A foreign body is any object that is not human. It can be a piece of food, a toy, a coin, or the top to a medicine container. It is possible for a foreign body to get stuck in a child’s airway or lung. Although this is really not very common, it can be serious or even fatal.
The mechanism for how this happens is called aspiration. When a child aspirates, something that was in his mouth gets swept down into the airway or lung with a deep breath. Often aspiration is accompanied by coughing or gagging, but sometimes not. Small objects, such as a button or popcorn kernel, make it down to the deep part of the lung; bigger objects, such as a wheel from a toy car or a piece of a hot dog, get stuck higher up in the airway. Given the way the right and left bronchi are shaped, it is more common for objects to wind up on the right side of the lung than the left.
The degree of seriousness depends on how much the object is obstructing the passage of air. A big foreign body, such as a grape, can become lodged in the trachea or main stem bronchus. Such a blockage can almost completely restrict the passage of air down to the lungs, causing shortness of breath and even respiratory distress. Big pieces lodged up high can also cause irritation, so coughing, gagging, or choking frequently accompanies this scenario.
A small foreign body, such as a bead, can travel much farther into the lungs. In this case, there is usually very little difficulty breathing (especially right after the incident) because only a small section of the lung is affected. But eventually, inflammation will develop in the area where the object has settled. Both the foreign object and the inflammation may lead to infection.
What can I do?
If your child is not breathing, start CPR and have someone call 911 immediately. If your child is choking, you can give back blows or use the Heimlich maneuver. Following the maneuver, sweep the mouth with your fingers to find and remove the object. Specific details about how to deal with choking are covered in basic first aid courses, and the importance of taking one of these courses cannot be overstated. It is worth noting that if your child is able to speak, it is not recommended to attempt the Heimlich maneuver or back blows. Likewise, if your child is awake, it is not recommended to check the mouth with your fingers.
If you aren’t sure whether your child has aspirated something but he is breathing comfortably, there is not much you can (or need to) do at home. You need to see a doctor. To avoid aspiration in the first place, make sure to keep all small toys out of the reach of a child. This is especially important around infants and young toddlers, who often put things into their mouths. Sort through an older child’s toys and remove any pieces that might present a choking hazard to your infant or young toddler. Anything the size or shape of a grape can pose a hazard. Instruct your older child never to feed your infant or young toddler solid food. It is probably best to avoid having foods the size and shape of a grape in the house.
When does my doctor need to be involved?
Anytime you think your child has aspirated, you need to see a doctor.
What tests need to be done, and what do the results mean?
The first and most important step is for a doctor to listen to your child’s breathing. Sometimes it is possible to diagnose aspiration when air movement through the chest is audible in some parts of the lung but not others.
Usually, if aspiration is suspected, a chest X ray is done. Unless it is made of metal or another material that shows up on an X ray, the object that was aspirated will not be visible. But a collapsed lung behind the object or fluid pooling around the object will be visible to someone who knows how to interpret X rays. If the X ray is inconclusive, other tests such as a CT scan may be done to help make the diagnosis.