1) Foreign body ingestions and aspirations are common in children due to their natural curiosity and developmental immaturity. Objects frequently inhaled include peanuts and coins, while button batteries pose a high risk if ingested. 2) Clinical presentation depends on the location of the foreign body. Esophageal foreign bodies may cause dysphagia or chest pain. Aspirated objects often result in respiratory distress. Diagnosis involves chest x-rays, fluoroscopy, or endoscopy. 3) Emergent foreign bodies in the airway are removed using back blows, chest compressions, or the Heimlich maneuver. Bronchoscopic removal is the standard approach for aspirated objects. Ingested items usually pass

1. FOREIGN BODIES IN CHILDREN
Dr.Md.Abir Tazim Chowdhury
Resident,Phase-A
CVTS
BSMMU

2. INTRODUCTION
 Infants and young children are naturally curious
about their environment.
 It is this childhood inclination for exploration
that results in the serious problems of
aspiration, insertion, and ingestion of foreign
bodies (FBs).
 The complications of FBs in the upper and lower
airway, the gastrointestinal tract, and the ears
carry a signification morbidity and mortality.

3. FOREIGN BODIES
• What is it?
An object or piece of
extraneous matter that has
entered the body by accident
or design
Or Everything else

4. EPIDEMIOLOGY
o Possibly 1500 to 3000 deaths per year in U.S.A
o 80 % of cases are pediatric
o < 10 % of pediatric cases have esophageal
disease
o Male to female ratio in children is 2:1
o 10 to 20 % require endoscopy
o 1 % require surgery

5. ALIMENTARY FOREIGN
BODIES

6. ALIMENTARY FOREIGN
BODIES
 Most swallowed foreign bodies pass
harmlessly through the gastrointestinal
(GI) tract.
 Foreign bodies damage the GI tract, when
it lodged.
 Children with preexisting GI abnormalities
are at an increased risk for complications.

7. Foreign Body Ingestions :
Risk Factors
Developmental immaturity
Psychiatric illness
Altered level of consciousness
Structural dental abnormalities
Abnormal deglutition
High risk foods
Chicken bones
Fish bones

8. Foreign Body Ingestions :
Common Types
Coins (most common foreign body)
Toys
Batteries
Sewing needles,screws
Safety pins
Marbles
Meat : most common in adults
Fish And Chicken bones : most
common cause of perforation
etc.

9. Esophageal foreign body
 Oesophagus is the narrowest portion of
alimentary tract
 It’s a common site for FB impaction

10. Esophageal foreign body
Cricopharyngeus muscle 63%–84%
Aortic crossover mid-esophagus 10%–17%
Lower esophagus sphincter 5%–20%
Level of Retention of Aspirated Esophageal
Foreign Bodies

11. Esophageal foreign body

12. Esophageal foreign body symptoms
 Dysphagia
 Food refusal, weight loss
 Drooling, gagging
 Emesis/hematemesis
 Foreign body sensation
 Chest pain, sore throat
 Stridor, cough
 Unexplained fever
 Altered mental status

13. Esophageal foreign body sign
 Oropharyngeal abrasion
 Crepitus
 Signs of peritonitis

14. Esophageal foreign body
Investigation
 Anterior-Posterior and lateral Chest and neck
Radiograph

15. Esophageal foreign body
Investigation
 Gastrografin oesophagrum
 Oesophagoscopy

16. Oesophagrum
FIGURE 11-3 ■ A piece of chicken
became lodged in this child’s upper
esophagus. The chest radiograph was
normal, but the esophagram shows the
foreign material (arrow) obstructing the
esophagus.

17. Oesophagoscopy

18. Esophageal foreign body
Retrival Option
 Endoscopy(rigid or flexible)
 Foley ballon extruction with
fluroscopy

19. GASTROINTESTINAL FOREIGN
BODIES
 FB ingestions that are found to
be distal to the esophagus are
usually asymptomatic when
discovered

20. GASTROINTESTINAL FOREIGN
BODIES
Sign and Symptoms
 Abdominal pain
 Nausea
 Vomiting
 Fever
 Abdominal distension

21. GASTROINTESTINAL FOREIGN
BODIES
Sign and Symptoms
Features of complications
 Intestinal obstruction
 Perforation

22. SPECIAL TOPIC INGESTION
Batteries
 Significant morbidity associated with
esophageal battery impactions
 Button batteries are more commonly
ingested than cylindrical batteries
 Symptoms occur in less than 10% of
cases
 Suspected cases warrants immediate
removal

23. Batteries
Impacted oesophageal batteries complicated
as-
 Oesophageal perforation
 Tracheooesophageal fistula
 Stricture
 Stenosis
 Death

24. Batteries
FIGURE 11-9 ■ This child presented within
12 hours of swallowing an unknown foreign
body. However, the double contour rim
raised suspicion of ingestion of a button
battery. This was confirmed upon emergency
removal of the battery via rigid
esophagoscopy.

