Consumer product ingestion and aspiration in children: A 15‐year review

Recent trends in foreign body ingestion (FBI) epidemiology: A national cohort study

BACKGROUND AND AIMS

Foreign body ingestion (FBI) in children is a critical health concern. This study aimed to describe the epidemiology of FBI in children in Italy.

METHODS

We retrospectively enrolled children <18 years admitted for FBI from January 2015 to December 2020. Data were collected across 21 hospitals with dedicated pediatric endoscopy services and normalized by the population of the corresponding municipalities.

RESULTS

A total of 5,771 FBI cases were analyzed. FBI incidents showed consistent time trends across age groups, with most events occurring at home and being witnessed (94.7 %). Children <6 years accounted for 74.3 % of cases. Comorbidities were present in 5.3 % of cases, primarily neurologic/psychiatric disorders in older children (6-17 years). Blunt objects accounted for 65.5 % of ingestions. Young males commonly ingested button batteries, while females showed higher rates of ingesting hair products and jewelry. Most children were discharged (60 %) or observed briefly (75 % of total admissions), with endoscopic removal performed in 24 % of cases.

CONCLUSIONS

Rates of FBI have remained stable over the years, including during the COVID-19 pandemic. FBI predominantly occurs in domestic settings among healthy young children, particularly those ≤5 years old. These findings emphasize the need for preventive measures to reduce the impact of FBI among children.

Multidisciplinary Management of Foreign Body Aspiration in Pediatrics: A Case Complicated by Bilateral Pneumothorax and Respiratory Failure

Foreign body aspiration (FBA) is a significant cause of morbidity and mortality in the pediatric population, particularly in children under three years of age. This condition often presents with nonspecific respiratory symptoms, leading to delays in diagnosis and an increased risk of severe complications such as pneumothorax and respiratory failure. Here, we present a case of a 2-year-old child with FBA complicated by bilateral pneumothorax, severe respiratory acidosis, and left lung collapse. Diagnostic imaging, including computed tomography (CT), identified an obstruction in the left main bronchus. High-frequency oscillatory ventilation (HFOV) and multidisciplinary planning were critical in stabilizing the patient before definitive management with rigid bronchoscopy under high-risk conditions. The case highlights the diagnostic and therapeutic challenges associated with severe FBA and underscores the importance of advanced therapeutic modalities, such as extracorporeal membrane oxygenation (ECMO), in managing critically ill pediatric patients.

Consumer Trends Reflected in the Contents of the Pediatric Esophagus: A 20-Year Review

OBJECTIVES

To evaluate epidemiological trends of pediatric esophageal foreign body (EFB) ingestion over two decades.

METHODS

A retrospective analysis was performed using data from the National Electronic Injury Surveillance System (NEISS) database for children <18 years who presented to a United States Emergency Department (ED) with EFB between 2003 and 2022. Number of cases and type of EFB were recorded. Rates of EFBs over time were analyzed via linear regression.

RESULTS

A total of 52,315 EFB cases were identified over the 20-year period, with a national estimate of 1,589,325 cases. The most frequently ingested objects were coins (37.6%), toys (13.5%), and batteries (6.8%). Overall incidence of EFB ingestion increased from 7.3 to 14.2/10,000 children from 2003 to 2022 (R2 = 0.8, p < 0.0001). Incidence of coin ingestion increased from 3 to 4.5/10,000 children (R2 = 0.06, p = 0.335) but represented a smaller proportion of all EFB over time (66% in 2003 versus 43% in 2022). Incidence of magnet, battery, and toy ingestion have increased from 0.3 to 1.0/10,000 (R2 = 0.9, p < 0.0001), 0.3 to 1/10,000 (R2 = 0.7, p < 0.0001), and 0.6 to 2.3/10,000 (R2 = 0.8, p < 0.0001) children, respectively, between 2003 and 2022. The proportion of magnet, battery, and toy ingestion have increased over time (3.2%, 6.5%, and 11.8%, respectively, in 2003 to 11.4%, 11.7%, and 22.2%, respectively, in 2022).

CONCLUSION

Magnet, battery, and toy ingestion have increased significantly in the past two decades, while the proportion of coin ingestion has decreased. This trend may reflect shifts within the consumer market and increased availability of electronics concurrent with the adoption of digital currency.

