Foreign object - inhaled or swallowed

Considerations

Children age 1 to 3 are most like to swallow or breathe in a foreign object. These items may include a coin, marble, pencil eraser, buttons, beads, or other small items or foods.

Causes

Young children can easily breathe in certain foods (such as nuts, seeds, and popcorn) and small objects (such as buttons and beads). This may cause a partial or total airway blockage.

If the object passes through the esophagus (food tube) and into the stomach without getting stuck, it will probably pass through the entire GI tract.

Symptoms

• Choking
• Coughing
• No breathing or breathing trouble (respiratory distress)
• Wheezing

Sometimes, only minor symptoms are seen at first,. The object may be forgotten until symptoms such as inflammation, or infection develop.

First Aid

WHEN THE OBJECT

Any child who may have breathed in (inhaled) an object should be seen by a doctor. Children with obvious breathing trouble may have a total airway blockage that requires emergency medical help.

If choking or coughing goes away, and the child does not have any other symptoms, he or she should be watched for signs and symptoms of infection or irritation. X-rays may be needed.

Bronchoscopy may be needed to confirm the diagnosis and to remove the object. Antibiotics and breathing therapy may be needed if infection develops.

FOR SWALLOWED OBJECT

Any child who is believed to have swallowed a foreign object should be watched for pain, fever, vomiting, or local tenderness. Stools (bowel movements) should be checked to see if the object exited the body. This may sometimes cause rectal or anal bleeding.

Even sharp objects (such as pins and screws) usually pass through the GI tract without complications. X-rays are sometimes needed, especially if the child has pain or the object does not pass within 4 to 5 days.

Esophagogastroduodenoscopy (EGD) may be needed to confirm the diagnosis and remove the object. This procedure involves placing a tube through the mouth into the gastrointestinal tract.

In severe cases, surgery may be needed to remove the object.

DO NOT

DO NOT force feed infants who are crying or breathing rapidly.

When to Contact a Medical Professional

Call a health care provider or local emergency number (such as 911) if you think a child has inhaled or swallowed a foreign object.

Prevention

• Cut food into appropriate sizes for small children. Teach them how to chew well.
• Discourage talking, laughing, or playing while food is in the mouth.
• Do not give potentially dangerous foods such as hot dogs, whole grapes, nuts, popcorn, or hard candy to children under age 3.
• Keep small objects out of the reach of young children.

Alternative Names

Obstructed airway; Blocked airway

References

Thomas SH, White BA. Foreign bodies. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 57.

Munter,DW. Esophageal Foreign Bodies. In: Roberts JR, Hedges, JR, eds. Roberts: Clinical Proceduresin Emergency Medicine. 5th ed. Philadelphia, Pa. Saunders Elsevier; 2009: chap 39.

Update Date: 1/1/2013

Updated by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.