Acute foreign body obstruction of the airway in children

Background. Acute airway obstruction by a foreign body in children is a life-threatening emergency respiratory condition. Respiratory foreign body aspiration mostly occurs in children up to 3 years of age. Food and in particular nuts are the most commonly ingested respiratory foreign bodies. Acute airway obstruction is present with a laryngeal or tracheal position of the foreign body. Diagnosis. Acute, sudden and severe coughing and/or choking sometimes accompanied by stridor and dyspnea are characteristic of a respiratory foreign body aspiration. Foreign bodies with a laryngeal or tracheal position may rapidly lead to respiratory insufficiency, decreased levels of consciousness and circulatory arrest. Severe bronchial obstruction, infectious or allergic upper airway obstruction or airway obstruction caused by a large esophageal foreign body should be excluded. Management. Children with acute airway obstruction by a foreign body with or without dyspnea and danger of suffocation but still with effective coughing and breathing have to be transferred by an emergency physician to a pediatric bronchoscopy unit without undertaking any external maneuvers at the scene. In awake children with inefficient coughing back slapping and thoracic compression in infants or abdominal compression in children aged less than 1 year old have to be performed to help the child to expel or to move the obstructing object to a more advantageous position. In children with asphyxia and loss of consciousness artificial ventilation should be started and if there is no reaction with ventilation, extrathoracic cardiac compression or cardiopulmonary resuscitation must be started. Experienced first aiders should inspect the larynx by direct laryngoscopy to remove or push a foreign body down into a main stem bronchus and ventilate the other lung using an endotracheal tube. Every child suffering from acute severe coughing or choking, even without symptoms must undergo bronchoscopic control to exclude or remove a residual foreign body, which can potentially cause secondary airway obstruction or poststenotic complications.