Foreign body aspiration is common in young children between 1-4 years old due to their curiosity and exploration. Common aspirated objects include small toys, foods, and coins. Clinical features may include coughing, wheezing, stridor, or cyanosis depending on the location of the foreign body. Emergent treatment involves back blows, chest thrusts, or abdominal thrusts to dislodge objects and prevent complete airway obstruction. Foreign bodies in other orifices like ears and nose are also common in young children and require careful removal to prevent further lodging or tissue damage.

1. Foreign body aspiration

2. Introduction
Children are found of putting objects into various orifices either their
own or others due to curiosity or innocence, during the oral phase of
psychosocial development and thereafter. Objects inserted into the
nose, ears, anus, vagina are usually easy to manage but foreign bodies
in the mouth can be difficult and often life-threatening because they
may track down into the respiratory tract or in the alimentary tract.
Foreign bodies in the eyes may also create serious problem but in the
soft tissue may be managed easily.

3. Definition-
A foreign body is any object originating outside the
body of an organism. In machinery, it can mean any
unwanted intruding object.
Most references to foreign bodies involve propulsion
through natural orifices into hollow organs.

4. Incidence:
Approximately 80 percent of pediatric FBA episodes occur in
children younger than three years, with the peak incidence
between one and two years of age. At this age, most children
are able to stand and be mobile independently and are apt to
explore their world via the oral route. They also have the fine
motor skills to put a small object into their mouths, but they
do not yet have molars to chew food adequately and may
have uncoordinated or immature swallowing mechanisms.

5.  Foreign body aspiration
• Foreign body aspiration should always be considered as a potential
cause of stridor and airway obstruction in children.
• Young children between 1 and 4 yr. of age are especially prone to
aspirate small objects in their air passages. The incidence of foreign
body location is similar in the right and left sides. Unless recognized
and treated, these children have significant morbidity, such as recurrent
wheezing, cough and pneumonia

6.  Common foreign body
• Round candies,
• food like carrot, apple and peanut
• coins
• toy car wheels
• marbles and beads
• buttons
• seeds

7. Etiology of FBA
• The child's curiosity and desire to explore objects,
provokes him to put the object into the mouth so as to taste
it. Also, if adults give infants and small children, any food
item for which they are nee developmentally prepared to
ingest (like hard candies, peanuts, carrot etc.), aspiration
may occur. The incidence of foreign body aspiration is
highest in the age of 6 months to 5 years.

8. Most of the aspirated foreign bodies pass through the
larynx and trachea to become lodged in the bronchi. The
right main bronchus is a common site for obstruction
because it is larger in diameter with greater airflow than
the left main bronchus. Obstruction may be partial or
complete. Complete airway obstruction usually occurs in
the airway and presents an immediate threat to life.
 PATHOPHYSIOLOGY :

9. Clinical Manifestestations
Clinical manifestations may
vary according to the location
and degree of obstruction.

10.  Features of foreign body in larynx are:
 Immediate Hoarseness
 Stridor
 Inability to speak (aphonia)
 Inflammation at the site of obstruction leading to
dyspnea, wheezing and cyanosis

11.  Features of foreign body in trachea are:
 Coughing
 Asthma like wheezing
 Hoarseness
 Stridor
 Dyspnea
 Cyanosis

12.  Features of foreign body in bronchi are:
 Coughing
 Wheezing, if there is partial airway obstruction.
 Hoarseness and stridor may be present.
 If there is partial obstruction, the child may be able to ventilate well.
• In case of complete obstruction, no air bypasses the obstruction, so no
breath sound are heard.

13. D&E of fba
Sign and symptoms of aspiration and choking help in
diagnosis. The child has ineffective cough, is unable to
speak and may develop cyanosed lips, nails and skin.
In many cases, aspiration of foreign body is not obvious. A
history of choking incident or a history of recurrent
intractable pneumonia are the reasons to suspect presence
of foreign body.

14. Cont……
 Chest and soft tissue radiographs help in locating
the foreign body. Radiographic examination
shows opaque objects like coin, but is less useful
in identifying food matter.
 Fluoroscopic examination shows a characteristic
air trapping when there is bronchial obstruction.

15. Management of obstructed airway:
Airway obstruction may be caused by aspirated material or
by infection that cause airway swelling. Children with an
infectious cause of obstruction need specific emergency
care, and time should not be wasted using airway clearance
techniques described here. Attempts to clear an airway are
made for:

16. Emergency Treatment of Infants and children with
Airway Obstruction caused by a foreign body
Infant
1. Straddle infant over rescuer's arm (head lower than
trunk) and support head by resting jaw in rescuer's hand.
2. Rescuer rests forearm on own thigh.
3 Deliver five back blows with heel of hand between
infant's shoulder blades.

