and prolonged hospitalization due to toys inhalation, aspiration or ingestion according to age and gender of patients, FB characteristics, circumstances of the accident, as emerging from the Susy Safe Registry. The Susy Safe Registry started in the 2005 to collect data to serve as a basis for a knowledge-based consumer protection activity. It is actually one of the wider databases collecting foreign body injuries in the upper aero-digestive tract in pediatric patients. It is distinguished by a deep characterization of objects which caused the injuries and a multi-step quality control procedure which assures its reliability. Preventive strategies imposing a regulation of industrial production, even if fundamental, are not sufficient and need to be integrated along with other intervention addressed to make aware caregivers toward a proper surveillance of children.

Foreign bodies in the airways: a meta-analysis of published papers

BACKGROUND

Very recently, some attempts have been made to start a systematic collection of foreign bodies (FB) in view of using them to characterize the risk of chocking in terms of size, shape and consistency of the FB. However, most of the epidemiologic evidence on foreign bodies in children comes from single-center retrospective studies, without any systematic geographical and temporal coverage. This paper is aimed at providing an estimate of the distribution of foreign body's injuries in children according to gender, age, type of FB, site of obstruction, clinical presentation, diagnostic/therapeutic procedures, complications, as emerging from a meta-analytic review of published papers.

METHODS

A free text search on PubMed database ((foreign bodies) OR (foreign body)) AND ((aspiration) OR (airways) OR (tracheobronchial) OR (nasal) OR (inhalation) OR (obstruction) OR (choking) OR (inhaled) OR (aspirations) OR (nose) OR (throat) OR (asphyxiation)) AND ((children) OR (child)) finalized to identify all English written articles referring to foreign body inhalation over a 30 years period (1978-2008) was performed. The target of the analysis has been defined as the proportion of injuries as reported in the studies, stratified according to children demographic characteristics, type of FB, site of obstruction. The pooled proportions of FB were calculated using the DerSimonian and Laird approach.

RESULTS

1699 papers were retrieved and 1063 were judged pertinent; 214 English written case series were identified, among them 174 articles were available and have been included in the analysis. Airway foreign body most commonly occurs in young children, almost 20% of children who have inhaled foreign bodies being between 0 and 3 years of age. Organic FB, particularly nuts, are the most documented objects while, among inorganic FBs, the greatest pooled proportion has been recorded for magnets, which can be particularly destructive in each location. Non specific symptoms or a complete absence of symptoms are not unusual, justifying mistaken or delayed diagnosis. Acute and chronic complications seem to occur in almost 15% of patients.

CONCLUSIONS

Even if an enormous heterogeneity among primary studies seems to exist and even if the absence of variables standardized definitions across case series, including class age definition and symptoms and signs descriptions, seriously impairs studies comparability, our results testify the relevant morbidity associated with foreign body inhalation in children, stressing the importance of preventive measures.

The complimentary role of diagnostic and therapeutic endoscopy in foreign body aspiration in children

OBJECTIVE

To review the importance and benefits of flexible bronchoscopy and rigid bronchoscopy in airway foreign body inhalation in children. Prompt diagnosis will lead to safer outcomes when both types of endoscopy are employed within the operating room setting.

METHODS

Retrospective review of all cases of foreign body inhalation seen and treated in our Department between July 1986 and December 2010.

RESULTS

Three-hundred and ten children were admitted to our Department from Pediatric Emergency Room for a suspected foreign body inhalation. All patients with suspected FB inhalation underwent bronchoscopy. Of 310 evaluations of tracheobronchial tree performed at our Department, 104 were negative, while an airway FB were observed and removed in 206 cases.

CONCLUSIONS

Rigid bronchoscopy under general anesthesia is an extremely accurate surgical technique to identify, localize and remove airway foreign body. In our experience, flexible bronchoscopy under total intravenous sedation and topical anesthesia is very useful in doubtful cases to absolutely exclude the presence of foreign body in upper airway tracheobronchial tree.

Aspirated foreign bodies in pediatric patients, 1968-2010: a comparison between the United States and other countries

OBJECTIVES

To identify the most commonly aspirated airway foreign bodies (FBs) and identify opportunities for intervention.

METHODS

Literature was searched and pertinent articles from 1968 to 2010 (n=58; 14 articles were from the United States and 41 international) were reviewed. A list of the most commonly retrieved FBs resulted from the analysis.

