Foreign Bodies in Lower Airways in Children 1–3 Years Old

Abstract

The common symptoms of foreign body aspiration (FBA) include coughing, wheezing, choking, and respiratory distress. Physical examination may reveal abnormal respiratory sounds, such as wheezing or stridor, as well as signs of respiratory distress, such as increased respiratory rate, retractions, and nasal flaring. A chest X-ray is often the initial imaging modality used to evaluate foreign body aspiration. Bronchoscopy is considered the gold standard for both diagnosis and removal of foreign bodies in the airways. The diagnosis of foreign body aspiration in children aged 1–3 years requires a comprehensive approach that includes clinical evaluation, radiological imaging, and bronchoscopy. If the foreign body (FB) is causing significant airway obstruction, respiratory distress, or if it is not spontaneously expelled, a prompt removal of the foreign body is necessary. The most immediate and significant complication of foreign body aspiration is airway obstruction. In some cases, foreign body aspiration can lead to long-term complications, such as chronic suppurative lung disease (CSLD) or bronchiectasis. Foreign body aspiration in children can have a significant psychological impact on parents and caregivers. It is important for healthcare providers to be aware of these potential complications associated with flexible bronchoscopy in foreign bodies in children. Careful patient selection, expertise in the procedure, and appropriate monitoring can help minimize these risks.

1. Introduction

Children from 1 to three years old are at greater risk of aspiration of foreign bodies in lower airways. This paper addresses clinicians to understand the physiopathology of aspiration, clinical signs, possible complications, and management of such a case.

2. Etiology and predisposing factors of foreign body aspiration

The clinical presentation of foreign body aspiration in children aged 1–3 years can vary depending on the type, size, and location of the foreign body. Common symptoms include coughing, wheezing, choking, and respiratory distress. However, it is important to note that the presentation can be nonspecific, leading to delayed diagnosis and potential complications.

Children from 1 to 3 years old have difficulties in coordinating breathing and swallowing.

Gag reflexes, cough, and glottic closure against chocking may not be fully developed from birth.

Children with development delays are at higher risk of aspiration in general and from aspiration of foreign bodies in airways especially. Children have smaller airways and even small changes in airway radius lead to much greater changes in airflow, decreasing dramatically airflow in airway (Flow = 1/R⁴) [1].

In an infant, the larynx is at a higher position and nearer to the base of the tongue, leading to more possible aspiration. Aspiration happens usually with organic materials, such as peanuts, nuts, seeds, or small pieces of toys, and at the same time children cry or laugh or run to escape the removal of the object from the mouth.

Secretion of mucus and edema of the bronchial mucosa can lead to further obstruction.

A study by Baharloo et al. [2] examined the clinical features of foreign body aspiration in children. They found that coughing was the most common symptom, present in 85.5% of cases, followed by wheezing (53.9%) and choking (39.2%). These findings highlight the importance of considering foreign body aspiration in the differential diagnosis of children presenting with respiratory symptoms.

Choking and asphyxia may happen as a first sign. This can be witnessed by caretakers and forgotten later on.

After penetration syndrome (when the foreign body bypasses subglottis) and choking seem to have already passed, the child may experience symptoms such as cough, stridor, or wheeze or may have minor symptoms, especially when the foreign body is lodged to one of the main bronchi.

This episode may be forgotten by caregivers or recalled when asked later.

Children may present at the clinician’s office complaining of cough, fever, wheeze, etc. When the diagnosis is delayed, they may present with grave complications such as atelectasis, emphysema, pneumothorax, bronchiectasis, and chronic suppurative lung disease.

3. Fiz pathology of a foreign body in bronchus

Depending not only on the bronchus size and foreign body size, but also on the fact that usually foreign bodies in lower airways are usually vegetal and can raise their size due to humidity, they can impact aeration on the affected lung or bronchus in different ways:

1. When it does not affect either inspiration or expiration (on the first day of inspiration, a small foreign body): bypass valve, clinically and X-rays normal

2. When it does affect the expiration, but does not affect inspiration (edema of the bronchial wall, secretions from inflammation), check the valve mechanism

3. When it does affect the inspiration (a complete obstruction of the bronchus due to swelling of the vegetal foreign body), the residual air is absorbed gradually, which blocks the valve mechanism [3].

4. Diagnostic approach for foreign body aspiration

The clinical evaluation begins with a thorough history and physical examination. The healthcare provider will inquire about the child’s symptoms, including coughing, wheezing, choking episodes, and any witnessed events of foreign body ingestion. The presence of risk factors, such as exposure to small objects or inadequate supervision, should also be assessed.

