Foreign Body Aspiration

Overview

Foreign body aspiration happens when an object is inhaled into the airway or lungs rather than swallowed into the stomach. The object can be food, such as a piece of nut, seed, or hot dog, or a small item such as a coin, bead, button battery, or part of a toy. It is most common in young children, who tend to put things in their mouths, and in older adults, particularly those with swallowing difficulties.

A large object that blocks the main airway is a life-threatening emergency because it can stop breathing within minutes. Smaller objects may lodge deeper in the lungs and cause symptoms over time, such as cough, wheezing, or repeated infections. Both situations need medical attention.

Symptoms

Symptoms depend on the size of the object and where it lodges:

• Sudden severe choking, gagging, or coughing.
• Inability to speak, cry, breathe, or cough, with possible clutching of the throat, which signals a complete blockage and is an emergency.
• High-pitched noisy breathing or wheezing.
• Bluish color of the lips or face from lack of oxygen, which is an emergency.
• Persistent cough, wheezing, or chest discomfort if the object lodges deeper.
• Recurrent pneumonia or lung infections in the same area, sometimes the only clue when an object is inhaled without anyone noticing.

In some cases, especially in children, the initial choking event is brief and is followed later by ongoing cough or breathing problems.

Causes

Aspiration occurs when the normal protective reflexes that direct food and objects into the esophagus fail and the item enters the airway instead. Contributing situations include:

• Putting small objects or food in the mouth, common in toddlers.
• Eating quickly, talking, or laughing while eating.
• Foods that are hard, round, or slippery, such as nuts, grapes, hard candy, and pieces of hot dog.
• Swallowing difficulties from stroke, neurological conditions, or aging.
• Reduced alertness from alcohol, sedatives, or certain medical conditions.
• Dental problems or poorly fitting dentures.

Risk Factors

Factors that increase the risk of aspiration include:

• Being a young child, especially under age three.
• Older age with weakened swallowing or cough reflexes.
• Neurological conditions such as stroke or Parkinson disease that affect swallowing.
• Reduced consciousness from sedatives, alcohol, or illness.
• Dental problems or missing teeth that affect chewing.
• Eating while distracted, rushing, or lying down.

Diagnosis

When the airway is not completely blocked, doctors diagnose aspiration using the history and tests:

• History and examination, including any witnessed choking event and listening to the lungs for reduced or noisy breathing on one side.
• Chest X-ray, which can show some objects directly and may reveal lung changes such as trapped air or collapse.
• CT scan for more detail in some cases.
• Bronchoscopy, in which a thin scope is passed into the airway to look directly for and remove the object. This is both a diagnostic and treatment tool.

Because many objects do not show up clearly on X-ray, a strong suspicion based on the story is often enough to proceed to bronchoscopy.

Treatment

Treatment depends on whether the airway is blocked:

• For a choking emergency with a complete blockage, immediate first aid is needed. For adults and children over one year, abdominal thrusts (the Heimlich maneuver) are used; for infants under one year, a combination of back blows and chest thrusts is recommended. Call emergency services right away, and begin CPR if the person becomes unresponsive.
• For objects that have reached the lungs, removal is usually done with bronchoscopy under controlled conditions.
• Antibiotics may be needed if an infection such as pneumonia has developed.
• Supportive care, including oxygen, may be provided.

People should not try to remove a deeply lodged object themselves, as this can push it further or cause injury.

Prevention

Many aspiration events can be prevented, especially in children:

• Cut food for young children into small pieces and avoid hard, round foods such as whole nuts, whole grapes, and hard candy for toddlers.
• Keep small objects, coins, button batteries, and small toy parts out of children's reach.
• Encourage sitting upright and not talking, laughing, or rushing while eating.
• For people with swallowing problems, follow recommended diet textures and feeding precautions.
• Supervise young children while they eat and play.

When to See a Doctor

Call emergency services immediately if a person cannot breathe, speak, cry, or cough; is making high-pitched noises; or turns blue. Begin choking first aid right away while help is on the way, and start CPR if the person becomes unresponsive.

Even if a choking episode seems to resolve, see a doctor if there is ongoing cough, wheezing, noisy breathing, or chest discomfort, since an object may remain in the lungs. Also seek care for repeated lung infections in the same area, which can be a sign of an inhaled object that went unnoticed.

Related Topics

Frequently Asked Questions

References

1. American Red Cross. Choking first aid.
2. Mayo Clinic.
3. MedlinePlus, U.S. National Library of Medicine.
4. American Academy of Pediatrics.