Young children, through being exploratory, may inadvertently swallow non-food items or inhale foreign objects, which may lodge in different parts of the breathing passages (airways) or swallowing passage (oesophagus). If not removed timeously, lodged objects will lead to complications, which may include the loss of life.
In our experiences, children accidentally ingest and inhale foreign objects all the time. Children under the age of five years are particularly at risk because they instinctively explore objects by placing them in their mouths.
Such young children do not have a fully developed swallowing mechanism that will afford them protection from inhaling or accidentally ingesting foreign objects. In hospitals, there are frequent cases of children who have foreign objects lodged in the swallowing or breathing passages and because of the risk it is worth raising awareness among parents and caregivers to reduce the incidence of such preventable accidents.
The most frequently encountered ingested foreign objects in Namibia are coins, batteries and bones, and because of the small calibre of the oesophagus of children, the coins become stuck at the point of natural narrowing along the oesophageal length. Most of these coins get stuck in the upper oesophagus resulting in obstruction of swallowing. The children often complain of pain or discomfort in the throat, are unable to swallow their saliva and, therefore, drool.
In a similar manner, toddlers and older children may accidentally ingest batteries. Batteries deserve emphasis because they can lead to severe complications and death. Stuck in the oesophagus, the battery continues to discharge current, which causes the oesophageal wall locally to die and cause a hole. Swallowed saliva and food end up in the inner spaces of the chest causing severe infection, which if detected too late can lead to death.
Further, the battery may erode into adjacent tissues commonly the airway passages of the large artery of the body, resulting in a hole between the swallowing and breathing pipes with severe infection and breathing problems ensuing. A hole in the large artery of the body can result in internal bleeding and certain death.
The breathing passages conduct air from the upper nasal and oral passages to the lungs. During swallowing a mechanism exists that prevents solid objects or liquids from entering the air passages. Accidental inhalation of water or solid particles stimulates choking followed by vigorous coughing.
Because of the immaturity of their swallowing mechanism children may place objects into their mouth and continue to talk, walk or laugh. Unfortunately, the event may not be witnessed by anybody. The inhaled object, if large enough, will result in the older child displaying the “universal choking sign”, clutching their throats A sudden paroxysm of coughing, difficulty breathing or breathing fast, turning dusky blue on the lips or in worse scenarios losing consciousness may ensue. Other signs may be noisy breathing of a sudden onset of wheezing or stridor.
Large objects may completely obstruct the breathing passages in the vocal cord. Timely intervention through performing back blows or abdominal thrust in older children may dislodge the foreign body. Such interventions, however, need to be performed correctly and in the appropriate category of the child. Done correctly, they may dislodge the foreign object.
In the event that the child is unconscious and has stopped breathing, medical emergency services should be immediately called and if the attending adult is capable, basic life support, such as cardiopulmonary resuscitation, should be started.
Smaller objects may pass into the distal airways usually lodging in the proximal airways of the right lung. The initial bout of coughing may cease, and because passage obstruction is partial, the child’s life is not immediately threatened. Nevertheless, the foreign object will inevitably lead to complications, including dislodging into the airways of the other lung or worse in the trachea causing complete obstruction. Presence of foreign material in the airways can lead to infection of pneumonia, which may progress to a collection of pus within the lungs. Other complications may include chronic coughing, coughing blood, lung collapse with difficulty breathing and in the long term structural changes to the lungs or airways that may need treatment with surgical removal of part of or the entire lung.
Whenever caregivers suspect a child has inhaled or swallowed a foreign object, they should take the child to the hospital immediately and inform the attending medical professionals of their suspicion. The earlier medical attention is sought; the less likely it is that the child will suffer complications.
In the event of a witnessed or suspected foreign object getting stuck in the swallowing pipe, caregivers should immediately take the child to the hospital. Do not induce vomiting or attempt to remove the object with your finger unless the object is clearly visible in the mouth and has no sharp edges.
Parents should be aware of the natural curiosity of children and the risk posed by objects placed in the mouth. It is imperative that caregivers put measures in place to prevent accidental ingestion or inhalation of foreign bodies.
* Dr Jones Nghaamwa is a cardiothoracic, heart and lung surgeon at Windhoek Central Hospital and Lady Pohamba Hospital. Drnghaamwa@gmail.com