QuestionSBA
QuestionChoice
Croup is a common cause of stridor in children and can also cause respiratory distress, this would be treated with steroids. However, the onset would not be so sudden and there is usually a history of low grade fever and coryzal illness. The history and examination is more consistent with an inhaled foreign body.
10035734
c
Dexamethasone, STAT dose
QuestionChoice
Anaphylaxis is an important differential for respiratory distress and stridor, however is is accompanied by hypotension, and allergic symptoms such as angioedema. The history and examination is more consistent with an inhaled foreign body.
10035735
d
150 micrograms IM adrenaline
QuestionChoice
The sudden onset and lack of temperature in this patient is not consistent with an infectious cause of respiratory distress. The history and examination is more consistent with an inhaled foreign body.
10035736
e
Amoxicillin
QuestionChoice
The history and examination is consistent with an inhaled foreign body. The immediate management is a rigid bronchoscopy to remove it. Foreign body inhalations are often unwitnessed in children and it is an important differential for anyone presenting with stridor and respiratory distress. Although not common practice, this question has appeared in previous writers' MLA AKT exams so we have included it in our bank.
10035732
a
Rigid bronchoscopy
QuestionChoice
Bronchoconstriction can cause respiratory distress in infants, however a wheeze rather than stridor would be found on examintation. The history and examination is more consistent with an inhaled foreign body.
10035733
b
Nebulised salbutamol
QuestionComment
Would CXR be indicated at all?
53165
QuestionComment
If it's already suspected that the kiddy has eaten the forbidden plastic chocolate brick then you are already there with the grabber to remove it with a bronchoscopy. A CXR would only confirm the diagnosis but exposure them to extra radiation and you would still need to go in with the scope. Hope this helps / makes sense :D 
53606
User
subscriber
Dr. Moe Lester
User
subscriber
Embolism Prone
QuestionComment
thanks uncs
56043
User
subscriber
AsciticImmigrant
Concept
Chapter
# Summary

Foreign Body Ingestion (FBI) refers to the swallowing of objects that are not intended to be ingested. Clinical manifestations vary from being asymptomatic to significant morbidity, including esophageal obstruction or perforation, depending on the type and location of the foreign body. Most instances can be managed conservatively, but high-risk objects may necessitate invasive interventions such as endoscopy or open surgery. High-risk objects include batteries, large objects, absorbent materials, magnets swallowed with metal objects, lead-based objects, and objects containing toxins.

# Definition

Foreign Body Ingestion is a common pediatric complaint and involves the swallowing of objects not intended for ingestion. While most foreign bodies pass harmlessly through the gastrointestinal tract, some can cause significant complications.

# Epidemiology

Foreign Body Ingestion is a prevalent issue among children, particularly those between the ages of six months to three years. This high incidence is attributed to their oral exploratory behavior. Most ingested objects pass spontaneously without causing complications, but a subset may pose a significant health risk.

# Aetiology

Objects often ingested include coins, toys, jewelry, batteries, and food items. The list of potentially ingestible items is virtually limitless but varies based on cultural, environmental, and individual factors. High-risk objects include batteries, large objects that may become trapped at the pylorus, absorbent materials that may cause obstruction, magnets swallowed with metal objects, lead-based objects, and objects containing toxins.

# Signs and Symptoms

The clinical presentation can range from asymptomatic to significant morbidity. Symptoms include, but are not limited to:

-   Drooling
-   Difficulty swallowing or painful swallowing
-   Refusal to eat
-   Chest, throat, or abdominal pain
-   Vomiting
-   Blood in the stool

The onset and type of symptoms can be influenced by the size, shape, location, and nature of the foreign body.

# Differential Diagnosis

Consider the following conditions in a patient presenting with symptoms suggestive of foreign body ingestion:

-   Gastroenteritis: Characterized by nausea, vomiting, diarrhea, abdominal pain.
-   Esophagitis or Gastritis: These could present with similar symptoms of painful swallowing, refusal to eat, and abdominal pain.
-   Appendicitis: Presents with abdominal pain, loss of appetite, nausea, and vomiting.
-   Esophageal stricture or tumor: Can present with difficulty swallowing, chest pain, weight loss, and regurgitation of food or fluids.

# Investigations

Investigations are unnecessary in an asymptomatic child with a low-risk ingestion. In symptomatic patients or those who have ingested high-risk objects, investigations may include:

-   Plain radiography: Most commonly used and can detect radio-opaque objects.
-   Computed Tomography (CT): Offers better sensitivity and specificity for detecting radiolucent foreign bodies.
-   Direct visualization with endoscopy: Useful when there is a high index of suspicion, even if radiological studies are negative.

# Management

The majority of foreign bodies that are swallowed can be managed conservatively, including observation and symptomatic treatment. High-risk objects such as batteries, sharp objects, or large objects may require endoscopic or surgical removal. Clinicians should provide clear discharge instructions regarding potential complications and when to seek immediate medical attention.

# References

[BMJ Best Practice: Foreign Body Ingestion](https://bestpractice.bmj.com/topics/en-gb/1050)
1094
1159
Ingested Foreign Body
Topic
29
Paediatrics
19550
Inhaled foreign bodies in children can cause sudden respiratory distress and stridor, necessitating immediate rigid bronchoscopy for removal.
Presentation
115
Breathlessness
UkmlaTopic
5
Child health
A 10-month old girl is rushed into the Emergency Department with sudden onset cough, respiratory distress, and noisy breathing. This started 20 minutes ago whilst at a playdate, and she had previously been well. On examination she is making a high-pitched inspiratory sound whilst breathing and is coughing ineffectively. There is no wheeze, rash, or angioedema. Her respiratory rate is elevated at 48 (30-40) and she is tachycardic at 152 bpm (80-140), her other vital signs are normal.

What is the most appropriate management?
a