What are the most common risk factors for Foreign Body (FB) aspiration?

From the Guidelines

Children under 5 years of age, particularly infants, are at the highest risk for foreign body aspiration, with liquids, balloons, small objects, and certain foods being the most common causes of foreign-body airway obstruction (FBAO) 1. The most common risk factors for foreign body aspiration include age, with more than 90% of childhood deaths from foreign-body aspiration occurring in children under 5 years of age, and 65% of the victims being infants 1.

• Young children are especially vulnerable due to their tendency to explore objects orally, immature swallowing coordination, smaller airways, and lack of molar teeth for proper chewing.
• Liquids are the most common cause of choking in infants, whereas balloons, small objects, and foods (such as hot dogs, round candies, nuts, and grapes) are the most common causes of FBAO in children 1.
• Signs of FBAO include a sudden onset of respiratory distress with coughing, gagging, stridor, or wheezing, and a sudden onset of respiratory distress in the absence of fever or other respiratory symptoms suggests FBAO rather than an infectious cause of respiratory distress 1. Prevention strategies include proper supervision of young children, avoiding high-risk foods for toddlers, cutting food into small pieces, and ensuring proper positioning during meals for those with swallowing difficulties.
• Recognizing these risk factors is essential for prevention and prompt identification of aspiration events, and can help reduce the morbidity, mortality, and impact on quality of life associated with foreign body aspiration 1.

From the Research

Foreign Body Aspiration Risk Factors

• Age: Children under 3 years old are at a higher risk of foreign body aspiration 2, 3, 4
• Lack of supervision: Inadequate supervision by caregivers, such as parents or teachers, can increase the risk of foreign body aspiration 2
• Food items: Certain food items, such as peanuts, sunflower seeds, and mozzarella cheese, are commonly aspirated by children 2, 3, 4
• Non-food items: Older children and adults are more likely to aspirate non-food items, such as pen caps, pins, paper clips, and needles 3, 4, 5
• Asymptomatic period: An asymptomatic period after aspiration can lead to a delay in diagnosis, increasing morbidity and mortality 3

High-Risk Foods and Objects

• Foods:
  • Peanuts 3
  • Sunflower seeds 4
  • Mozzarella cheese 2
  • Pear 2
  • Raw beans 2
• Non-food items:
  • Pen caps 3
  • Pins 3
  • Paper clips 3
  • Needles 4, 5
  • Pebbles 2