From the Guidelines
The protocol for managing foreign bodies in pediatric patients involves a series of steps to ensure the airway is cleared and the child's safety is maintained.
Key Steps
- Backslaps: The first step is to use backslaps in children with a foreign-body airway obstruction and an ineffective cough, as suggested by 1 and 1.
- Abdominal Thrusts: If backslaps are ineffective, abdominal thrusts should be used in children over 1 year of age, as recommended by 1, 1, and 1.
- Manual Extraction: Rescuers should consider the manual extraction of visible items in the mouth, as suggested by 1 and 1.
- Avoid Blind Finger Sweeps: Blind finger sweeps should be avoided in patients with a foreign-body airway obstruction, as recommended by 1 and 1.
- Chest Thrusts: Chest thrusts should be used in unconscious adults and children with a foreign-body airway obstruction, as suggested by 1 and 1.
- Bystander Intervention: Bystanders should undertake interventions to support foreign-body airway obstruction removal as soon as possible after recognition, as suggested by 1 and 1.
Important Considerations
- Age: The management of foreign bodies in pediatric patients varies depending on the child's age, with different techniques recommended for infants, children over 1 year, and adults.
- Consciousness: The level of consciousness of the child also plays a role in determining the appropriate management technique.
- Visible Obstruction: If the foreign body is visible, manual extraction may be attempted.
- Specialized Equipment: In some cases, specialized equipment such as Magill forceps may be necessary to remove the foreign body, as suggested by 1 and 1.
Additional Recommendations
- Flexible Endoscopy: Flexible endoscopy may be used to diagnose and treat foreign body aspiration in children, as discussed in 1.
- Radiographic Abnormalities: Radiographic abnormalities such as recurrent/persistent atelectasis, recurrent pneumonia, and persistent pulmonary infiltrates may indicate the need for flexible endoscopy, as mentioned in 1.
From the Research
Protocol for Managing Foreign Bodies in Pediatric Patients
The management of foreign bodies in pediatric patients depends on various factors, including the type of object ingested, its location, and the patient's age and size 2, 3. The following are key considerations in managing foreign bodies in pediatric patients:
- Type of object ingested: Coins are the most commonly ingested foreign bodies, followed by other objects such as toys, toy parts, sharp objects, batteries, bones, and food 2, 4.
- Location of the foreign body: Esophageal foreign bodies require early intervention due to the potential for respiratory symptoms and complications, esophageal erosions, or even an aortoesophageal fistula 2.
- Patient's age and size: The management approach may vary depending on the patient's age and size, with younger children requiring more careful evaluation and management 4, 5.
- Symptoms: The presence or absence of symptoms, as well as the type of symptom, can aid clinicians in implementing diagnosis and proper management approaches in patients who ingest foreign bodies requiring endoscopy 4.
Methods for Dealing with Foreign Bodies
Various methods can be used to deal with foreign bodies, including:
- Endoscopic removal: Urgent endoscopic removal is required for ingested batteries that lodge in the esophagus, even in asymptomatic patients, due to the high risk of complications 2.
- Suture technique: The suture technique, double snare technique, and combined forceps/snare technique can be used for long, large, and sharp foreign bodies 2.
- Retrieval nets and specialized forceps: Newer equipment, such as retrieval nets and a variety of specialized forceps, can also be used to remove foreign bodies 2.
Protocol of Care
A protocol of care for foreign-body ingestion in children should be developed based on the object ingested, time of ingestion, symptoms, and local epidemiological context 3. The protocol should include:
- Evaluation: Radiographic evaluation and endoscopy for cases with symptoms of impaction and radiolucent objects 3.
- Conservative management: Asymptomatic patients may require only conservative management 3.
- Endoscopic or surgical approach: Ingestion of batteries, magnets, and sharp objects carries a high risk of serious clinical complications and should have an endoscopic or surgical approach 3.