Physical examination may reveal abnormal respiratory sounds, such as wheezing or stridor, as well as signs of respiratory distress, such as increased respiratory rate, retractions, and nasal flaring. Cyanosis or other signs of inadequate oxygenation should also be assessed.

4.1 Radiological imaging

Chest X-ray: A chest X-ray is often the initial imaging modality used to evaluate foreign body aspiration. It is mandatory for all cases/suspected cases and can help to localize it through evaluating asymmetry, air trapping, mediastinal shift, and atelectasis. It is also important to differentiate other cases of respiratory distress not related to FBA.

In older children who can cooperate, inspiratory/expiratory films are more helpful. During expiratory films, mediastinal shifts are more obvious.

However, it is important to note that chest X-rays may not always detect radiolucent objects or early signs of aspiration. In one study [4] of 265 children with foreign bodies in airways, 110 of them had normal plain chest by the time they had bronchoscopy.

Only 10% of the foreign bodies on airways are radio opaque.

Chest radiographs may be normal in 17% of the foreign bodies in airways shown later on.

Pneumothorax or pneumomediastinum is found rarely. Their presence is dedicated to emphysema and flow through the fascia. When foreign bodies (FBs) (vegetal materials) carry germs, inflammation and infection can lead to pyopneumothoraxis.

4.2 Computed tomography (CT) scan

In stable children, CT and virtual bronchoscopy are more useful compared to plain X-ray Adaletli et al. [5]. In cases where the chest X-ray is inconclusive or there is a high suspicion of foreign body aspiration, a computed tomography (CT) scan may be performed. CT scans provide more detailed images of the airways and can help identify smaller or radiolucent foreign bodies. It is especially useful in cases where there is a concern for complications or when bronchoscopy is planned.

4.3 Bronchoscopy

Bronchoscopy is considered the gold standard for both diagnosis and removal of foreign bodies in the airways. It involves inserting a flexible or rigid bronchoscope through the mouth or nose to visualize the airways and remove the foreign body if present. Bronchoscopy allows direct visualization of the airways, identification of the foreign body’s location, and assessment of any airway- associated injury or inflammation.

In some cases, bronchoscopy may be performed urgently if there is a complete airway obstruction or significant respiratory distress. In other cases, it may be performed electively after initial evaluation and imaging. The timing and approach to bronchoscopy depend on the clinical presentation, radiological findings, and the expertise available in the healthcare setting.

The diagnosis of foreign body aspiration in children aged 1–3 years requires a comprehensive approach that includes clinical evaluation, radiological imaging, and bronchoscopy. Chest X-rays are commonly used as an initial diagnostic tool, but they may not always detect radiolucent objects or early signs of aspiration. There are studies that show that X-rays on the first 24 hours of a foreign body aspiration are normal.

It requires a high index of suspicion from the clinician when evaluating a child from 1 to 3 years old with cough and indirect signs in X-rays.

Persistent atelectasis, hyperventilation of a lobe, or the lung accompanied by dull sounds on auscultation might rise the suspicion of a foreign body aspiration lodged on lower airways.

A study by E. Svedström et al. [6] in an analysis of a radiograph of 83 consecutive patients, in which the prevalence of FB aspiration was 41%, the diagnostic accuracy was 67%, sensitivity 68% and specificity 67%. Therefore, a negative chest X-ray does not rule out foreign body aspiration, and further evaluation is necessary.

When there is a history of choking and there are clinical signs as cough, wheeze, and/or indirect radiological signs such as: hyperventilated lung or lobe, atelectasis, or persistent pneumonia, the diagnosis of confirmation/exclusion of a foreign body in airways should be made.

Clinical signs that show a possible foreign body in trachea should indicate prompt rigid bronchoscopy. Persistent pneumonia or radiological signs of emphysema of the lobe or the lung may first require a flexible bronchoscopy.

5. Management of foreign body aspiration

Foreign body aspiration in children requires prompt and appropriate management to ensure the child’s safety and prevent complications. The management approach involves a combination of supportive care, removal of the foreign body, and follow-up care.

5.1 Supportive care

In cases of partial airway obstruction or mild symptoms, supportive care may be sufficient. This includes closely monitoring the child’s respiratory status, providing reassurance, and ensuring a calm environment. Encouraging the child to cough and maintaining an upright position can help facilitate the spontaneous expulsion of the foreign body.

