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Foreign body ingestion and aspiration

Through play, experimentation, or normal daily activities, children are likely to place foreign bodies just about anywhere. Once an object or food is in a child’s mouth, it can lodge in the respiratory tract (aspiration) or be ingested (swallowed) into the gastrointestinal tract. In some cases the ingestion or aspiration is not witnessed by a caretaker. Missed or late diagnosis may lead to serious health problems and occurs more often with aspirated foreign bodies. The seriousness of the “choking episode” depends on the nature of the object (e.g., sharp, long) and where in the airway or gastrointestinal tract it is lodged. Fortunately, most foreign body ingestions are well tolerated and pass through a child without complications.

Who is at risk for a foreign body ingestion and aspiration?

  • The most common age for ingestion or aspiration of a foreign body occurs between 6 months and 3 years.
  • Over 90,000 calls are made each year to poison control centers across the US concerning foreign body ingestion and aspiration in children less than 6 years of age.
  • Most ingestions or aspirations of a foreign body occur in developmentally normal children in their own home, under their parents’ care.
  • In 2004, according to CDC’s National Vital Statistics Report, 58 infants less than 1 year of age died from complications related to a foreign body lodged in the esophagus or airway.

What types of objects do young children typically ingest or aspirate?

  • Coins, usually pennies, are the most often ingested objects.
  • Other frequently ingested objects include fish bones, buttons, toy parts, batteries and jewelry.
  • Food particles (ie. peanuts, seeds and nuts) are the foreign bodies most often aspirated into the airway, followed by toy parts.

What are the signs and symptoms of a foreign body ingestion and aspiration?

  • For ingestion of a foreign body, most children do not have symptoms and most have a normal physical examination.
  • Sometimes the child may have gagging, choking and/or vomiting after swallowing a foreign body.
  • For aspiration, the child may develop a period of choking, gagging, wheezing or decreased breath sounds, although as many as 40% of these children do not develop symptoms.
  • Delayed onset of symptoms may lead to misdiagnosis of aspiration as another common condition such as croup,asthma, or recurrent pneumonia.

How would my child be evaluated by a doctor if he/she were to ingest or aspirate a foreign body?

  • For ingestion: an emergent evaluation will be performed to remove the foreign body if drooling, breathing problems or significant abdominal symptoms are present.
  • Xrays will be performed of the chest and abdomen to confirm presence and location of the foreign body.
  • Some objects do not show up on plain xrays such as fish bones, wood, plastic and aluminum.
  • When suspected, a barium swallow may be needed to find a foreign body that would not be expected to show up on a plain xray.
  • Objects found in the upper to the middle part of the esophagus require removal by a specialist.
  • If a smooth object is in the lower part of the esophagus or in the stomach and no symptoms are present, the child can be observed at home for the passage of the object.
  • This passage may take days to weeks so the child may need to have repeat xrays done once a week until the object has passed.
  • Any sharp objects (e.g., toothpicks, needles, fish bones) should be removed immediately because of the risk of intestinal perforation.
  • Disc button batteries (found in hearing aids for example) are a special problem in that if they become lodged in the esophagus they must be removed immediately because of the risk for esophageal burns.
  • For aspiration: if a child aspirates a foreign body and is unable to breathe this is a medical emergency and emergency maneuvers should be performed such as the Heimlich maneuver (in children older than 1 year) or back blows (for children less than 1 year old).

To perform the Heimlich maneuver on children over 1 year old:

  1. Remain calm.
  2. Stand or kneel behind a child who is conscious.
  3. Make a fist with one hand.
  4. Place the thumb side of the fist right above the belly button, and well below the bottom of the breastbone.
  5. Cover the fist with your other hand.
  6. Deliver five upward and inward thrusts into the child’s abdomen. The thrusts should quickly squeeze in the abdomen to help the child “cough out” the obstruction.
  7. Check the child after every five thrusts.
  8. Continue the abdominal thrusts until the object comes out or the child becomes unconscious.
    If the child becomes unconscious, call for emergency medical services.

To perform backblows in infants less than 1 year of age:

  1. Support the infant’s head and neck.
  2. Turn infant face down on your forearm.
  3. Lower your forearm onto your thigh.
  4. Give four (4) back blows forcefully between infant’s shoulder blades with heel of hand.
  5. Turn infant onto back.
  6. Place middle and index fingers on breastbone between nipple line and end of breastbone.
  7. Quickly compress breastbone one-half to one inch with each thrust.
  8. Repeat backblows and chest thrusts until object is coughed up, infant starts to cry, cough, and breathe, or medical personnel arrives and takes over.

CPR training is strongly recommended for any parent or caretaker of a child! Click on CPR for more information.


Never stick your finger into the child’s mouth
 even if the object is visible, because it may force the object in farther down the airway, leading to complete blockage.

  • If the child is breathing well and not suffering from airway blockage, the doctors will obtain regular xrays of your child’s neck and chest.
  • If the suspicion is high that a foreign body was aspirated, even if the xrays are normal, the doctor may elect to look into your child’s airway for a foreign body with a bronchoscope or fluoroscope.

How can choking be prevented in children?

  • The American Academy of Pediatrics recommends that parents be very careful when their children begin to eat table foods.
  • Older infants and children under age four are at greatest risk for choking on food and small objects.

The following foods have been identified by the American Academy of Pediatrics as presenting choking hazards:

  • hot dogs
  • hard candy
  • chewing gum
  • nuts and seeds
  • chunks of meat or cheese
  • whole grapes
  • popcorn
  • chunks of peanut butter
  • raw vegetables
  • raisins

The following objects have been identified as presenting choking hazards:

  • coins
  • buttons
  • marbles
  • small balls
  • deflated balloons
  • watch batteries
  • jewelry
  • ball point pen caps and paper clips
  • arts and crafts supplies
  • small toys and toys with small detachable parts

Here are some tips to prevent choking:

  1. Supervise mealtime for young children.
  2. Keep dangerous food away from children under the age of four.
  3. Do not permit young children to eat while running or playing.
  4. Prepare and cut food into the appropriate size.
  5. Teach children to chew well.
  6. Keep small toys, marbles, balloons and coins out of the reach of small children.
For a useful poster developed by the International Food Information Council (IFIC) Foundation, in partnership with the National SAFE KIDS Campaign, called ”Prevent Childhood Choking: It’s Up to You” go to http://www.ific.org/publications/brochures/chokingpos.html.

When should I call my pediatrician concerning a choking episode in my child?

  • You should call your pediatrician anytime you believe your child has swallowed or aspirated a foreign body.
  • If you believe that your child has swallowed or aspirated a foreign body and your child has mild symptoms (e.g., gagging or cough or upset stomach) but no trouble breathing, you can call your pediatrician but I would not delay getting your child evaluated in an emergency department.
  • If you believe that your child has swallowed or aspirated a foreign body and your child has trouble breathing, an emergency maneuver should be performed as discussed above and 911 called for immediate transfer to an emergency department.