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Foreign body aspiration in children
A toddler aged 1–3 with a sudden coughing fit while eating (usually nuts), followed by wheeze or reduced air entry on one side, has aspirated a foreign body until proven otherwise; a normal X-ray does not exclude it, and diagnosis and treatment are by rigid bronchoscopy.
Why it matters in the exam
The question describes a child treated for "asthma" or "pneumonia" without improvement, whose history includes a choking episode while eating peanuts. A history of choking is the most sensitive finding. Examination shows unilateral wheeze, cough and reduced air entry; in most cases the foreign body is not visible on X-ray, so indirect signs such as unilateral hyperinflation on an expiratory or lateral decubitus film are sought.
The second part of the questions is first aid for complete obstruction: an infant under one year — 5 back blows and 5 chest thrusts; a child over one year — abdominal thrusts (Heimlich); a child who loses consciousness — CPR, and before each breath look in the mouth and remove a foreign body only if it is seen. Blind finger sweeps are forbidden. A child who is coughing forcefully and talking — do not intervene, encourage coughing and refer.
Separate an oesophageal foreign body: a coin in the oesophagus appears as a full circle on an AP film, and a button battery appears as a circle with a "double halo". A button battery in the oesophagus is an emergency that needs immediate endoscopic removal, because it causes a burn within two hours; in a child aged one year or more, within 12 hours of ingestion, honey may be given on the way to hospital. Swallowing several magnets is dangerous because of perforation.
Key points
- Peak age 1–3; nuts are the commonest foreign body.
- A choking history is the most sensitive finding; the X-ray is usually normal.
- Diagnosis and treatment: rigid bronchoscopy.
- Infant: 5 back blows and 5 chest thrusts; child: abdominal thrusts.
- Button battery in the oesophagus — immediate removal.
Summary table
| Situation | Finding | Work-up | Treatment |
|---|---|---|---|
| Airway aspiration | Choking episode, unilateral wheeze, reduced air entry | Expiratory or decubitus film; the object is usually not seen | Rigid bronchoscopy |
| Complete obstruction, infant under one year | Cannot cry or breathe | Clinical | 5 back blows and 5 chest thrusts, repeated |
| Complete obstruction, child over one year | Cannot speak, silent cough | Clinical | Abdominal thrusts until relief or loss of consciousness |
| Loss of consciousness | Not breathing | — | CPR; look in the mouth before breaths, no blind sweeps |
| Button battery in the oesophagus | Drooling, pain, food refusal or no symptoms | X-ray: circle with a double halo | Immediate endoscopic removal; honey from age one on the way |
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Sources
- AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care — Pediatric Basic Life Support, 2020 (with 2025 update) — Relief of foreign-body airway obstruction
- Nelson Textbook of Pediatrics, 22nd edition (2024) — Foreign Bodies in the Airway
- National Capital Poison Center button battery ingestion triage and treatment guideline, 2018 (current) — Pre-hospital honey and urgent endoscopy
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.