In infants, back slap with the head down, chest thrust, or a combination of both is encouraged when asphyxia happens after witnessing the episode of choking.

In older children, Heimlich maneuver is more effective.

5.2 Removal of the foreign body

If the foreign body is causing significant airway obstruction, respiratory distress, or if it is not spontaneously expelled, a prompt removal is necessary. The primary method of removal is through bronchoscopy, which allows direct visualization and retrieval of the foreign body.

Bronchoscopy can be performed using a flexible or a rigid bronchoscope, depending on the availability and expertise of the healthcare setting. The procedure is typically performed under general anesthesia to ensure the child’s comfort and safety. During bronchoscopy, the foreign body is located and removed using various instruments, such as forceps or suction catheters.

The management of foreign body aspiration in children aged 1–3 years involves ensuring a patent airway, providing appropriate oxygenation, and removing the foreign body. Bronchoscopy is considered the gold standard for both diagnosis and removal of foreign bodies.

A study by Cheng et al. [7] assessed the outcomes of bronchoscopic removal of foreign bodies in children. They reported a success rate of 97.6% and a low complication rate. This study emphasizes the importance of prompt bronchoscopy intervention for optimal management of foreign body aspiration.

Both rigid bronchoscopy and flexible bronchoscopy are used to remove a foreign body from lower airways.

Despite a lot of studies showing the efficacy of flexible bronchoscopy on removal of foreign bodies in airways, interventionists should always have a backup of rigid bronchoscopy.

Rigid bronchoscopy requires general anesthesia, but allows control of the airways at the same time, as the instrument is advanced to remove the foreign body in a safe way, also facilitating mucus plugging aspiration at the same time and installation of saline or mucolytics in the collapsed area.

If a foreign body is surrounded by granulation tissue, a balloon catheter may be used in order to ensure removal of a round object under the granulation. Prevention of disintegration of vegetal foreign bodies is important, in order to prevent smaller parts obstructing more peripheral airways.

On rare circumstances, when the foreign body gets stuck on the subglottic area during removal (monkey trap), it should be moved downward where the trachea is wider and allows oxygenation. Emergency tracheostomy may be required. Rigid bronchoscopy has the advantage of proper oxygenation during the procedure and the removal can take more time. Another advantage is bypassing the risk of the foreign body getting stuck on subglottic area that may lead to asphyxia when removal is effectuated with a flexible bronchoscope.

Flexible bronchoscopy is increasingly used for the removal of the foreign body. In a study on more than 1000 children, foreign bodies were successfully removed in 90% of them. Flexible bronchoscopy is recommended especially in distant foreign bodies in airways and for upper lobe lodged foreign bodies.

Management of complications from a long-standing foreign body as bronchiectasis may require lobectomy.

6. Anesthesia regime for flexible bronchoscopy and for rigid bronchoscopy

For flexible bronchoscopy, spontaneous breathing is possible with the use of propofol, propofol plus sevoflurane, and midazolam as anxiolytic. On the other hand, for rigid bronchoscopy paralysis is indicated rather than spontaneous ventilation. There is a lack of consensus about the regime Fidkowski et al. [8]. As regards foreign bodies in a child, any procedure such as positive end-expiratory pressure (PEEP) is recommended in order to reinflate the parts of the collapsed lung and adrenaline 1:1000 is applied locally in minor bleedings after the removal.

Antibiotics are used for several days after removal. Steroids are used for short courses to decrease edema of the airways.

All other bronchi are checked to rule out any other foreign body lodged there.

6.1 Follow-up care

After successful removal of the foreign body, a close follow-up care is essential. The child should be monitored for any signs of complications, such as persistent respiratory symptoms, recurrent infections, or airway injury. Follow-up visits with the healthcare provider may be scheduled to assess the child’s respiratory status and ensure proper healing.

6.2 Prevention

Prevention is crucial in reducing the risk of foreign body aspiration in children. Parents and caregivers should be educated about potential choking hazards and the importance of providing a safe environment for the child. This includes keeping small objects out of reach, ensuring proper supervision during playtime and meals, and promoting age-appropriate toy selection.

In summary, the management of foreign body aspiration in children involves supportive care, prompt removal of the foreign body through bronchoscopy, and close follow-up care. Prevention plays a vital role in reducing the risk of aspiration and should be emphasized to parents and caregivers.

