From the Guidelines
A retained foreign body in an infant's throat typically presents with sudden onset of respiratory distress, choking, gagging, coughing, drooling, or refusal to eat, and may also exhibit stridor, wheezing, or decreased breath sounds if the airway is partially obstructed. The infant may appear anxious, irritable, and may have other symptoms such as fever, foul breath, or neck swelling later due to infection 1. If the foreign body has been present for some time, symptoms can include recurrent pneumonia, chronic cough, or unexplained wheezing.
Some key points to consider in the presentation of a retained foreign body in an infant's throat include:
- Sudden onset of respiratory distress
- Choking, gagging, coughing, drooling, or refusal to eat
- Stridor, wheezing, or decreased breath sounds
- Anxiety, irritability, fever, foul breath, or neck swelling
- Recurrent pneumonia, chronic cough, or unexplained wheezing if the foreign body has been present for some time
Immediate medical attention is essential if a foreign body is suspected. Do not attempt to remove the object yourself as this could push it further down. Instead, if the infant is in severe distress with complete airway obstruction, perform back blows and chest thrusts appropriate for infants, as recommended by the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. Foreign bodies are dangerous because they can cause complete airway obstruction leading to respiratory arrest, or they can cause inflammation, infection, and damage to surrounding tissues if left in place.
In terms of diagnosis, flexible endoscopy of pediatric airways can be used to evaluate the airways and diagnose foreign body aspiration, as well as other conditions such as congenital malformations of the tracheo-bronchial tree, and recurrent or persistent atelectasis 1. However, the decision to perform flexible endoscopy should be made on an individual basis, taking into account the patient's history, physical examination, and the results of previous diagnostic tests.
It is also important to note that the diagnostic yield of flexible endoscopy will depend on the population studied, and the previous investigation and treatment performed. Therefore, it is essential to carefully evaluate the indications for flexible endoscopy and to consider the potential risks and benefits of the procedure in each individual case.
From the Research
Presentation of Retained Foreign Body in the Throat of an Infant
- The presentation of a retained foreign body in the throat of an infant can be variable, ranging from asymptomatic to life-threatening emergencies 2.
- Infants with a retained foreign body may present with acute onset cough, chest pain, breathlessness, or sub-acutely with unexplained hemoptysis, non-resolving pneumonia 2.
- In some cases, the foreign body may be discovered incidentally on imaging, such as a chest X-ray or CT scan 3, 4.
Clinical Symptoms and Signs
- The clinical symptoms and signs of a retained foreign body in an infant's throat can mimic respiratory diseases common in the same age group 5.
- A careful history and physical examination are essential in suspecting a foreign body aspiration, even if the clinical symptoms or radiographic findings are not pathognomonic 6.
- Witnessed aspiration is an important prognostic factor for the length of hospitalization, and adults witnessed 85% of the incidents in infants 5.
Diagnostic Imaging
- Chest X-ray and CT scans can be useful in diagnosing a retained foreign body in an infant's throat 3, 4.
- CT scans with multiplanar reconstruction can provide detailed information about the location, shape, and volume of the foreign body, helping the surgeon plan for operative bronchoscopy and safe removal of the foreign body 4.
- The negative predictive value (NPV) of CT scans can be as high as 99.2%, making it a reliable alternative to endoscopy under general anesthesia, especially in asymptomatic patients 3.