Foreign body aspiration happens when a child, usually between 1 and 3 years old, breathes a small object such as a nut, grape or toy piece into the airway. A complete blockage is an emergency, while a partial one may cause a cough or wheeze that lasts for days.
Key symptoms
- Sudden choking or coughing fit while eating or playing
- New wheeze or noisy breathing
- Cough that does not go away
- Unable to cry, speak or breathe if the blockage is severe
- Repeated pneumonia in the same area if the object is missed
What you find on exam
- Work of breathing and ability to cry, speak or cough
- Wheeze or reduced breath sounds on one side
- Stridor if the object is high in the airway
- Oxygen saturation and color
Tests
- Chest X-ray with inspiratory and expiratory views: air trapping on one side
- A normal X-ray does not rule it out; most food objects do not show
- Rigid bronchoscopy to confirm and remove the object
Treatment basics
- Complete blockage in a child: abdominal thrusts; in an infant: 5 back blows and 5 chest thrusts
- No blind finger sweeps in the mouth
- If the child becomes unresponsive, start CPR and look in the mouth before each breath
- Partial blockage: keep the child calm, give oxygen and transport
- Rigid bronchoscopy in the operating room to remove the object
Red flags
- Cannot cry, speak or cough
- Cyanosis or decreasing consciousness
- Stridor or severe breathing distress
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Related guides
Sources: NREMT psychomotor skill sheets (EMT and Paramedic); NASEMSO National Model EMS Clinical Guidelines; NCCPA PANCE Content Blueprint. Written by Making Synapses. Making Synapses is not affiliated with these organizations.