Keep an eye on what goes into nose and mouth

Inhaling or swallowing foreign objects can make children critically ill, even resulting in death warns Consultant ENT Surgeon, Dr. A.D.K.S.N. Yasawardene

By Kumudini Hettiarachchi, Pix by Berty Mendis

On a large display board, numerous small sachets depict items such as peanuts, kadala, safety pins, tiny pieces of plastic flowers, a teddy’s black eye and many more that defy classification. Are they food items or metal objects? Are they used for employment or in households?

The board displaying foreign objects.

They are the variety of “foreign objects” that children have inhaled, explains Consultant ENT Surgeon, Dr. A.D.K. S.N. Yasawardene, whose team at the Lady Ridgeway Hospital for Children has collected and carefully put on a display board.

Stressing the seriousness of such inhalation, Dr. Yasawardene explains that in the worst-case scenario the child could have respiratory (breathing) difficulty, turn blue, choke and die or become critically ill.
This is the acute form, which the LRH team, sadly saw in the case of two children within the last seven years, when every effort failed to revive them.

If the object is not causing severe obstruction, the child who soon after inhalation develops a severe bout of coughing, noisy breathing (stridor) and wheezing may seem to get back to normal. But, warns Dr. Yasawardene, don’t be fooled. The object would still be in the airway and it is of utmost importance and urgency to see a doctor.

Last year the LRH ENT Unit treated 73 such children, a majority of whom were below three years of age. “There are two peaks for such inhalation of foreign objects. Those below three and those around 7-8 years old because then they are very confident and are prone to put things into their mouths,” he says.
It is not only caused by putting a foreign object into the nose but even into the mouth, he says, because in small children, those less than three years old, the coordination between the food (digestive) passage and the airway (respiratory) passage is not so good. “Even if the child swallows a foreign object, the chances are that without going into the stomach it will go the other way into the bronchial tubes and the lungs.”

The squeaky part of a toy that was fished out through a bronchoscopy.

If a child swallows such an object it is less problematic than inhaling it, The Sunday Times learns, for it is very difficult to remove it, other than through an intervention called a bronchoscopy or airway endoscopy. This intervention which entails the passing of a camera down the child’s airway and using a special instrument to fish out the foreign object is not without risks.

For, it is performed after the child is put under general anaesthesia, says Dr. Yasawardene, underlining the fact that any surgical procedure carries a certain risk. Citing the case of a seven-year-old boy, Dr. Yasawardene says, the parents brought him because when he coughed, out came a strange “kees, kees” noise…….and what did the bronchoscopy fish out -- the squeaky part of a toy that the boy had inhaled.

Inhalations, if not attended to, could cause recurrent lung infections such as pneumonia and sometimes rarely perforation of the airway, he emphasizes, adding that such children should be brought without anything being given to eat or drink as surgical intervention is required.

However, according to Dr. Yasawardene, prevention is the “best medicine”. Otherwise resources such as operating theatre time, Intensive Care Unit beds and the time and energy of health personnel are expended on such children, taking them away from seriously ill children.

He advises parents to watch their children closely. “Don’t allow a child less than three years to put anything into the mouth without supervision. Don’t give hard food like peanuts and gram to children under three years old. Keep to good feeding practices. When selecting toys read the fine print carefully whether it is suitable for your child. The teddy or the doggy soft toy may be cute, but the tiny black eye may tempt your little one to swallow it.”

Those little deadly objects

They are tiny and most parents will not think twice about putting them here and there. The wrist-watch stops. You change the shiny “button” batteries and leave the old ones on the table. In the blink of an eyelid, the toddler has picked them up and they are missing.

This is the most dangerous foreign object that can be inhaled or swallowed, warns Dr. Yasawardene, for the toxic chemicals secreted by old button batteries cause severe tissue damage.

“Potent,” he calls them and he should know, because he has seen a hole created by such a battery in the wall between the nostrils of a child and also how a button battery stuck in the airway of another child had eaten through the airway wall and food passage creating a hole there as well.

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