A healthy, boisterous boy with no previous complaints.  Two and a half years old.  At home, while her mother and father are eating hazelnuts, they give some to their children.  A coughing attack develops all of a sudden.  Mom and dad immediately do maneuvers such as hitting on the back and pressing on the stomach.  Then the child relaxes.  But every time the child runs or moves fast, they hear a whistling sound in their breathing.
When I heard this story, I immediately knew what it was.  In my physical examination, I hear that the breath sounds of both lungs are not equal.  The chest X-ray also supports me.  I see that there is a foreign object in one of the main airways, possibly a nut, has escaped, and I explain that it is necessary to look at the airways with the camera.  We bring the child down to the operating room, my anesthetist friends put him to sleep, and I remove the foreign object from one of the main airways by performing bronchoscopy.
This is one of the best results of the foreign object scenarios I have experienced many times.  Life may not always be sunny, warm spring day.  I will tell you about foreign object aspirations in the Pediatric Surgeon’s journal.  Do not bring objects that can get into their throats or airways until children are older.  Enjoy reading.
Foreign object aspiration, which is a foreign object entry into the airway, can be a potentially life-threatening event.  It is very important.  It can cause very serious mortality and morbidity, especially in children under the age of two or three.  Think about it, in the past, almost a quarter of foreign object aspirations resulted in death.  Fortunately, bronchoscopy techniques have developed well, we are also quite used to bronchoscopy, for this reason, this mortality rate has decreased to 1 in 100.00.  However, knowing that foreign object aspiration ranks fifth among unexpected deaths in the United States shows how common this issue is and how serious it can result.
We see foreign object aspirations in children frequently in the first three years of age.  In the publications already made, it is stated that eighty percent of them are in the first three years of age.  Because at this age, most children can now stand up, be more active, and try to explore and explore the world with their own oral ways.  In addition, as their motor skills increase during this period, they can easily take the objects they find with their hands to their mouths.  Yes, they take it into their mouths, but they cannot crush these objects well because their molar teeth are not sufficiently developed yet.  Also, since their swallowing mechanisms are not sufficiently coordinated, that is, they are not yet fully developed, they can easily slip these objects into their airways.
Another danger is that most children at this age often have a brother or sister.  Because these brothers or sisters a few years older can put foreign objects in their mouths with good intentions.
Another reason for the foreign object to enter the airway in children under the age of three is that the diameter of the airways is not large enough at this age.
When we investigate the foreign objects that have escaped into the airways of children, we see that small children mostly choke on pieces of food, but in older children, we can see that many objects such as coins, some small stationery items, paper and pen caps have also escaped into the airways.  Also, it can pose a serious risk for girls who wear hijab to hold the needle in their mouths while wearing their hijabs.  Believe me, I had to pull out a pin many times.  Still, of course, there are much more hazelnut aspirations in Turkey, which is a beautiful hazelnut paradise.  In fact, foreign names have some common points that can cause them to choke.  For example, round objects, those that cannot be crushed by teeth in the mouth, and those with slippery surfaces can more easily escape into the airway.
The major problem caused by foreign objects escaping into the airway is the suffocation problem, that is, they prevent the air from entering the lungs.  But sometimes children can throw the drugs they find into their mouths, and the drugs can easily escape into the airway because they can be slippery and round-surfaced.  These drugs, especially those containing potassium or iron, can dissolve in the airway and cause very serious inflammation and subsequently narrowing.  Of course, these may need to be removed immediately.
The story of the mother, father or the person next to the child in foreign object aspirations is very important for us.  We can see that we reach a high rate of 75-95% when we do bronchoscopy with only a proper history, especially in the case of a witnessed choking event, that is, the child suddenly coughing while eating a hard object.  However, sometimes it is possible to apply to the hospital later, because no one has observed the aspiration of the foreign object, and the child may have passed it into the airway when he was alone.  In this case, it takes some time.  Foreign objects can start to cause infections inside, and lung infections, which we call pneumonia, begin to come to the fore.  If there is no history of escaping in the throat, foreign body aspiration may not come to mind first.  If there is no response to the treatment, we start suspecting foreign object in the airway. 
As a result, in the physical examination we will do in a child who is brought with the suspicion of foreign object in their throat, if we clearly hear less sound in one of the two lungs, and if there is a very clear suspicion of foreign object aspiration in the mother’s advice given by the family, then we can bring it directly to the operating room without asking for additional imaging and carry out bronchoscopy.  However, if the situation is not very urgent, we definitely prefer to see a chest X-ray first.  In the chest X-ray, we can sometimes not always achieve the image we expect.  Especially if the chest X-ray was taken while the child was inspiring, it may not show us the image we want.  Although it is very difficult for the radiologist, if the film of the child is seen while he is exhaling, the difference in ventilation in both lungs will be clearly seen, and it will also give us information about which side the foreign object is on.  Even if we cannot see the image we want on the chest X-ray, if the story told by the family makes us think that there is a very clear foreign object and our physical examination supports this, we perform bronchoscopy on the patient.  If the story given by the parents is not very clear, that is, if they are not sure that something is in the child’s throat, and we cannot be sure about foreign body aspiration in our examination, then further imaging examination can be performed.  By further imaging examination, I mean computed tomography.  If we do not see a foreign object as a result of the accepted computed tomography, and we are sure that we will not do bronchoscopy, then it is recommended that we take the computer tomography.  In other words, if we are going to request an examination, we should act according to the results of the examination.  Which means if I suspect a foreign object in history and examination, if I am going to do bronchoscopy, there is no point in doing a computer tomography.  Computed tomography is an additional examination that we can only use in cases where we can’t decide, we are not sure, and the story is not strong.
Foreign object aspiration is a truly fatal problem.  This problem needs to be avoided.  We can avoid this problem.  For this, there are already statements on many packages about which products should not be taken into the house.  It is written on the labels on some toys should not be given to children under the age of four as they contain small parts.  I’m talking about them.  It is generally accepted that round objects less than 4.5 inches in diameter and longitudinal objects less than 7.5 inches in length can cause suffocation, which can cause very serious death.  What shall we do then?  First of all, it is necessary to train mothers, fathers and caregivers.  From the age of six months, children can choke on many things.  At least until the age of four or five, marbles, small plastic balls, latex balloons, round dishes, I mean especially nuts, should not be brought into the house.  Small candies should not be taken into the house.  Small pieces of meat, small grains of grapes, small grains of rice, nuts, very small pieces of hard carrot, watermelon seeds, you can think of, anything that can escape into the airway should not be brought into the house.  Especially when infants are fed with solid food, they must be under the supervision of an adult.  Also, they must be fed in an upright position.
What we need to teach children is to chew their food very well.  It should be ensured that they do not shout, talk, play, run, cry or laugh when there is food in their mouths.  Chewable tablets should be given to children after the age of three, that is, after their molars have erupted.  The giving of metal money as a reward, which is done so much in our country, should be abandoned.  Children should be encouraged to stay away from the habit of holding objects in their mouths.  Small pieces of toys should not be brought into the house.  Attention should be paid to the siblings of children, younger children should not be left alone with their siblings.  And parents, teachers, caregivers who care for children must undergo serious emergency intervention training.
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And stay happy.
Prof. Dr. Egemen Eroğlu
September 2021