LEVEL OF EVIDENCE

4 Laryngoscope, 135:438-444, 2025.

Accidental ingestion of a fractured piece of orthodontic aligner: a case report

BACKGROUND

Ingestion and aspiration of orthodontic devices are rare occurrences, typically associated with components such as expansion keys, archwire segments, dislodged fixed appliances (including brackets, buccal tubes, and bands), as well as fractured metal or plastic appliances. This article describes the clinical diagnosis and treatment process of a case of accidental ingestion of a fractured piece of orthodontic aligner.

CASE PRESENTATION

A 31-year-old female under orthodontic treatment by aligners accidentally ingested a fractured piece of the aligner. The special difficulty of this case is that the transparent orthodontic aligner has a low radiopacity. At the beginning, no foreign body was found in the commonly used soft tissue window, causing difficulty in its location until greyscale was adjusted to lung window. The 2-centimeter fractured piece was taken out under anesthesia and endoscopic surgery.

CONCLUSION

Materials with low radiopacity should be read with a lower grayscale range. Fractured orthodontic appliances with low retention force should not continue to be worn until consultation with attending doctor.

Laryngeal Foreign Body Aspiration in Infancy: A Diagnostic Challenge

Foreign body aspiration (FBA) is a significant cause of accidental death among children, with laryngeal FBA being relatively rare but potentially fatal due to airway obstruction. This report highlights a case of laryngeal FBA in an 11-month-old child, initially misdiagnosed as viral croup. Otolaryngological evaluation, particularly in the case of laryngeal FBA, may facilitate management. An 11-month-old male was brought to the emergency department, presenting with inspiratory stridor following a choking episode. A chest radiograph and CT scan of the chest were read as normal. He was suspected of having croup and treated with dexamethasone and racemic nebulized epinephrine, which led to temporary clinical improvement.  The child returned with persistent stridor to the emergency department eight days after his initial visit, prompting an otolaryngological consultation. Flexible laryngoscopy ultimately identified a star-shaped sequin lodged in the glottis. The foreign body was successfully removed via direct laryngoscopy and bronchoscopy (DLB). Following the removal, the patient demonstrated significant improvement and eventually made a full recovery. This case emphasizes the difficulty in diagnosing laryngeal FBA due to its non-specific symptoms and the limitations of imaging techniques. The importance of a thorough clinical history, physical examination, and proper imaging combined with a high index of suspicion is crucial for early diagnosis and treatment. Additionally, the report discusses the potential for severe complications if diagnosis and treatment are delayed, highlighting the need for awareness and prompt intervention in suspected laryngeal FBA cases.

National Trends of Pediatric Aspirated/Ingested Foreign Bodies

Foreign body (FB) aspiration/ingestion in children represents a major cause of hospital admission and mortality. Evaluating risk factors and identifying trends in specific FB products could improve targeted health literacy and policy changes. A cross-sectional study querying emergency department patients less than 18 years old with a diagnosis of aspirated/ingested FB was conducted using the National Electronic Injury Surveillance System database between 2010 and 2020. Incidence rates per 100 000 people-year were calculated and multivariate analyses were performed to identify risk factors for hospital admission and mortality. There has been a significantly decreasing rate of aspirated (-23.6%; P = .013) but not ingested FB (-9.4%; P = .066) within the study period. Within pediatric aspirated FB, black compared with white patients had decreased odds of same hospital admission (odds ratio [OR]: 0.8), but increased odds of transfer admission (OR: 1.6) and mortality (OR: 9.2) (all, P < .001).

Changes in the global burden of foreign body aspiration among under-5 children from 1990 to 2019

Background

To evaluate the changes in the global burden of foreign body aspiration (FBA) among children under 5 years old at regional, age, sex, and socio-demographic index (SDI) levels between 1990 and 2019.

Methods

Data on FBA was derived from the Global Burden of Disease (GBD) Study 2019 database on pulmonary aspiration and foreign body in airway. The means and 95% uncertainty intervals (UIs) were calculated for incidence, and disability-adjusted life-years (DALYs). The temporal trends were represented by estimated annual percentage change (EAPC) using Joinpoint regression.

Results

Globally, FBA caused 109.6 (95% UI: 69.5, 175.7) per 100,000 incidence and 317.9 (95% UI: 270.7, 372.4) per 100,000 DALYs under 5 years old in 2019. Many European countries (such as Italy, Netherlands, Iceland, etc.) showed a high incidence rate, but did not cause a large disease burden (DALYs all less than 200 per 100,000). Compared to 1990, although a decrease in both incidence and DALYs occurred in 2019, the Joinpoint regression showed an increasing trend in incidence rate from 2014 to 2019 [APC: both (2.10), female (2.25), male (1.98), P < 0.05)], especially China, Netherlands, and Malta. Despite the lower incidence rate in early neonatal group and middle SDI areas, they instead resulted in higher DALYs than other age groups and areas.