25. Batteries
FIGURE■ This infant accidentally
swallowed a lithium battery. The
battery was removed within a few
hours of its ingestion. However, 1
week later, the patient developed
respiratory distress and
bronchoscopy revealed this
tracheoesophageal fistula (arrow).

26. Magnets
 Ingestion of multiple magnets or a single
magnet and a second metallic FB are increase
risk of morbidity
 Patients may asymptomatic
 Oesophageal and Stomach magnets should
remove endoscopically
 Beyond stomach it may lead complications

27. Magnets
 Children should observe in patient
department with serial xray
 Intervention may warranted any time ,if
develops sign of obstruction or failure to
progress in >24hr

28. Magnets
This 11-year-old child
swallowed two small
magnets 24 hours prior to
presentation to the
emergency department.

29. Sharp Foreign Bodies
 Ingestion of sharp FB associated with 15-
35% risk of perforation.
 Perforation occurs most likely narrow
portions or areas of curvature in the
alimentary tract.
 Smaller objects and straight pins are low
risk can manage conservatively
 Others need endoscopic retrival (if poosible)
Or Surgical intervention (if complicated)

31. 2 year old with safety pin in the cervical esophagus

32. Bezoars
 A bezoar is a tight collection of undigested
material that may causing gastro-intestinal
obstruction.
 These includes lactobezoars, phytobezoars, or
trichobezoars.
 Symptoms -nausea, vomiting, weight loss, and
abdominal distention
 Diagnosis may be confirmed on plain
radiographs, upper GIcontrast studies, or
endoscopy.

33. Bezoars
FIGURE■ This was a gastric bezoar with extension into
the proximal duodenum found in a 12-year-old child that
presented to the hospital with obstructive signs and
symptoms. The size and density of the trichobezoar
necessitated a laparotomy for removal. The scale bar is
15 cm.

34. AIRWAY FOREIGN BODIES
oForeign body (FB) aspiration into the airway is
one of the dramatic pediatric emergencies.
oIncoordination of swallowing leads to
aspiration.

35. AIRWAY FOREIGN BODIES
oDepending on size, shape and nature, the aspirated FB
lodges in the larynx, trachea or bronchial system.
oIt is a completely treatable and to much extent
preventable situation.
oDelay in recognition and removal leads to chronic
complications.

36. PATHOGENESIS
Predisposing factor for aspiration:
(a) Oral phase, i.e., tendency to take everything into
mouth;
(b) Poor mastication;
(c) Inadequate control of deglutition;
(d) Crying /laughing while eating;
(e) Certain parental behavior patterns like thumping
or spanking while feeding, feeding a crying child, etc.

37. PATHOGENESIS
•Loss of co-ordination during swallowing results in
aspiration of foreign bodies into the airway.
•In 90% of such occasions FB are coughed out by strong
cough reflex, in only 10% it gets lodged in the airway.

38. Natural History
Three phases have been recognized in the natural
history of FB aspiration:
Phase I: "Choking" –
Immediately after aspiration, the child develops
violent cough, stridor, respiratory distress and/ or
wheezing.
Later the receptors get adapted and child passes
on to ….

39. Natural History(cont.)
 Phase II; i.e., the asymptomatic phase:
During this phase that FB aspiration is
either forgotten or neglected.
This stage may last from hours to weeks.

40. Natural History(cont.)
oPhase III is the stage of complications –In the
form of
secondary effects of airway obstruction
and/or
secondary infection. .

41. Clinical Features
1. Only 10-20% cases are larynx or tracheal FB
Presented with acute life threatening upper airway
obstruction characterized by
stridor and
suprasternal retractions.
2.80-90% cases airway FB lodge in the bronchial tree
& its presentation depends on the severity of
obstruction and mechanism involved.

