November 21, 2010


Anyanwu, E. B. Department of Family Medicine, Delta State University Teaching Hospital, Oghara, Nigeria. ABSTRACT A father, who happens to be a health worker in the state, bought some sweets for his children when returning home from work. The youngest one, aged 18 months apparently swallowed his own in a bid to be given another one. But his mother noticed that the baby was choking and a quick assessment that he might have swallowed his sweet “as usual” was made. Now what is to be done as life was draining from the boy? This case is hereby reported to reiterate the caution that young children should not be given objects that can be inhaled such as peanuts, beads and ‘sweets’. Keywords: Children, inhalation, swallow, sweets Corresponding Author: Dr. E. B. Anyanwu. Department of Family Medicine, Delta State University Teaching Hospital. P. O. Box 7, Oghara, Delta State, Nigeria. E-mail Tel: +2348035701711 CASE PRESENTATION The father of a family of five children, while returning from his workplace stopped over at a supermarket and bought some sweets for his children, as was his practice. These sweets cost Five Naira (N5.00) each and are quite cheap even in this economic situation. In the past, the sweets and occasional biscuits were distributed among the five children and the parents had noted that the youngest child who is aged 18 months always either crushes his sweet with his teeth or swallow it quickly and then starts asking for more. This has always generated laughter in the home, little knowing that they were courting a near disaster. On this fateful day, the father bought some of these chocolate sweets and met the family watching television. He distributed them and went in to wash and change when his wife called out that there was something the matter with the baby of the house. The boy had been well and fine until after he was given his own share of the sweets. The father ran out from his room and saw mummy holding the baby boy, shouting that the baby was having difficulty in breathing. A quick assessment by the father, who incidentally is a health worker showed that the boy was actually gasping for breath, and that he was breathing with his mouth, rolling his eyes and was struggling and throwing his arms around erratically. He grabbed the struggling boy from the screaming mother and gave him some sharp slaps on the back but the gasping breathing and struggling by the boy continued. By now, the father had panicked and gave the struggling boy some sharper slaps on the back to no avail. In total panic by now, he vaguely remembered some maneuvers that he was taught in school, and then did some abdominal thrusts in quick succession and the offending sweet literally popped out of the boy’s mouth and landed audibly on the floor. The boy immediately relaxed and his breathing gradually got better. At this junction, mother gave a decree that no more sweets of any kind should be brought into the house, and everybody agreed. DISCUSSION Foreign body inhalation or aspiration occurs most often in children aged five years and less. Any small object that can get into the trachea or large bronchi can lead to sudden airway obstruction and lead to choking in the child. Such objects as orange seeds, peanuts, erasers from the top of pencils, balloons, chocolate sweets and other small object can cause the problem (1, 2). In the case under discussion, there was a clear history of the child having been given a chocolate sweet and the wrap seen lying on the floor, amongst others from his siblings. He was breathless, coughing and struggling, and throwing his arms around erratically. No assessment of cyanosis was made and his chest movement was not checked by his thoroughly frightened parents. In the near chaotic situation, the boy’s father gave him repeated back blows, but the boy was positioned in an upright position as against the recommended prone position usually with the head in a lower position than the chest (1). Therefore, no result was achieved. The abdomen thrust or Heimlich maneuver was successful but again it was not properly done as defined in the literature by the panicking parents. The thrusts were done with the baby sitting on the mother’s lap and the father pressing the abdomen frantically and frontally. The recommended provision would have been from behind a sitting child or straddled over a child lying supine (2,3). Abdominal thrusts are not recommended in infants for fear of possible rupture of abdominal organ (3). In the case under review, the foreign body fell out after the abdominal thrust, but occasionally, under direct visualization, one may remove the foreign body if it is in the mouth. Blind finger sweeps of the mouth should not be used in infants and young children (4). The airway of children is a common site for the lodgment of foreign bodies. Problems usually arise from poor supervision by adults or older siblings. Care should therefore be taken to keep all potential objects away from children. REFERENCES 1. Southall, D., Coulter, B., Ronald C., Nicholason, S., Parkins, S. International Child Health Care: A practical manual for hospitals worldwide. Child Advocacy International, Inhaled Foreign Body In: Acute respiratory infection Smyth A (Ed). PP 155 – 160. BMJ Books. United Kingdom 2002. 2. Gunn, L. V., and Nechyba, C. (Ed). The Harriet Lane Handbook. Foreign Body aspiration. In Emergency Management; Upper airway obstruction. Soileau – Burke, M PP 3 – 23. 16th edition. Mosby, Philadelphia. 2002. 3. Simon, C., Everitt, H., and Kendrick, T. (Ed). Oxford Handbook of General Practice. The Choking Child. In: Oxford Handbook of General Practice. PP 1052 – 1053. Oxford University Press. 2nd Edition. 4. Bohrman, E. R. Kliegman, M. R., and Arvin, M. A. Nelson Textbook of Pediatrics. Foreign Bodies in the Larynx, Trachea, and Bronchi: In: Bohrman, E. R. Kliegman, M. R., and Arvin, M. A. (1996) Nelson Textbook of Pediatrics. 15th edition Orenstein D. (Ed) PP 1205 – 1208. W. B. Saunders Company Philadelphia USA, 1996.