Conclusion

Although declines occurred in incidence and DALYs of FBA among children under 5 years of age from 1990 to 2014, an upward trend began to emerge from 2014 to 2019. The incidence and DALY rates were correlated with age and SDI. Increased efforts are needed to improve the necessary monitoring and reporting systems, hazard assessment, and public education activities.

Case report: Foreign body aspiration requiring extracorporeal membrane oxygenation

Introduction

Foreign body aspiration is a common cause of respiratory distress in pediatrics, but the diagnosis can be challenging given aspirated objects are mostly radiolucent on chest radiographs and there is often no witnessed choking event. We present a case of a patient who was initially managed as severe status asthmaticus, requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for refractory hypercarbia and hypoxemia, but was later found to have bilateral bronchial foreign body aspiration. This case is unique in its severity of illness, diagnostic dilemma with findings suggesting a more common diagnosis of asthma, and use of ECMO as a bridge to diagnosis and recovery.

Patient case

A previously healthy 2-year-old boy presented during peak viral season with a 3-day history of fever, cough, coryza, and increased work of breathing over the prior 24 h. There was no reported history of choking or aspiration. He was diagnosed with asthma and treated with bronchodilator therapy. Physical examination revealed pulsus paradoxus, severe work of breathing with bilateral wheeze, and at times a silent chest. Chest radiographs showed bilateral lung hyperinflation. Following a brief period of stability on maximum bronchodilator therapies and bilevel positive pressure support, the patient had a rapid deterioration requiring endotracheal intubation, with subsequent cannulation to VA-ECMO. A diagnostic flexible bronchoscopy was performed and demonstrated bilateral foreign bodies, peanuts, in the right bronchus intermedius and the left mainstem bronchus. Removal of the foreign bodies was done by rigid bronchoscopy facilitating rapid wean from VA-ECMO and decannulation within 24 h of foreign body removal.

Conclusion

Foreign body aspiration should be suspected in all patients presenting with atypical history and physical examination findings, or in patients with suspected common diagnoses who do not progress as expected or deteriorate after a period of stability. Extracorporeal life support can be used as a bridge to diagnosis and recovery in patients with hemodynamic or respiratory instability.

Hemodynamic Response, Coughing and Incidence of Cerebrospinal Fluid Leakage on Awakening with an Endotracheal Tube or Laryngeal Mask Airway in Place after Transsphenoidal Pituitary Surgery: A Randomized Clinical Trial

We aimed to compare systemic and cerebral hemodynamics and coughing during emergence after pituitary surgery after endotracheal tube (ETT) extubation or after replacing ETT with a laryngeal mask airway (LMA). Patients were randomized to awaken with an ETT in place or after replacing it with an LMA. We recorded mean arterial pressure (MAP), heart rate, middle cerebral artery (MCA) flow velocity, regional cerebral oxygen saturation (SrO2), cardiac index, plasma norepinephrine, need for vasoactive drugs, coughing during emergence, and postoperative cerebrospinal fluid (CSF) leakage. The primary endpoint was postoperative MAP; secondary endpoints were SrO2 and coughing incidence. Forty-five patients were included. MAP was lower during emergence than at baseline in both groups. There were no significant between-group differences in blood pressure, nor in the number of patients that required antihypertensive drugs during emergence (ETT: 8 patients (34.8%) vs. LMA: 3 patients (14.3%); p = 0.116). MCA flow velocity was higher in the ETT group (e.g., mean (95% CI) at 15 min, 103.2 (96.3-110.1) vs. 89.6 (82.6-96.5) cm·s-1; p = 0.003). SrO2, cardiac index, and norepinephrine levels were similar. Coughing was more frequent in the ETT group (81% vs. 15%; p < 0.001). CSF leakage occurred in three patients (13%) in the ETT group. Placing an LMA before removing an ETT during emergence after pituitary surgery favors a safer cerebral hemodynamic profile and reduces coughing. This strategy may lower the risk for CSF leakage.

Persistence of choking injuries in children

BACKGROUND

Choking injuries are a significant cause of morbidity and mortality in children and represent a significant public health concern. Evaluating trends and the impact of interventions are essential to highlight whether progress has been made and to target public health efforts.

OBJECTIVE

To investigate how rates of nonfatal and fatal choking injuries have changed before and after 2010 when policy recommendations were made by the American Academy of Pediatrics.

