Abstract
(1) Background: Foreign body aspiration (FBA) is a significant public health concern among the pediatric population, and fatalities are dramatic for families. It typically involves organic foreign bodies (mainly food) aspirated by children under three years old, usually at home or school. This review aimed to focus on the preventive measures around four actual cases of fatal foreign body aspiration, emphasizing the correct execution of the Heimlich maneuver and cardiopulmonary resuscitation, supervised mealtimes, and high-risk foods. (2) Methods: Four fatal cases of foreign body aspiration in children are presented here. The children were in a free environment, such as school, home, and the countryside, and were in the presence of teachers, parents, and a grandmother who did not supervise the children adequately. A literature review was performed via the MEDLINE database using the key terms: “foreign body aspiration,” “infant choking, 1.5 to 3 years,” “food and foreign body aspiration,” “common household,” “prevention of foreign body aspiration,” “guidelines,” “recommendations,” “training of caregivers (parents, educators),” “resuscitation,” “Heimlich maneuver,” and “disengagement of the upper airways.” We focused on the prevention of foreign body aspiration. (3) Results: a complete postmortem examination was performed. In three cases, the foreign bodies were food (mozzarella cheese, pear, or raw bean), while in one case, the foreign body was a pebble. (4) Conclusions: This review aimed to discuss recent scientific literature and provide a perspective on the benefits of a dedicated approach to the management of fatal foreign body aspiration in children by caregivers who usually have no experience with the best ways of supervising children in a safe environment, especially regarding the correct execution of resuscitation maneuvers, such as the Heimlich maneuver. Recommendation updates could improve healthcare quality in a pediatric setting and reduce medico-legal implications.
Highlights
Foreign body aspiration (FBA) is a life-threatening pediatric emergency due to the accidental impaction of objects in the respiratory tract and represents a significant public health problem, sometimes resulting in fatal outcomes [1,2]
The Susy Safe register shows that almost half of the foreign body accidents occurred under adult supervision [21]. These results indicate a lack of knowledge from adults responsible for child supervision regarding the problem of FBA, as confirmed by a recent survey conducted on families with children under four years old [22]
The same guidelines recommend that families and adults responsible for supervising the child know the rules regarding food preparation and behavior at the table for the prevention of suffocation from food; families and adults responsible for the child’s supervision should acquire knowledge and skills regarding maneuvers to unblock airways and cardiopulmonary resuscitation
Summary
Foreign body aspiration (FBA) is a life-threatening pediatric emergency due to the accidental impaction of objects in the respiratory tract and represents a significant public health problem, sometimes resulting in fatal outcomes [1,2]. The in-hospital mortality rate for airway foreign bodies is between 0.26% and 13.6% after complications due to delayed hypoxia (severe laryngeal edema or bronchospasm requiring a tracheotomy or re-intubation, pneumothorax, pneumomediastinum, cardiac arrest, tracheal or bronchial laceration, and hypoxic brain damage) [3,4,5,6,7]. Food foreign bodies are the most common items identified in choking events, where boys less than five years of age may be at the highest risk [8]. The lack of private insurance has been associated as a risk factor for foreign body aspiration in children; this may be related to a potential lack of anticipatory guidance and caretaker education
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