7. Complications and prognosis of foreign body aspiration

Foreign body aspiration in children can lead to various complications, some of which can be serious and potentially life-threatening. The prognosis of foreign body aspiration depends on several factors, including the type and location of the foreign body, the duration of the obstruction, and the promptness of medical intervention.

7.1 Complications

1. Airway obstruction: The most immediate and significant complication of foreign body aspiration is airway obstruction. This can cause respiratory distress, cyanosis, and even respiratory arrest, if not promptly addressed. Complete obstruction requires urgent intervention to restore the airway and ensure adequate oxygenation.

2. Respiratory infections: Aspiration of a foreign body can lead to respiratory infections, such as pneumonia or bronchitis. The presence of a foreign body in the airways can obstruct normal airflow, trap bacteria, and cause inflammation, increasing the risk of infection. Prompt removal of the foreign body and appropriate antibiotic therapy are essential to prevent or treat respiratory infections.

3. Airway injury: The presence of a foreign body in the airways can cause injury to the surrounding tissues. This can result in inflammation, edema, and even ulceration or perforation of the airway walls. Airway injury may require additional interventions, such as medication to reduce inflammation or surgical repair, depending on the severity.

4. Long-term complications: In some cases, foreign body aspiration can lead to long-term complications, such as chronic suppurative lung disease or bronchiectasis. These conditions can result from recurrent respiratory infections, persistent inflammation, or damage to the airway structures. Close follow-up care and appropriate management are important to monitor and address any potential long-term complications.

7.2 Prognosis

The prognosis of foreign body aspiration depends on several factors. Prompt recognition and intervention are crucial in preventing complications and improving outcomes. The prognosis is generally favorable when the foreign body is promptly removed and there are no significant complications.

However, the prognosis may be influenced by factors such as the type and size of the foreign body, the duration of the obstruction, the presence of associated injuries or infections, and the child’s overall health. In some cases, the prognosis may be less favorable if there are significant complications or delays in diagnosis and treatment.

It is important to note that each case is unique, and the prognosis should be discussed with the healthcare provider based on the specific circumstances.

8. Case study of a foreign body in airways

Nursing diagnosis (ND), female, 2 years old, 1 week with fever, admitted to hospital as having pneumonia. Child was alert, no respiratory distress, sat O2 96%, respiratory frequency (FR) 36/min, and cardiac rate (FK) 106/min.

Decreased breath sounds on the left side. Some bronchial rale on the right side.

Blood workup normal. X-ray is shown (Figure 1):

Figure 1.

Atelectasis of the left lung. Mediastinal shift to the left side.

After evaluation of X-rays, the caregivers were asked about the possibility of a foreign body aspiration. They denied at first and then admitted that 2 weeks ago all the family had consumed sunflower seeds and the child as well.

Flexible bronchoscopy was performed and a sunflower seed was found on the end of left main bronchus (Figures 2 and 3).

Figure 2.

Flexible bronchoscopic view of the foreign body on lower left bronchus.

Figure 3.

X-rays after removal of the foreign body (FB). RI expansion of the reopening of lung. Some left perihilar consolidation.

Removal of the foreign body was made possible by rigid bronchoscopy. Treatment after removal included antibiotics, short-acting corticosteroids (Figure 4).

Figure 4.

X-rays after 5 days of treatment with antibiotics and steroids. Normal findings.

9. Psychological impact of foreign body aspiration on parents and caregivers

Foreign body aspiration in children can have a significant psychological impact on parents and caregivers. The experience of witnessing a child choking or struggling to breathe can be traumatic and distressing. The psychological impact can vary from mild anxiety and worry to more severe emotional distress and post-traumatic stress symptoms.

1. Acute stress reaction: Parents and caregivers may experience acute stress reactions immediately following the incident. This can include symptoms, such as fear, helplessness, guilt, and intrusive thoughts or nightmares about the event. They may also experience physical symptoms like increased heart rate, sweating, or difficulty sleeping.

2. Anxiety and worry: After the incident, parents and caregivers may develop heightened anxiety and worry about their child’s safety and well-being. They may become overly cautious or hypervigilant, constantly monitoring the child’s activities and surroundings to prevent any potential harm. This anxiety can persist, even after the foreign body has been successfully removed.

3. Guilt and self-blame: Parents and caregivers may experience feelings of guilt and self-blame, questioning their own actions or supervision during the incident. They may blame themselves for not preventing the aspiration or for not recognizing the signs earlier. It is important to reassure parents and caregivers that foreign body aspiration can occur, even with the best supervision and that seeking prompt medical attention is crucial.