METHODS

A descriptive study investigating unintentional nonfatal and fatal choking injuries in children aged 0-19 years using national data from 2001 to 2016 through the Centers for Disease Control and Prevention's WISQARS™ and WONDER databases, focusing on the 6 years prior and 6 years after release of the AAP's recommendations. The data was categorized by age, gender, year, and race/ethnicity for descriptive and statistical analyses.

RESULTS

From 2001 to 2016, there were a total of 305,814 nonfatal injuries and 2347 choking deaths in children from 0 to 19 years. Children under five years of age accounted for 73% of nonfatal injuries and 75% of choking fatalities. There was a statistically significant increase in the nonfatal injuries rate when comparing 2005-2010 and 2011-2016 (19/100,000 versus 26/100,000, respectively). There was a decrease in the choking fatalities rate in all children (0.18/100,000 versus 0.16/100,000, respectively) but no change in fatalities rate for children under five. White and Black children experience nonfatal choking injuries at a higher rate than Hispanics. Black children had highest rates of choking fatalities over Hispanic, White, Asian, and Alaskan or American Indian ethnicities. The lowest rates of death occurred in Asians.

CONCLUSIONS

Overall rate of nonfatal choking injuries increased, while rate of choking fatalities in children decreased after 2010. However, the choking fatalities rate in 0-4 years olds, the highest risk group, did not change. Racial gaps exist with highest rates of injury in Black children. We must continue to educate and raise awareness of choking injuries, with targeted efforts to address racial disparities.

[Top ten pediatric radiological emergencies]

Pediatric emergencies encompass a wide range of different findings. These include injuries to the child's body due to high-energy trauma or abuse, unclear limitations of consciousness and primarily unspecific abdominal or thoracic pain as well as swallowing or inhalation of foreign bodies. Detailed knowledge of the various imaging methods and the correct application are important. This article gives an overview of the significance of imaging techniques for emergency diagnostics in childhood and adolescence.

Clinical variables responsible for early and late diagnosis of foreign body aspiration in pediatrics age group

Background

Incidence of foreign body aspiration has been noticed predominantly in age group ranging from 12 months-3 years. Foreign body in the trachea is a medical emergency as presentation is in respiratory distress. Obstruction of only one main or distal bronchus, leads to severe cough, choking sensation and breathlessness. Without early intervention, it can lead to collapse, consolidation and pneumonia of the affected lung.

Methods

We retrospectively analyzed 37 pediatric case records who presented from January 2014–December 2018 with foreign body aspiration. Our primary aim was to assess the parameters responsible for early and late diagnosis of foreign body aspiration. We concluded with a diagnostic algorithm for management of foreign body aspiration on the basis of this outcome.

Results

Around 32.5% came with a history of aspiration, 43% were referred from the primary centers with a suspicion for the same and the rest came to our tertiary care hospital directly. Those who presented within a week came with complaints of wet cough, wheeze and tachypnea. Furthermore, those who came in after a week had a dry cough and fever as their main complaint. Majority of ingested foreign bodies was a vegetative type (80%) as compared to the non –vegetative.

Conclusion

Unlike adults, foreign body aspiration in children is most commonly diagnosed on history, suspicion and clinical findings. Chest x ray has been the primary investigation of choice but in the majority of the cases it was normal with subtle changes. Early diagnosis is the key to avoid complication.

Injuries due to foreign body ingestion and insertion in children: 10 years of experience at a single institution

AIM

Foreign body (FB) injuries represent a severe public health problem during childhood. The aim of this study was to report our experience with patients with injuries due to FB ingestion and insertion who were treated surgically at our institution.

METHODS

A total of 78 paediatric patients who were hospitalised for FB injuries were retrospectively reviewed.

RESULTS

The series was composed of 27 males and 51 females, with a median age of 3.6 years. The cases included 35 cases of FB ingestion and 43 cases of FB insertion, including 40 cases with a vaginal insertion, 2 cases with a rectal insertion and 1 case with a urethra insertion. Intestinal perforation (n = 26) was a more common complication than intestinal obstruction (n = 9) in patients who had ingested a FB. The main clinical symptom was persistent vaginal discharge, followed by vaginal bleeding for patients with a vaginal FB insertion. Exploratory laparotomy was performed on 36 patients, while a laparoscopic approach was employed in 1 patient. Forty patients underwent hysteroscopy and one patient underwent cystotomy to remove the FB. All FBs were successfully removed. Of the 78 FBs recovered, 26 were food objects, while non-food objects were found in 52 patients. All patients recovered well, except one patient with an intestinal obstruction from adhesions that occurred approximately 1 month after discharge.

