Foreign bodies: Treatment, symptoms, advice and help

All toys which are small, or consist of small parts which can be taken off or fall off, come with a warning that they are not suitable for children under 36 months. This relates mainly to the danger of small parts being put into the mouth, inhaled into the lungs and blocking the main windpipe (trachea), potentially causing death. You may have noticed that many of the caps of biros now have the tops cut off , to allow air to pass through should they end up in the trachea.

Symptoms

Foreign bodies in the lungs are clearly the most dangerous as death can occur rapidly. However small objects including peanuts can lodge in the peripheral parts of the lungs blocking off smaller airways. This initially does not cause a problem and may not have been noticed by the parents. However eventually the blocked airways become infected and the child develops pneumonia. This will show up on a chest X-ray but if no-one knows of the possibility of a foreign body being the cause, it may take a little time before this is realized unless the object itself can be seen on the chest X-ray, for example if it is metal.

Treatment
When it is diagnosed treatment is to remove the foreign body from the lungs via a tube passed into the lungs (bronchoscopy).

Children older than 36 months are capable of doing exactly the same thing, as well as being able to introduce foreign bodies into their ears, nose, vagina or swallowing something that gets stuck.

Young children explore objects partly by using the mouth and so putting the objects into the mouth. These objects can be inhaled into the lungs or they can also be swallowed. If the object is relatively small it will pass down through the gullet into the stomach and eventually out. However the gullet is quite narrow and objects such as coins, pieces of toys, safety pins etc. can end up stuck in the upper part of the gullet. This is not usually painful but the child may have the sensation of food being stuck. This may cause some children to refuse to eat as this sensation gets worse but they will still drink. Again it may take some time to sort this out if no-one had noticed the child swallow the object and chest X-ray will only show something up if it is metallic. Treatment is again by removing the object via a tube into the gullet (oesophagoscopy).

Foreign bodies such as small rubbers, pieces of paper, pieces of toys, pieces of sponge can be introduced into the ear, nose or vagina. In the ear or nose the object may be visible but too far in to be taken out. On the other hand there may be nothing to see. Eventually the area around the foreign body will become infected and this usually produces a foul smelling discharge which should alert your doctor to the possibility of a foreign body. If the foreign body is far up the nose however then the discharge may trickle down the back of the nose so the only clue is an unpleasant smell from the child.

Treatment again is by removal. In the ear it may be possible without sedation but anaesthetic is normally needed for a foreign body up the nose.

A similar problem happens in the vagina. A vaginal discharge apart from an odourless white or creamy discharge is uncommon in prepubertal girls. The infection caused by the foreign body will eventually cause a foul smelling discharge and anaesthetic will be needed to examine the vagina carefully and remove any foreign body.

Small objects are hazardous for young children and their orifices. It is best to keep the two apart.