4. Post-traumatic stress disorder (PTSD): In some cases, parents and caregivers may develop symptoms of post-traumatic stress disorder (PTSD). This can include flashbacks, nightmares, avoidance of reminders of the event, and persistent anxiety or hypervigilance. If these symptoms persist and significantly impact daily functioning, it is important to seek professional help.

5. Support and coping strategies: It is crucial to provide support and resources to parents and caregivers to help them cope with the psychological impact of foreign body aspiration. This can include offering reassurance, providing accurate information about the incident and its management, and connecting them with support groups or counseling services. Encouraging self-care and stress management techniques can also be beneficial.

It is important to recognize that the psychological impact can vary from person to person, and individuals may have different coping mechanisms. Providing a supportive and understanding environment can help parents and caregivers navigate through their emotions and seek appropriate help if needed.

10. Education and awareness for foreign bodies

Education and awareness about foreign bodies are essential in preventing incidents of aspiration, especially in children. By providing information and promoting safety measures, we can help reduce the risk of foreign body aspiration and its associated complications. Here are some key aspects of education and awareness for foreign bodies:

1. Parent and caregiver education: Parents and caregivers should be educated about the common objects that pose a risk for aspiration, such as small toys, coins, buttons, and food items. They should be aware of the signs and symptoms of foreign body aspiration, including coughing, choking, wheezing, and difficulty in breathing. Providing information on proper supervision and age-appropriate toys can also help prevent incidents.

2. Safe eating practices: Educating parents and caregivers about safe eating practices is crucial in preventing food-related foreign body aspiration. This includes cutting food into appropriate sizes for children, encouraging them to chew food thoroughly, and avoiding giving young children foods that are hard, small, or sticky. Emphasizing the importance of sitting down and eating slowly can also reduce the risk of choking.

3. First aid training: Basic first aid training can be valuable in emergency situations. Parents, caregivers, and even older children should be educated on how to perform the Heimlich maneuver or back blows to relieve airway obstruction in case of choking. This knowledge can help save lives during critical moments before medical professionals arrive [9].

4. Public awareness campaigns: Public awareness campaigns can play a significant role in educating the general population about the risks and prevention of foreign body aspiration. These campaigns can utilize various platforms, such as social media, television, and community events, to reach a wide audience. Providing clear and concise information, along with practical tips, can help raise awareness and encourage proactive measures.

5. Healthcare provider education: Healthcare providers, including pediatricians, nurses, and emergency personnel, should receive education and training on the recognition and management of foreign body aspiration. They should be familiar with the appropriate diagnostic tools, such as X-rays or bronchoscopy, and the recommended interventions for different scenarios. Continuous education and updates on guidelines can ensure that healthcare providers are equipped to handle these cases effectively.

6. Collaboration with schools and childcare centers: Collaboration with schools and childcare centers is crucial in promoting safety and awareness. Educators and staff should be trained in recognizing signs of foreign body aspiration and responding appropriately. Creating a safe environment with age-appropriate toys and regular inspections of play areas can also minimize the risk of incidents.

By implementing comprehensive education and awareness programs, we can empower individuals, families, and communities to take proactive measures in preventing foreign body aspiration. This can ultimately reduce the number of incidents and improve the overall safety and well-being of children.

11. Conclusions on foreign bodies in children

Foreign body aspiration in children is a serious concern that requires attention and proactive measures to prevent and manage. Here are some key conclusions regarding foreign bodies in children:

1. Prevention is key: Education, awareness, and proactive measures are crucial in preventing incidents of foreign body aspiration in children. By providing information to parents, caregivers, and the general public about the common objects that pose a risk, safe eating practices, and first aid techniques, we can reduce the occurrence of these incidents.

2. Supervision and age-appropriate toys: Proper supervision is essential in ensuring the safety of children, especially during playtime and mealtime. Parents and caregivers should be vigilant and provide age-appropriate toys and foods to minimize the risk of choking or aspiration.

3. Prompt recognition and response: Recognizing the signs and symptoms of foreign body aspiration is vital for prompt intervention. Parents, caregivers, and healthcare providers should be aware of the common symptoms, such as coughing, choking, wheezing, and difficulty in breathing. Knowing how to perform basic first aid techniques, such as the Heimlich maneuver, can be life-saving in emergency situations.

4. Collaboration and education: Collaboration between healthcare providers, schools, childcare centers, and parents is essential in promoting safety and awareness. Healthcare providers should receive education and training on the recognition and management of foreign body aspiration, while schools and childcare centers should implement safety measures and educate staff and parents about prevention.