CONCLUSIONS

Early recognition of FB injuries and appropriate management can significantly reduce complications. Surgical removal of a FB can be safe and effective, and relatively better outcomes can be achieved.

Rattled: Analysis of Facial Trauma Among Toddlers

OBJECTIVE

The aim of this study was to determine the national incidence of facial trauma among toddlers and delineate patterns of injury and their causes.

METHODS

A retrospective review was designed to explore patterns of maxillofacial trauma within toddler-aged children using the National Electronic Injury Surveillance System from the Consumer Product Safety Commission. The database was searched for emergency department visits involving facial trauma sustained by children 12 months through 3 years of age from 2010 through 2014 and analyzed for patient demographics, primary diagnosis, and associated products/activities. Subset analyses were performed between age groups to determine the relationship between causes of injury and age using extrapolated national incidences.

RESULTS

A sample of 45,249 patients extrapolated to an estimated 1.3 million emergency department visits for facial trauma in toddlers from 2010 to 2014, averaging 260,000 annually. Injuries involving foreign bodies and fractures had a higher incidence in toddlers 2 years or older, and fractures comprised fewer than 1% of facial injuries in any age group. Furniture was the most common source of trauma overall, with a higher frequency among toddlers aged 12 to 17 months. Trauma in the setting of sports was more common in toddlers aged 3 years.

CONCLUSIONS

The low incidence of facial fractures further supports recommendations against routine imaging in toddler facial trauma and suggests that more focus should be placed on investigating for concurrent traumas and soft tissue injuries where fractures are involved. Our findings highlight prevention opportunities, particularly in furniture-related injuries for toddlers aged 12 to 17 months and sports-related traumas in toddlers aged 3 years. Our study also suggests restricting certain toys from 3-year-old toddlers to decrease the risk of aspiration.

Pediatric Ingestions of Christmas Past, Present, and Future: A Review of Holiday Trends, 1997 to 2015

During the observance of Christmas, many families display decorations, which increases the risk of unfettered access and subsequent ingestion of small objects by children in the home. Our aim was to characterize the epidemiology of Christmas foreign body ingestion (CFBI) by children. National Electronic Injury Surveillance System data from 1997 to 2015 were obtained for children aged 0 to 17 years who presented to United States Emergency Departments matching "ingested" for "artificial Christmas trees"; "Christmas tree lights"; "Christmas tree stands or supports"; "Christmas decorations, nonelectric"; and "Christmas decorations, electric" (excluding tree lights). An estimated 22 224 children (95% confidence Interval = 18 107-26 340) presented to the emergency department for CFBI over the study period. Children aged 2 years and younger ingested Christmas objects most frequently ( P < .001). CFBI visits demonstrated a seasonal trend ( P < .001). Christmas decoration ingestions are a frequent reason for children to present to the ED, which require dedicated awareness for appropriate diagnosis and care.

Foreign-Body Ingestions of Young Children Treated in US Emergency Departments: 1995-2015

OBJECTIVES

To describe the epidemiology of foreign-body ingestions (FBIs) of children <6 years of age who were treated in US emergency departments from 1995 to 2015.

METHODS

We performed a retrospective analysis using data from the National Electronic Injury Surveillance System for children <6 years of age who were treated because of concern of FBI from 1995 to 2015. National estimates were generated from the 29 893 actual cases reviewed.

RESULTS

On the basis of those cases, 759 074 children <6 years of age were estimated to have been evaluated for FBIs in emergency departments over the study period. The annual rate of FBI per 10 000 children increased by 91.5% from 9.5 in 1995 to 18 in 2015 (R ² = 0.90; P < .001). Overall, boys more frequently ingested foreign bodies (52.9%), as did children 1 year of age (21.3%). Most children were able to be discharged after their suspected ingestion (89.7%). Among the types of objects ingested, coins were the most frequent (61.7%). Toys (10.3%), jewelry (7.0%), and batteries (6.8%) followed thereafter. The rates of ingestions of those products also increased significantly over the 21-year period. Across all age groups, the most frequently ingested coin was a penny (65.9%). Button batteries were the most common batteries ingested (85.9%).

CONCLUSIONS

FBIs remain common in children <6 years of age, and their rate of ingestions has increased over time. The frequency of ingestions noted in this study underscores the need for more research to determine how best to prevent these injuries.