42. Location of Impacted Foreign
Bodies
 Larynx 1-5%
 Trachea 5-15%
 L Main Bronchus 30-
35%
 R Main Bronchus 30-
40%
 L Lobar Bronchus 5-15%
 R Lobar Bronchus 5-15%

43. Clinical Features
The common modes of presentation of bronchial
FB are:
(a)Acute respiratory distress;
(a)Recurrent respiratory symptoms
(c) Chronic respiratory illness.

44. Clinical Features
Usually the child recovers from acute phase and
presents later in one of the following ways-
Obstructive emphysema.
Recuuent Pneumonia, non-resolving pneumonia.
Recurrent wheeze
Recurrent hemo-ptysis,
Lung abscess, or
 Bronchiectasis.

45. INVESTIGATION
(a)Plain Chest X-ray(CXR):
 A/P,Lateral view & inspiration and expiration
phase
 80% of laryngotracheal FB and
 15-28% of bronchial FB can have normal
CXR.
 A radiopaque FB is seen in only 6- 17%
patients.

46. Useful diagnostic findings are-
 Obstructive emphysema,
 segmental or lobar collapse and
 pneumonia

47. INVESTIGATION
(b) Fluoroscopy:
 Its a dynamic method of evaluation
Its more sensitive than plain X-ray.
It is most useful when radiolucent FB is suspected and
plain X-ray is inconclusive.
fluoroscopy would show phasic mediastinal shift.
Mediastinal shift during inspiration indicates the side
of FB.

48. INVESTIGATION
(A) The anteroposterior chest
radiograph shows slight
hyperexpansion of the right lung in a
four year old who aspirated
a peanut..

49. INVESTIGATION
(B) On the expiratory film, note the
increased lucency of the right lung
compared to the left. This hyper-
lucency on the right is due to air
trapping from obstruction of the right
main stem bronchus.

50. INVESTIGATION
In suspected chronic FB aspiration,
CT scan, and
Contrast study may be required.

51. Diagnosis
•With a history of choking with or without clinico-
radiologic signs.
•Diagnosis may be delayed beyond 24 hours
because of ignorance by parents or lack of a high
index of suspicion by the primary physician.
•

52. Diagnosis
• Confusion in diagnosis -
 Bronchial asthma or
 Pulmonary tuberculosis

53. Management
Signs of upper airway obstruction including
aphonia or apnea need to be urgently managed.
(a) Infants :
5 back blows with head held low followed by 5
chest compressions.
Visualize the pharynx with jaw lift, if FB is seen,
extract (avoid blind finger sweeps).
 If above measures fail, give rescue breathing,
then repeat the above procedure.

54. Emergency Management
 <1 year: 5 Back
slaps and 5 chest
thrusts
 Blind finger sweeps
should not be done

57. Management
(b) Children above 1 year (Heimlich maneuver):
6-10 abdominal thrusts, visualize pharynx, if FB is seen,
extract.
If failed, give rescue breathing, then repeat the above
procedure.
However, these measures should not be instituted in a
child who is able to speak or cry or is breathing.
.

58. Heimlich Maneuver

59.  If above measures fail:
 Urgent cricothyrotomy
 Tracheostomy.
 Endotracheal intubation with smaller
size tube

60. Management
Intubation should not be tried in cases of:
Large FB,
Subglottic FB
Certain seeds such as tamarind seeds, as they
can slip down and straddle across the carina,
Similarly postural drainage should not be
attempted.

61. Management
Bronchoscopy.
Rigid bronchoscopes are the best.
 Flexible bronchoscopes are generally not
preferred.
.

62. Management
(A) This young child accidentally
aspirated this nail which was found to
be in the left main stem bronchus on
chest radiography.

63. Management
(B) At bronchoscopy,
with the bronchoscope in the trachea,
the nail is seen to be peering out of the
left main stem bronchus.

64. Management
(C) The nail was removed, and the
child recovered uneventfully. Note the
size of the nail relative to the child’s
face and
mouth..

65. Management
 Chronic bronchial FB may
require:
 Thoracotomy or lobectomy

66. EAR AND NOSE FOREIGN BODIES
NASAL FBs
 FB in the nose may
leadsinflammation&infection.
 Common objects placed are dried beans, plastic
objects, buttons,metals, food, erasers, nuts,
seeds, and button batteries.
 Presenting signs and symptoms - rhinorrhea,
crusting, air flow obstruction, rhinitis,sinusitis,
lymphadenopathy, epistaxis, otitis media,and
adenoiditis

67.  Button batteries may lead to septal perforation
and destruction of cartilage, leading to a saddle-
nose deformity

68. FOREIGN BODIES

69. FOREIGN BODIES