5. Psychological impact: Foreign body aspiration can have a significant psychological impact on parents and caregivers. It is important to provide support, reassurance, and resources to help them cope with the emotional aftermath of such incidents.

6. Continuous improvement: Ongoing research, education, and awareness campaigns are necessary to continuously improve our understanding and prevention strategies for foreign body aspiration in children. By staying updated with the latest guidelines and sharing knowledge, we can work toward reducing the incidence and impact of these incidents.

In conclusion, foreign body aspiration in children is a preventable and manageable condition. By focusing on prevention, prompt recognition, and collaboration, we can create a safer environment for children and reduce the occurrence of these incidents. Additionally, addressing the psychological impact on parents and caregivers is crucial for their well-being. With continuous improvement and education, we can strive to minimize the risks associated with foreign body aspiration and ensure the safety and health of children.

12. Complications of flexible bronchoscopy in foreign bodies in children—Literature review

Flexible bronchoscopy is a valuable diagnostic and therapeutic tool for the management of foreign bodies in the lower airways of children. While it is generally considered safe and effective, there are potential complications that healthcare providers should be aware of. Here is a literature review of the complications associated with flexible bronchoscopy in foreign bodies in children:

Complications of foreign body aspiration are;

1. Physiological, due to hypoxemia, with or without hypercapnia.

2. Mechanical, as is epistaxis, hemoptysis, pneumothorax, or post subglottic edema.

3. Infectious (bacteriological complications).

4. Anesthetic, when most life-threatening adverse events involve: overdose, inadequate monitoring, or inappropriate sedation

5. Post bronchoalveolar lavage (BAL) fever

J de Blic et al. [10] described in a study with 1328 procedures, 1153 children, who underwent diagnostic procedures of flexible bronchoscopy, presented major complications such as important desaturation (oxygen saturation value (Sat O2) <90%), 21 children (1,6%) had all procedures done, 6 children (0,6%) suffered from laryngospasm, and one patient (0,1%) presented difficulty due to pneumothorax.

Six children (0,5%) presented minor complications such as epistaxis, whereas 15 children (1,1%) presented isolated desaturation.

Ninety-one patients (6,9%) presented overall complications (at least one).

The majority of procedures were performed under conscious sedation (93%), and only 7% of procedures were performed under deep sedation.

Complications of flexible bronchoscopy are:

1. Bleeding: Several studies have reported bleeding as a potential complication of flexible bronchoscopy in children. The incidence of bleeding varies, ranging from minor mucosal bleeding to more significant bleeding requiring intervention. Careful technique and expertise are necessary to minimize the risk of bleeding.

2. Airway injury: Airway injury, including mucosal abrasions, edema, or even perforation, can occur during the manipulation of the bronchoscope in the airways of children. The literature suggests that airway injury is more common in younger children due to the smaller size and more delicate airway structures. Proper training and experience are crucial to minimize the risk of airway injury.

3. Infection: The introduction of a foreign object (the bronchoscope) into the airways can increase the risk of infection. While rare, cases of airway infection following flexible bronchoscopy in children have been reported in the literature. Proper sterilization and disinfection techniques should be followed to minimize the risk of introducing bacteria or other pathogens into the airways.

4. Respiratory compromise: The presence of a foreign body in the lower airways can already cause partial or complete airway obstruction in children. During the removal procedure, there is a risk of dislodging the foreign body and causing further airway compromise. This can lead to respiratory distress or even respiratory arrest, requiring immediate intervention.

5. Anesthesia-related complications: Flexible bronchoscopy in children is often performed under sedation or general anesthesia. While generally safe, there are inherent risks associated with anesthesia, such as allergic reactions, respiratory depression, or cardiovascular complications. Proper patient selection, monitoring, and anesthesia management are crucial to minimize these risks.

6. Failure to remove the foreign body: The literature suggests that the success rate of foreign body removal using flexible bronchoscopy in children is generally high. However, in some cases, the removal may not be successful due to factors such as the size, shape, and location of the foreign body, as well as patient factors. In such cases, alternative methods, such as rigid bronchoscopy or surgical intervention, may be required.

It is important for healthcare providers to be aware of these potential complications associated with flexible bronchoscopy in foreign bodies in children. A careful patient selection, expertise in the procedure, and appropriate monitoring can help minimize these risks. Additionally, prompt recognition and management of complications are crucial for ensuring optimal outcomes.