From the Guidelines
Management of a fishbone in an infant requires prompt medical attention, and if a fishbone is suspected to be lodged in an infant's throat, do not attempt to remove it at home but seek immediate medical care at an emergency department. The initial evaluation should be based on the patient’s history and physical examination, and recommended biochemical investigations are complete blood count (CBC), C-reactive protein (CRP), blood gas analysis for base excess, and lactate 1.
Key Considerations
- For visible fishbones in the oral cavity or throat, careful removal with forceps may be performed by medical professionals.
- If the fishbone has moved deeper into the esophagus or beyond, endoscopy under sedation is usually required for safe removal, as recommended by the WSES guidelines 1.
- Emergent flexible endoscopy (preferably within 2 h, at latest within 6 h) is recommended for sharp-pointed objects, such as fishbones, and for foreign bodies inducing complete esophageal obstruction 1.
- After removal, the infant may be prescribed a soft diet for 24-48 hours and possibly antibiotics if there is evidence of infection or significant tissue damage.
- Pain relievers such as acetaminophen (10-15 mg/kg every 4-6 hours) may be given if the infant appears uncomfortable, as guided by the clinical judgment of the healthcare provider.
Important Diagnostic Tools
- Computed tomography (CT) scan should be performed in patients with suspected perforation or other complications that may require interventional endoscopy or surgery, as it has a high sensitivity and specificity for detecting fish bones 1.
- CT scan is necessary if there is suspicion of FB-related complication (perforation, abscess, mediastinitis, aortic/tracheal fistulas) 1.
Post-Removal Care
- Parents should watch for signs of complications including difficulty swallowing, persistent pain, fever, drooling, or refusal to eat, which warrant immediate medical reassessment.
- Fishbones are particularly dangerous in infants due to their narrow airways and inability to communicate discomfort clearly, making professional evaluation essential even if symptoms seem mild.
Additional Recommendations
- Urgent (< 24 h) flexible endoscopy is recommended for other esophageal foreign bodies without complete obstruction 1.
- In addition to therapeutic endoscopy, diagnostic work-up for potential underlying disease including histological evaluation is recommended, as an underlying esophageal disorder can be found in up to 25% of patients 1.
From the Research
Management of Fishbone in Infant
- The provided studies do not directly address the management of fishbone in infants.
- However, a study on fish bone foreign body impaction in the upper aerodigestive tract 2 suggests that in patients < 40 years old presenting within 24 hours from ingestion, imaging has little diagnostic value due to the low probability of esophageal fish bones.
- For infants, who are < 40 years old, and presenting within 24 hours, discharge without imaging studies may be considered safe in the absence of clinical findings, as per the study on fish bone foreign body impaction 2.
- Other studies on intestinal obstruction and colonoscopic perforation 3, 4, 5 do not provide relevant information on the management of fishbone in infants.
- There is no specific study on the management of fishbone in infants, and the provided studies are not directly relevant to this topic.