Foreign Bodies in the Airway

Children put many things in their mouths (including food) that can cause trouble. When you know that a child has ingested a foreign object, consider this a medical emergency and seek immediate attention. If your child is choking – cannot breathe, is gasping, cannot talk, or is turning blue – call 911 or an ambulance immediately.

Parents should be alert for these commonly ingested items:

Pebbles	Nuts
Hot dogs	Toy parts
Grapes	Buttons
Seeds	Marbles
Small button-shaped batteries	Coins (especially newer pennies)

Aside from choking, trouble may happen if the object becomes lodged in the "airway" tube (trachea) instead of the "eating" tube (esophagus), which may make the child's distress harder to see.  Children may experience symptoms differently; some children can even have vague symptoms that do not immediately suggest ingestion.  While most swallowed foreign objects pass harmlessly through the esophagus, the stomach, and intestines, a foreign body may also cause harm if it has associated toxicity or becomes lodged in the gastrointestinal tract.

Parents should suspect their child might have swallowed a foreign object if breathing or swallowing difficulties persist longer than two weeks despite medical treatment. For example, continuing asthma or upper respiratory treatment without seeing improvement.

If you know that your child has swallowed a foreign object look for these symptoms of choking first, and then look next for signs of obstruction:

• Not breathing, unconscious;
• Choking or gagging when the object is first inhaled;
• Inability to speak;
• Blueness around the lips.

Signs of airway obstruction:

• Stridor (a high pitched sound usually heard when the child breathes);
• Cough that gets worse;
• Inability to speak;
• Pain in the throat area or chest;
• Hoarse voice;
• Blueness around the lips;
• Not breathing, unconscious;
• Unexplained fever.

Signs of gastrointestinal (GI) blockage:

If you are fairly sure that a foreign body has been swallowed and your child is not experiencing an airway obstruction, continue to watch for the following:

• Vomiting;
• Blood in the stool;
• Unexplained fever
• Abdominal distention/pain

Toxicity is another consequence of ingestion that may cause problems. Coins (for instance newer copper-coated zinc pennies) and batteries may cause system-wide reactions because some metals are extremely toxic and may cause inflammation.

Treatment for foreign bodies in the airway

Treatment of the problem varies with the degree of airway blockage. If the object is completely blocking the airway, the child will be unable to breath or talk and his/her lips will become blue. This is a medical emergency and you should seek emergency medical care.

Sometimes, surgery is necessary to remove the object. Children that are still talking and breathing but show other symptoms also need to be evaluated by a physician immediately.

Follow these steps if your child is unconscious: Call 911 or an ambulance. Lay the child on the floor on his/her back. Place one hand on the child's abdomen and cover it with your other hand, then press on the abdomen four times. (This should release the object that is obstructing the airway.) Repeat this life saving procedure until the ambulance arrives. Make sure you tell the medical team immediately what caused the child to choke or what obstructs the breathing so that proper treatment can be administered.

© 2004 AAO-HNS/AAO-HNSF