Foreign Body Aspiration

Foreign body aspiration occurs when an object is accidentally inhaled into the airway rather than swallowed into the food pipe. It is most common in young children and can be life-threatening if it causes complete airway blockage.

• Sudden onset of coughing, choking, or gagging, often during eating or play with small objects
• Difficulty breathing or noisy breathing (wheeze or stridor)
• In complete airway obstruction: inability to speak, cough, or breathe, and the person may clutch their throat — a medical emergency
• After the initial choking episode, some children may seem to recover but later develop persistent cough, wheeze, or recurrent chest infection if the object remains lodged

• Most commonly occurs in young children exploring their environment by placing small objects, such as toys, beads, nuts, or seeds, in their mouths.
• Can also occur in older children and adults, particularly while eating, talking, or laughing with food in the mouth, or with reduced consciousness or swallowing difficulty.

• Diagnosed based on a history of a choking episode, together with examination findings such as reduced air entry or wheeze on one side of the chest.
• Chest X-ray, where available, may show the object directly if it is visible on imaging, or show indirect signs of obstruction, though some objects are not visible on X-ray.
• A history of choking followed by persistent respiratory symptoms should raise suspicion even without a clearly witnessed event.

For a person who is choking but still able to cough, speak, or breathe, they should be encouraged to keep coughing, as this is often the most effective way to clear the object.

For complete airway obstruction — when the person cannot cough, speak, or breathe — emergency first aid measures (back blows and abdominal thrusts for adults and older children, or back blows and chest thrusts for infants) should be started immediately, alongside calling for emergency help.

Any object that is not cleared, or any case with persistent breathing difficulty after a choking episode, requires urgent medical assessment, which may include removal of the object using specialised equipment at a hospital.

Even if a choking episode seems to resolve, seeking medical assessment afterward is important, as the object can be lodged further down the airway and cause ongoing problems if not identified and removed.

• Keep small objects, such as toys with small parts, coins, and button batteries, out of reach of young children.
• Avoid giving young children foods that are common choking hazards, such as whole nuts, hard sweets, or round foods like grapes, without appropriate preparation.
• Supervise young children closely during meals and play.
• Learn basic first aid for choking, as prompt action can be life-saving.