Foreign Body Aspiration


  • Over 3,000 deaths per year are caused by foreign body aspiration.
  • Most common in children 1 to 3 years old, since they:
    • Are able to walk
    • Tend to put objects in their mouths
    • Do not yet have molars, so food may be insufficiently chewed
  • Food items (e.g., peanuts) are the most commonly aspirated objects.
  • Aspirated foreign bodies lodge in a bronchus in 80-90% of cases.
  • The aspiration event may not be witnessed, thus foreign body aspiration should be considered any time a child has:
    • Acute onset of respiratory symptoms, especially coughing or choking
    • New wheezing that does not respond to usual treatment (e.g., bronchodilators)
    • Unexplained recurrent or persistent pneumonia


Signs and Symptoms

  • Classic triad of cough, wheezing, and diminished breath sounds may not be present.
  • Patients often have an episode of choking and prolonged coughing, but symptoms may cease as the cough reflex is exhausted and/or the object lodges in a bronchus
  • Other signs and symptoms
    • Dyspnea
    • Neck or throat pain
    • Stridor and hoarseness may occur if object is lodged in upper airway (uncommon)
    • Asymmetric breath sounds
    • Tachypnea
    • Nasal flaring
    • Cyanosis
  • It is important to ask caregiver about the possibility of foreign body aspiration since patient’s symptoms may resolve and imaging may be unremarkable.


Work-up and Management

For patients with a life-threatening complete airway obstruction in whom a foreign body is suspected

  • Proceed with basic life support (BLS) to attempt to remove the object
    • Back blows and chest thrusts for infants less than 1 year old
    • Abdominal thrusts for older children
  • If unsuccessful, visualization via direct laryngoscopy and removal with Magill forceps may be attempted.
  • If unable to visualize object, it may lifesaving to intubate and dislodge the object into a more distal airway, followed by removal via rigid bronchoscopy in the OR.

For patients who are stable:

  • Proceed with history, physical, and imaging.
  • Object removal, however, should be done promptly since object could become dislodged to a larger airway and cause a complete airway obstruction.
  • Imaging
    • Chest x-ray may show
      • Radiopaque foreign body
      • Hyperinflation
      • Atelectasis
      • Mediastinal shift
      • Consolidation if diagnosis is delayed
    • Expiratory chest x-ray may be helpful in demonstrating air trapping, but difficult to obtain in a younger child. Lateral decubitus is an alternative.
    • Fluoroscopy may also be helpful
    • CT rarely used
  • Normal imaging does NOT rule out foreign body aspiration!
  • Definitive management is visualization and removal of object via rigid bronchoscopy


Possible complications of delayed diagnosis

  • Recurrent pneumonia and abscess
  • Airway granulomas
  • Bronchiectasis
  • Esophageal erosion or perforation
  • Pneumothorax
  • Esophageal stricture



Image A: Frontal radiograph of a 2-year old boy who experienced a sudden onset of cough. Air trapping in the right hemithorax is evident, with shift of the mediastinum to the left.

Adapted from: Rovin JD, Rodgers BM. Pediatric foreign body aspiration. Pediatr Rev. 2000 Mar;21(3):86-90. 



Image B: Rigid bronchoscopy under general anesthesia revealed a peanut lodged in the right mainstem bronchus, which was removed successfully with a peanut grasper

Adapted from: Rovin JD, Rodgers BM. Pediatric foreign body aspiration. Pediatr Rev. 2000 Mar;21(3):86-90. 




Pediatricians should provide parents with anticipatory guidance regarding choking prevention.

  • Parents may want to avoid giving their child high-risk foods such as peanuts or hard candy until they are able to chew it adequately.
  •  Keep potential choking hazards (such as small spherical objects and balloons) out of reach of children.
  • Older siblings should be advised not to give potentially dangerous objects to younger children.



Information for parents:



  1. Louie MC, Bradin S. Foreign body ingestion and aspiration. Pediatr Rev. 2009 Aug;30(8):295-301, quiz 301.
  2. Rovin JD, Rodgers BM. Pediatric foreign body aspiration. Pediatr Rev. 2000 Mar;21(3):86-90.
  3. Rodríguez H, Passali GC, Gregori D, Chinski A, Tiscornia C, Botto H, Nieto M,  Zanetta A, Passali D, Cuestas G. Management of foreign bodies in the airway and oesophagus. Int J Pediatr Otorhinolaryngol. 2012 May 14;76 Suppl 1:S84-91.
  4. Foltran F, Ballali S, Passali FM, Kern E, Morra B, Passali GC, Berchialla P, Lauriello M, Gregori D. Foreign bodies in the airways: a meta-analysis of published papers. Int J Pediatr Otorhinolaryngol. 2012 May 14;76 Suppl 1:S12-9.


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