What is the management for a pediatric patient with a foreign body (candy) lodged in their throat?

Management of Foreign Body (Candy) Lodged in a Pediatric Patient's Throat

For pediatric patients with a candy lodged in their throat, first determine if the airway obstruction is mild or severe, then provide appropriate interventions based on severity. For severe obstruction in children, perform abdominal thrusts (Heimlich maneuver); for infants, use 5 back blows followed by 5 chest compressions until the candy is expelled or the child becomes unresponsive. 1

Initial Assessment: Determining Severity

The management approach depends on whether the foreign body airway obstruction (FBAO) is causing mild or severe symptoms:

Signs of Mild Obstruction:

• Child can cough effectively
• Can make sounds
• Can breathe, though may have some difficulty

Signs of Severe Obstruction:

• Unable to cough effectively or at all
• Unable to make any sounds
• Unable to breathe
• Cyanosis (blue discoloration)
• Decreased level of consciousness

Management Algorithm

For Mild Obstruction:

• Do not interfere with the child's attempts to clear the airway 1
• Allow the child to cough and expel the candy naturally
• Closely monitor for signs of deterioration to severe obstruction
• Position the child in a comfortable position that facilitates coughing

For Severe Obstruction:

In Children (>1 year):

1. Perform subdiaphragmatic abdominal thrusts (Heimlich maneuver)
2. Continue until the candy is expelled or the child becomes unresponsive 1

In Infants (<1 year):

1. Position the infant face down along your forearm with head lower than trunk
2. Deliver 5 back blows (slaps) between the shoulder blades
3. Turn the infant over and deliver 5 chest compressions
4. Repeat these cycles until the candy is expelled or the infant becomes unresponsive 1
   • Important: Do NOT perform abdominal thrusts on infants as this may damage their relatively large and unprotected liver 1

If Child Becomes Unresponsive:

1. Begin CPR with chest compressions (do not check pulse first)
2. After 30 chest compressions, open the airway
3. If you can see the foreign body, remove it
4. Do not perform blind finger sweeps as they may push the candy further into the pharynx 1
5. Attempt to give 2 rescue breaths
6. Continue cycles of compressions and ventilations
7. After 2 minutes, activate emergency medical services if not already done 1

Special Considerations

• Age-related risk: More than 90% of childhood deaths from foreign body aspiration occur in children under 5 years of age 1
• High-risk foods: Round candies are among the most common causes of choking in children 1
• Avoid blind finger sweeps: This can push the object further into the airway 1
• Subtle presentations: Some foreign body aspirations may present with minimal symptoms and can be easily missed, leading to delayed diagnosis 2
• Post-expulsion monitoring: Even after successful removal of the candy, monitor the child for potential complications such as aspiration pneumonia or airway injury

When to Seek Emergency Medical Care

Activate emergency medical services immediately if:

• The child becomes unresponsive
• The obstruction persists despite appropriate interventions
• The child has significant respiratory distress even after apparent clearing of the obstruction
• There is uncertainty about complete removal of the foreign body

Remember that early recognition and appropriate management of foreign body airway obstruction are critical for preventing morbidity and mortality in pediatric patients.