Epidemiology and Etiology

Infants and toddlers use their mouths to explore their surroundings. Most victims of foreign body aspiration are older infants and toddlers (Fig. 379-1). Children <3 yr of age account for 73% of cases. Preambulatory toddlers can aspirate objects given to them by older siblings. One third of aspirated objects are nuts, particularly peanuts. Fragments of raw carrot, apple, dried beans, popcorn, and sunflower or watermelon seeds are also aspirated, as are small toys or toy parts.

Figure 379-1 Number of fatalities vs victim age, all fatalities.

(From Milkovich SM, Altkorn R, Chen X, et al: Development of the small parts cylinder: lessons learned, Laryngoscope 118[11]:2082–2086, 2008.)

The most serious complication of foreign body aspiration is complete obstruction of the airway. Globular or round food objects such as hotdogs, grapes, nuts, and candies are the most frequent offenders. Hot dogs are rarely seen as airway foreign bodies because toddlers who choke on hot dogs asphyxiate at the scene unless treated immediately. Complete airway obstruction is recognized in the conscious child as sudden respiratory distress followed by inability to speak or cough.

Clinical Manifestations

Three stages of symptoms may result from aspiration of an object into the airway: