Aspiration of food and non-food items is a common problem in paediatric populations, and represents a potential medical emergency. This is a brief overview of the identification and management of the above. Sources for all imagery and sources listed in references section where possible. I do not claim ownership of any images or graphics. Slides for educational purposes only, and should not replace clinical judgement. No monetary gain was made for this work.

1. Dr. Robert Ferris

2. Patient Case:
 3y/o, F
 Brought directly to ED by parent
 Had inserted small piece of Lego into R nostril while
playing
 No facility for GP visit at time
 Witnessed by parent, who was confident that no other
foreign bodies were inserted

4. Examination
 Child alert, oriented, not distressed
 No apparent breathing difficulty
 Vitally stable
 Lego piece could be visualised deep in R nasal cavity
using pen torch
 Radiological exam deemed unnecessary

7. Foreign Body Aspiration
 Most common in children 1-3 years old
 Can walk
 Undeveloped teeth
 Explore the world with their mouths
 Usually food items, but toys or other small objects
(buttons, small caps etc.) are also common
 Swallowed objects usually pass
through GI system unaided,
however aspiration is a
potentially life-threatening
emergency
(8)

8. Signs on Exam
 Agitation + distress
 Abnormal breath sounds on auscultation
 ↓ in flow distal to obstruction
 Wheeze + stridor, unilateral
 Tachypnoea
 Laboured breathing +/- croupy cough
 Impaired/total loss of speech in older children
 Absence of the above does not rule out foreign body
aspiration!
(1, 9)

9. (1)
Many CXRs will not illustrate a radiolucent foreign body, but may still show
• mediastinal shift
• lobar collapse or pneumothorax
• oedema
• air trapping and atelectasis

10. Management
 Urgency of intervention determined by clinical picture
 Avoid attempts at blind-removal of foreign body
In an emergency:
 Back blows
 Chest thrusts/abdominal thrusts in older children
 Bronchoscopy → removal via forceps
 Cricothyrotomy/tracheostomy may be required in extreme
cases
(8, 9)

11. Back to our
case...

12. (3)
Despite object being visualised, its depth in the nasal cavity meant that attempting
forceps removal may inadvertently push the piece back into the nasopharynx →
aspiration risk.

13. ‘Parent’s Kiss’ technique
Modified (6)
2, 4, 5, 7

14. Attempted fixing and removal with wound glue tip was
considered in lieu of removal by forceps, however the risk of
gluing the nasal mucosa is high and success would require good
cooperation from patient.
This method was ultimately not attempted.

15. Despite best efforts...
 Pt. Would ultimately not comply with removal
attempts, regardless of attempted bribery with stickers
 Referred to ENT

16. References
1. Rovin, J and Rogers, B (2000); ‘Pediatric Foreign Body Aspiration’, Pediatrics in Review
21 (3) 86-90, accessed at https://pedsinreview.aappublications.org/content/21/3/86 on
31/08/2020
2. Purohit, N, Ray, S, Wilson, T and Chawla, OP (2008); ‘The ‘Parent's Kiss’: An Effective
Way to Remove Paediatric Nasal Foreign Bodies’, Annals of the Royal College of Surgeons
of England 90(5): 420–422
3. Nickson, C (2019); ‘Nasal foreign body’, Life In The Fast Lane, accessed at
https://litfl.com/nasal-foreign-body/ on 31/08/2020
4. Mann, D (2012); ‘'Mother’s Kiss' Can Remove Objects From Kids' Noses’, WebMD,
accessed at https://www.webmd.com/children/news/20121015/mothers-kiss-expel-
foreign-objects-kids-noses on 31/08/2020
5. Royal Australian College of General Practitioners (2013); ‘Mother’s kiss: nasal foreign
bodies’, RACGP Handbook of Non-Drug Interventions, accessed at
https://www.racgp.org.au/getattachment/b56b4770-4fd4-4bbf-9a0f-
dd85c5faf00f/Mother-s-kiss-nasal-foreign-bodies.aspx on 31/08/2020
6. Benjamin, E (2012); ‘Modified Parent’s Kiss’, YouTube, accessed at
https://www.youtube.com/watch?v=Smr0wcXJnbo on 31/08/2020
7. Cook, S, Burton, M, Glasziou, P (2012); ‘Efficacy and safety of the “mother’s kiss”
technique: a systematic review of case reports and case series’, Canadian Medical
Association Journal 184(17): E904–E912
Thank you.
Questions?

17. References (contd.)
8. The University of Chicago (2013); ‘Foreign Body Aspiration’, Pediatrics Clerkship, accessed at
https://pedclerk.bsd.uchicago.edu/page/foreign-body-aspiration on 11/09/2020
9. Hadi, N. (2017); ‘Foreign Body Aspiration in Children’, SlideShare, accessed at
https://www.slideshare.net/balsamalzaman9/foreign-body-aspiration-in-children on
11/09/2020
10. Children’s Health (2020); ‘What to do if your child swallows a penny – or other object’, accessed
at https://www.childrens.com/health-wellness/what-to-do-if-your-child-swallows-an-object
on 11/09/2020
11. Wormley, M. (2015); ‘Foreign-Body Aspiration: A Pediatric Airway Emergency’, EM Resident,
accessed at https://www.emra.org/emresident/article/foreign-body-aspiration-a-pediatric-
airway-
emergency/#:~:text=Blind%20sweeping%20of%20the%20mouth,forceps%20should%20be%20
attempted%20emergently on 13/09/2020