Foreign Body Ingestion

Question 1

What are the initial steps if the child is in respiratory distress or has signs of complete airway obstruction (severe stridor, cyanosis, altered mental status)?

Answer 1

Perform back blows and chest thrusts for infants under 1 year old.

Perform abdominal thrusts (Heimlich maneuver) for children >1 year and adults.

Direct laryngoscopy or bronchoscopy is performed immediately in the operating room (OR) or emergency department (ED) to visualize and remove the foreign body. In cases of complete obstruction, waiting for imaging is a waste of precious time. Immediate direct laryngoscopy is required to assess the airway, and if the object is not visualized or retrievable, rigid bronchoscopy is performed in the OR.

Question 2

What are the initial steps is the child has partial airway obstruction (stridor, but stable vital signs, oxygen saturation ≥ 90%, and no severe respiratory distress)?

Answer 2

Order a chest X-ray (PA and lateral views) to identify the foreign body. Most foreign bodies (like nuts, food, and plastic toys) are radiolucent, so they won’t appear on X-ray, but you may see indirect signs (e.g., air trapping, atelectasis, mediastinal shift) or a visible radio-opaque object (e.g., coin, battery, metal objects).

If the X-ray is inconclusive but clinical suspicion is high (based on choking history, stridor, or persistent respiratory symptoms), the next step is a rigid bronchoscopy.

Question 3

What changes the manner of how an obstruction is approached?

Answer 3

The degree of obstruction:

complete airway obstruction
(severe stridor, cyanosis, altered mental status)

partial airway obstruction
(stridor, but stable vital signs, oxygen saturation ≥ 90%