Foreign bodies in the airway

Abstract

In the USA approximately 300 children die each year from choking. In the UK approximately 24 children die each year. The number of children presenting to emergency rooms with foreign body aspiration (FBAO) is at least 100-fold higher. The majority of deaths from FBAO occur in children under the age of 5. The objects most commonly aspirated are liquids in infants, and food, nuts, candy, small objects, and balloons in older children. Prevention of FBAO involves a combination of parental education and manufacturing law. In the UK the Consumer Affairs Department of the Department of Trade and Industry monitors accidental injuries from choking in children.1 Standards relating to the design and safety of toys are regulated by European directive BB/378/EEC and in the USA by Federal law (Consumer Product Safety Commission "small arts regulations"). 2,3 This legislation involves testing childrens' toys using a "small parts cylinder" with dimensions that mimic the size of an infant's pharynx (Fig. 28.1). Toys with detachable components less than 2.5 cm × 3.2 cm are deemed unsuitable for children under the age of 3. Considerable effort has been put into first aid and paramedic training to deal with FBAO.4,5 Algorithms for treatment are centered around basic life support and the Heimlich maneuver (Fig. 28.2).6,7 Recent advice suggests that the Heimlich maneuver should not be used on infants because of the potential risk of injury to the abdominal viscera. 8'10 Infants should be inverted and foreign bodies disimpacted using chest thrusts.