17. Cont…..
4. Turn the infant. This is done by keeping one hand on front of infant,
supporting neck, jaw, and chest and the other hand supporting back.
5. Infant is placed on rescuer's thigh with head lower than trunk.
6. Continue to support head and neck, then perform five chest thrusts in
the location where external chest compressions are performed (i.e., on
sternum one finger-breadth below imaginary line drawn across nipple
line)

18. Child - Heimlich Maneuver with Victim Standing or Sitting
1.Rescuer stands behind the child and wraps arms around child's waist.
2. One hand is formed into a fist.
3. Rest thumb side of the fist against child's abdomen slightly above
navel (well below the tip of xiphoid process)
4. Grasp fist with other hand and give a quick upward thrust into child's
abdomen. Thrust must be at midline and not toward either side.
5. The thrust is repeated as needed. Each thrust should be a separate and
distinct movement. Thrust must be gentle in small children.

19. Child-Heimlich Maneuver with Victim Lying
(Conscious or Unconscious)
1. Position the child supine with face up.
2. If child is on floor, kneel near the child's feet (this
position is not used for small children but can be
used for older children), if child is on table, stand at
child's feet.

20. Cont…
3. Place heel of hand on child's abdomen, slightly above navel but
well below rib cage.
4. Place other hand on top of first hand and press into abdomen with
an upward thrust. Thrusts must be at midline and not to either side of
the abdomen.
5. Thrust is repeated several times as needed. Each thrust should be a
separate and distinct movement. Thrust must be gentle in small
children.

21. Foreign Body in Ear
Foreign bodies in the ear are very common and easy to
diagnose. The foreign body may remain in ear several
days before generating enough inflammatory response to
alert parents for seeking medical attention. Anything
small enough to fit in the external ear may be placed
there by a small child.

22.  Living foreign bodies (say insects) may find
their way into the ear canal and cause intense
irritation and pain
 Non-living foreign bodies often inserted into the
external auditory canal include pieces of paper,
chalk, or eraser, grain seeds which tend to swell
with passage of time and get tightly impacted.

23.  Non-living foreign bodies are of two types:-
 Non-hydroscopic foreign bodies: The objects which do
not absorb water are known as non-hygroscopic. These
include small stones, beads, eraser, mini cell batteries etc.
 Hydroscopic foreign bodies: The objects that absorb
water and swell up are known as hygroscopic foreign
bodies. These include peas, grams, vegetable pieces etc.

24. Diagnostic Evaluation
Diagnosis is usually based on history
of ear pain and purulent drainage.
The foreign object can be visualized
through an otoscope unless excessive
purulent drainage is present.

25. a. Removal of living foreign bodies
Insects which enter the ear should be killed before
removal; otherwise, their mouth parts and claws
may break and are left behind. If the tympanic
membrane is intact, instill a few drops of mineral or
vegetable oil or liquid paraffin in the ear to kill the
insect. Thereafter the insect can be removed by
grasping with a forceps.

26. b. Removal of non-hygroscopic foreign bodies
Non hygroscopic objects like small beads etc. are
removed by syringing the ear. Spherical foreign bodies
like iron shots and glass beads etc. that are large enough to
occlude the ear canal cannot be removed by syringing.
These spherical objects cannot be grasped by forceps and
an attempt to do this will only push the object inwards.
Such spherical objects must be removed by using foreign
body hook.

27. c. Removal of Hygroscopic foreign bodies
Objects that absorb water and swell up are not removed by
syringing, because if they fail to come out, they will absorb
water, swell up and get impacted in the ear canal. These
objects are therefore removed either by grasping them with
a pair of forceps or by using a foreign body hook. If the
foreign body is impacted deep in the ear canal, then it is to
be removed by giving post aural incision, under general
anaesthesia.

28.  foreign body in nose
Inanimate foreign bodies found in the nose
include beads, buttons, paper, peas, erasers
and metal and plastic components of toys.
When retained for a long time, they produce
granulation tissue.

29. Clinical Features: Clinical features of foreign body in
nose include:
Foul smelling nasal discharge from one nostril.
Foreign body which remains for very long time in nose
can lead to formation of a stone in nose, known as
“Rhinolith.”
 Wheezing sound
 Pain in nose
 Swelling in nose
 Respiratory obstruction

30. Management: The nose is examined by simply lifting the tip
of nose with examiner's thumb. Nasal speculum can also be
used for examining the nasal cavity. For easily visualized,
non-spherical, non-friable objects, most physicians prefer
direct instrumentation. If the object is poorly visualized or
spherical or cannot be successfully removed by direct
instrumentation, Balloon-catheter removal is the preferred
method. Large, occlusive nasal foreign bodies may be
removed by either positive pressure technique or under
general anaesthesia.