According to the National Safety Council, choking was the fourth
leading cause of unintentional injury-related death in the United
States in 2000, and the leading cause of death for children under
age 12 months. In the same year, the Centers for Disease Control
and Prevention (CDC) reported that 160 children under age 14 years
died from inhaled or ingested foreign bodies. Of the objects that
caused death, 41% were food items and 59% were
nonfood. Although children of all ages are at risk, most (75–90%)
documented aspirations of foreign bodies by children involve preschoolers.
The approximate distribution by age is under 1 year is 10% to 15%;
1 to 2 years 40% to 50%; 2 to 3 years 15% to
25%; and over 3 years 15% to 20%. Statistics
show that boys aspirate foreign bodies more often (2:1) than girls.
Fortunately, most choking episodes are nonfatal. They are common,
however, an estimated 17,537 children younger than 14 years were
treated in US emergency departments (ED) for choking episodes in
2001. Sixty percent of nonfatal choking episodes were associated
with non-food items. Coins were involved in 18% of all choking-related
ED visits for children ages 1 to 4 years.1
During their orally focused phase of development, infants and
younger children are likely to place anything, both edible and inedible,
into their mouths. Choking and aspiration may occur because they
have not yet developed molar teeth; the coordination of the mechanisms
for swallowing and airway protection are not fully mature; the object
is inedible in the first place, or they are trying to climb and
run at the same time as they are chewing. Adolescents most often
aspirate nonfood items; they may absentmindedly chew on objects
such as pen caps, or hold items that are in use, like head scarf
pins, in their mouths. Large case studies indicate that nuts, peanuts,
raw carrots, apple slices, and beans account for over half of all
foreign-body aspirations by children. Toys and toy parts, and other
small objects such as Velcro diaper tabs and button batteries, make
up the rest. One report of 103 asphyxiation deaths of young children
by food identified hot dogs (17%) as the single most common
aspirated food, followed by candy, peanuts, nuts, and grapes.
Although foreign bodies in the larynx and tracheobronchial tree
are most likely to cause airway obstruction, occasionally an esophageal foreign
body will also result in airway obstruction (see Chapter 395).
Therefore, if the patient develops symptoms of airway obstruction
after swallowing a foreign object, a diagnostic workup that may
include radiographic evaluation and endoscopy are still required
for management and removal. It is also possible for a patient to
cough up, and subsequently swallow, a foreign body from the larynx
or tracheobronchial tree; conversely, a patient may regurgitate
a foreign object or piece of food from the esophagus into the airway.
Finally, foreign bodies may lodge in the nasopharynx, either primarily
or as a result ...