Practice Easily Missed?

Foreign body inhalation in children

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c3924 (Published 18 August 2010) Cite this as: BMJ 2010;341:c3924
  1. Kay Wang, senior clinical research fellow1,
  2. Anthony Harnden, university lecturer in general practice1,
  3. Anne Thomson, consultant respiratory paediatrician2
  1. 1Department of Primary Health Care, University of Oxford, Oxford OX3 7LF
  2. 2John Radcliffe Hospital, Oxford OX3 9DU
  1. Correspondence to: A Thomson anne.thomson{at}orh.nhs.uk
  • Accepted 22 June 2010

Children, especially toddlers, tend to place objects in their mouths while exploring their environment. They are therefore at increased risk of inhaling foreign bodies, which may become lodged in the tracheobronchial system.

Case scenario

A 2 year old boy presented to his general practitioner with a two week history of a dry, persistent cough. His mother recalled an episode two weeks ago when he had a violent coughing fit while eating nuts and raisins. She took him to the nearest hospital emergency department, but he was discharged a few hours later after a normal physical examination and normal chest radiograph. Nevertheless, this history of persistent cough following a choking episode should raise concern about possible foreign body inhalation.

How common is it?

  • During 2008-9, just over 300 hospital admissions in England were due to foreign body inhalation in children up to 14 years of age1

  • Worldwide, 55% of children who have inhaled foreign bodies are between 1 and 3 years of age and 7-10% are under 1 year of age2

  • In the United States, foreign body inhalation accounts for 7% of accidental deaths in children under 4 years of age3

Why is it missed?

Diagnosis of an inhaled foreign body was delayed by more than a week in 29% of cases …

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