Foreign body

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Introduction

Children are prone to injury from foreign bodies because of their curiosity and desire to taste and manipulative objects and toys. It is this childhood inclination for exploration that results in the serious problems of aspiration, insertion, and ingestion of foreign bodies. The complications of foreign bodies in the upper and lower airway, the gastrointestinal tract, and the ears carry a signification morbidity and mortality.

A) Foreign body aspiration

Foreign body aspiration results in airway obstruction and hypoxia. It is usually seen in children <5 years of age.

Commonly aspirated foreign bodies

Commonly aspirated foreign bodies by children are following as:

  • Coins
  • Round candies
  • Food such as carrot, peanut
  • Buttons and beads
  • Seeds

Etiology

  • Majority of aspirations in children younger than 3 years
  • Love to put things in their mouth
  • Lack of efficient molars
  • Activity while eating
  • Boys outnumber girls 2:1
  • Anatomically abnormal airway
  • Neuromuscular disease
  • Poorly protected airway (e.g., alcohol or sedative overdose)

Clinical features

Features of foreign body in larynx:

  • Stridor
  • Hoarseness
  • Aphonia
  • Dyspnea, wheezing and cyanosis

Features of foreign body in trachea:

  • Coughing
  • Asthma
  • Dyspnoea
  • Cyanosis

Features of foreign body in bronchi:

  • Wheezing, if there is partial airway obstruction
  • Hoarseness and stridor may be present
  • If there is partial obstruction, the child may be able to ventilate well
  • If there is complete obstruction, no air by passes the obstruction, so no breath sounds are heard

Diagnostic evaluation

  • Suggestive history more likely with youngest and oldest children.
  • Witnessed choking episode has a sensitivity of 76-92% for diagnosing aspiration.
  • Plain radiographic studies.
  • 10% of objects are radio opaque.
  • Normal in about 65% of studies.
  • Often indirect evidence of obstruction.
  • Various techniques to improve diagnostic likelihood • Fluoroscopy • CT/MRI 

Management

  • Laryngeal foreign body needs to be removed by rigid endoscope.
  • Tracheotomy may be required with severe degree of dyspnea.
  • Bronchoscopy is necessary to removal of the bronchial and tracheal foreign body.
  • Antibiotics are needed for secondary infections.

Nursing care management

  • A major role of nurse is to recognize the signs of foreign body aspiration and implement immediate measures to relieve the obstruction.
  • Choking on food or other material should not be fatal.
  • Two simple procedures-Back blows and the Heimlich maneuver which can used by health professionals can save lives.
  • A child who is choking nurses need to recognize the signs of distress.
  • Teach parents not to feed peanuts and popcorn to their child until he or she is at least 3years old.
  • Harmful liquids should be kept out of the reach of children

B) Foreign body in ear

Foreign bodies in the ear canal can be anything a child can push into his or her ear. The foreign body may remain in ear for several days before generating enough inflammatory response to alert parents for seeking medical attention.

Items commonly put in ears

  • Food
  • Insects
  • Toys
  • Buttons
  • Pieces of crayon
  • Small batteries

Diagnostic evaluation

  • It is usually based on history of ear pain and purulent drainage.
  • The foreign object can be visualized through an otoscope unless excessive purulent drainage present.

Treatment

  • Instruments may be inserted in the ear
  • Magnets are sometimes used if the object is metal
  • Flushing the ear canal with water
  • A machine with suction to help pull the object out
  • After removal of the object, your child’s healthcare provider will then re- examine the ear to determine if there has been any injury to the ear canal.
  • Antibiotic drops for the ear may be prescribed to treat any possible infections.

C) Foreign body in nose

Children can insert foreign body in their nose. It is very common and easy to diagnose.

Items commonly put in nose

  • Tissue
  • Clay
  • Pieces of toys
  • Erasers

Clinical features

  • Foul smelling nasal discharge from one nostril
  • Wheezing sound
  • Pain in nose
  • Swelling in nose
  • Rhinolith
  • Respiratory destruction

Management

  • The nose is examined by simply lifting the nose with examiner’s thumb.
  • Nasal speculum can also be used for examining the nasal cavity.
  • If the object is poorly visualized or can not be successfully removed by direct instrumentation, in this case balloon-catheter removal method is used.
  • Large, occlusive nasal foreign bodies may be removed by either positive pressure technique or under general anesthesia.

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