295 children’s bronchoscopy due to choking episode with suspected foreign body in the of pediatric ent department – analysis of choking risk factors

Abstract

Introduction. Aspiration of foreign body by children is a common cause of respiratory failure and an indication for urgent bronchoscopy. This procedure under general anesthesia is very difficult, stressful and dangerous in children due to their small diameter of the respiratory tract with a symptom of dyspnea. The tendency to put everything in to the mouth for cognitive purposes, incomplete dentition, immature swallowing mechanism are all the factors of high risk of choking episodes in very young children. Over the years still has been discussions on how to limit the number of bronchoscopies performed in children. Aim.The authors of this analysis try to find an answer to the question of whether and which way the number of bronchoscopy of the lower respiratory tract in children can be limited. Material and methods. 295 children underwent a bronchoscopy in the Department of Pediatric Otolaryngology of the Medical University of Warsaw in 2015-2020 after an episode of choking with suspected foreign body of the lower respiratory tract. The procedure was done after an appropriate pediatric examination and X-ray of the chest. In the analysis, particular attention was paid to the type of foreign bodies, pathology in clinical examination and tests. Results. 295 patients underwent rigid bronchoscopy under general anestesia. The indications for this procedure was single episode of choking. All children presented some patology in physical examination or on chest X-ray. Only in 142 (48%) patients a various foreign bodies were found and removed. That were 110 (77.5%) organic and 32 (22.5%) inorganic foreign bodies. Among all 142 cases only 9 (6%) were visible on X-ray. Peanuts and seeds were the most common foreign bodies, identified in 81% patients. The median age was 2 years. Conclusions. There are not characteristic symptoms of foreign body in respiratory tract in clinical investigation after single episode of choking. The suspicion of aspiration is still the main indicates for urgent bronchoscopy in children. It seems that the number of performed bronchoscopies could be reduced by prevention. Extensive education for young parents should be providing to inform them about choking hazard. We should pay special attention to them not to give small hard organic food to their children; especially nuts and grains. Parents’ attention should also be paid to toys, which for toddlers must be free of small, moving parts. Also companies producing food and toys for children should be obliged to place information on the risk of chocking on their products.