RESULTS

11,880 FBs were analyzed (1934 from the US and 9946 international, p<0.0001). Food (edible) and food-related (inedible, e.g. bones) FBs were associated with most cases (68% in US and 84% internationally, p<0.0001). In this category, most common in the US were: nuts (41%, 44% of which were peanuts), seeds (8%, 19% of which were sunflower seeds), vegetables (5%, 41.7% of which were carrots), popcorn (4%), and bones (2%). Internationally: nuts (37%, 76.9% of which were peanuts), seeds (29%, 32.7% of which were watermelon seeds), beans (7.8%), and bones (2%). Non-food sources were the source of FBs in 25% of US patients and 12% internationally (p<0.0001). Of non-food sources, the most common FBs in US were: metallic (8%) and plastic (7%). Internationally: metallic (5%) and plastic (2%).

CONCLUSIONS

Most FB aspirations in pediatric patients occur while eating, with peanuts posing the greatest risk. The majority of FBs worldwide are nuts, seeds, and metallic objects. The significantly higher proportion of non-food FBs in the US may suggest that tighter regulation of products is needed. Educational or more stringent regulatory interventions should be considered to reduce FB aspirations from the sources highlighted herein.

Pediatric foreign body aspiration: How much does our community know?

Aims:

Foreign body aspiration (FBA) is one of the main causes of accidental death in childhood. This study was designed to evaluate the level of awareness of FBA and its resultant dangers in the community.

Materials and Methods:

Sixty-three primary caregivers were interviewed about their awareness of FBA, its attendant dangers, preventive measures taken, and how will they take care of a child in the event of a FBA according to an agreed protocol.

Results:

Awareness levels about FBA were abysmally low in the population that was studied. Twenty-five percentage of the study population had not heard about this condition, and 46% could not recognize a FBA if it happened. Also, 76% of the study group did not know about the attendant dangers of this condition.

Conclusions:

There is a dire need to spread awareness about both prevention and treatment of this morbid condition. Health care professionals need to increase their efforts to spread more knowledge in the community about FBA.

Suspected foreign body inhalation in children: what are the indications for bronchoscopy?

OBJECTIVE

To define the criteria for bronchoscopy in children with suspected foreign body (FB) inhalation.

STUDY DESIGN

Health history, physical examination, and radiologic examination were performed before bronchoscopy in all children referred for suspected FB inhalation between 2003 and 2005.

RESULTS

A total of 142 children, ranging in age from 3 months to 14 years (median age, 20 months), were referred with a history of suspected FB inhalation. An FB was found in 42 children with abnormal physical and radiologic findings, in 17 children with abnormal physical or radiologic findings, and in 2 children with normal physical and radiologic finding but persistent cough. Bronchoscopy revealed no FB in the children with normal physical and radiologic examinations and no symptoms (n = 16).

CONCLUSION

In children with a history of choking, bronchoscopy is mandatory in the presence of persistent symptoms, such as cough, dyspnea, and fever, or any abnormal physical or chest radiography findings. Bronchoscopy is not necessary in asymptomatic children with normal physical and radiographic examinations.

Foreign body aspiration in children: a nationwide survey in Japan

BACKGROUND

Foreign body aspiration (FBA) is a common cause for a respiratory emergency in young children and can be a life-threatening event. We, therefore, conducted the first nationwide survey in Japan.

METHODS

We asked doctors of 261 tertiary hospitals across the nation to fill out a case card of FBA-diagnosed cases they had experienced for the past 2 years. In the case card, age and gender of the patients, elapsed time until being referred to the hospital, presenting symptoms, previous diagnosis, suspected aspiration episode, type and location of aspirated foreign body, and consequences were inquired. This retrospective survey was carried out during 21 months, since January 2005 through September 2006.

RESULTS

Replies from 169 hospitals (64.8%) revealed that 163 cases of FBA had been treated in 114 hospitals during the past 2 years. Median age of cases was 1 year (2 months to 15 years), and 66.5% were male. Only 50.9% of the cases were referred to hospitals within 24h. Comparing these early-diagnosed cases, children with delayed diagnosis had similar age and sex distribution. In respect of presenting symptoms, characteristic ones such as choking or dyspnea were observed significantly more often in the early-diagnosed cases, whereas significantly predominant symptoms in children with delayed diagnosis were non-specific ones like coughing and wheezing (both, p<0.05). Although significantly more cases with early diagnosis reported suspected aspiration episodes (p<0.05), even in the delayed diagnosis group more than half cases (65%) had suspected episodes as well. Severe consequences occurred in seven cases (4.3%): four cases of irreversible hypoxic brain damage and one death due to multiorgan failure in the early diagnosis group; one bronchiectasis and one recurrent pneumonia in the delayed diagnosis group.

CONCLUSIONS

Characteristics of FBA among children in Japan were not substantially different from the reports from other countries. Suspected episodes were important, and there were some differences in presenting symptoms between early and delayed diagnosis cases. However, there are still no key sings to make a prompt diagnosis. In order to prevent FBA and make a timely diagnosis, continuous and extensive educational programs should be provided.