Aspirated foreign bodies in pediatric patients, 1968-2010: a comparison between the United States and other countries

Abstract

Objectives: To identify the most commonly aspirated airway foreign bodies (FBs) and identify opportunities for intervention.

Methods: Literature was searched and pertinent articles from 1968 to 2010 (n=58; 14 articles were from the United States and 41 international) were reviewed. A list of the most commonly retrieved FBs resulted from the analysis.

Results: 11,880 FBs were analyzed (1934 from the US and 9946 international, p<0.0001). Food (edible) and food-related (inedible, e.g. bones) FBs were associated with most cases (68% in US and 84% internationally, p<0.0001). In this category, most common in the US were: nuts (41%, 44% of which were peanuts), seeds (8%, 19% of which were sunflower seeds), vegetables (5%, 41.7% of which were carrots), popcorn (4%), and bones (2%). Internationally: nuts (37%, 76.9% of which were peanuts), seeds (29%, 32.7% of which were watermelon seeds), beans (7.8%), and bones (2%). Non-food sources were the source of FBs in 25% of US patients and 12% internationally (p<0.0001). Of non-food sources, the most common FBs in US were: metallic (8%) and plastic (7%). Internationally: metallic (5%) and plastic (2%).

Conclusions: Most FB aspirations in pediatric patients occur while eating, with peanuts posing the greatest risk. The majority of FBs worldwide are nuts, seeds, and metallic objects. The significantly higher proportion of non-food FBs in the US may suggest that tighter regulation of products is needed. Educational or more stringent regulatory interventions should be considered to reduce FB aspirations from the sources highlighted herein.