Abstract
ObjectiveTo identify an age at which initiation of whole nut into the pediatric diet could be considered safe, by evaluating the age distribution of children undergoing bronchoscopy with removal of nut or seed material from the airway.MethodA retrospective chart review over a ten-year period identifying children age 0–18 that have undergone bronchoscopy with retrieval of airway foreign bodies. A statistical analysis of demographic data was carried out to identify age distribution of aspiration events.ResultsSixty-four cases of foreign body aspiration were identified, of which 43 (67%) were of organic origin, specifically nuts. A Fisher’s exact test was carried out on the cumulative percentage of organic foreign body aspirations to identify the age distribution of nut aspiration events. A statistically significant decrease in organic foreign body aspirations occurred at approximately 36 months of age (p = 0.004).ConclusionForeign body aspiration is a leading cause of accidental injury or death in children. Nut and other small organic foreign bodies account for a significant portion of accidental aspiration events, however, no guidelines exist regarding appropriate age of whole nut introduction into the diet. Our study suggests that 90% of pediatric nut aspiration events occur under the age of 36 months. We suggest supervised introduction of whole nuts between the ages of 3 and 4 years. Official guidelines regarding this should be considered by professional pediatric societies.Level of evidence4
Highlights
A 2017 New York Times article highlighted the importance of exposing children to peanuts in their diet “early and often;” it did not specify the fact that the recommended peanut exposure should be in the form of powder or paste [1]
Airway foreign body aspiration is a major concern in the pediatric patient presenting with sudden onset coughing spells, respiratory distress, or choking
Two patients were excluded after chart review revealed that the foreign body location was extraneous to the airway, leaving 64 patients in the study
Summary
A 2017 New York Times article highlighted the importance of exposing children to peanuts in their diet “early and often;” it did not specify the fact that the recommended peanut exposure should be in the form of powder or paste [1]. Pediatric aspiration of airway foreign body is the admitting diagnosis to US hospitals for approximately 2000 children annually [2]. Airway foreign body aspiration is a major concern in the pediatric patient presenting with sudden onset coughing spells, respiratory distress, or choking. These patients are usually seen in the emergency department and undergo radiographic evaluation with chest x-ray or airway CT scan to evaluate presence of lung hyperinflation or airtrapping. Even with negative or ambiguous radiographic data, many surgeons will proceed with rigid bronchoscopic evaluation based on age and a suspicious history [4]. Bronchoscopy is the gold standard of diagnosis for airway foreign body [5], subjects the child to the risks of anesthesia
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