Let’s talk about pediatric obstruction maneuvers and the various risks.
Despite advancements and widespread dissemination of preventive measures, incidents of aspiration and ingestion of foreign bodies remain prevalent in pediatric patients, carrying severe, and at times fatal, consequences. Children between the ages of 1 and 3 are particularly susceptible to such injuries. Within this age group, children tend to explore the world using their mouths, yet they possess immature swallowing coordination and underdeveloped neuromuscular mechanisms for airway protection. Furthermore, older infants develop incisor teeth before molars, enabling them to bite and detach morsels of solid food that they may struggle to crush.
An essential stride in injury prevention has been the implementation of safety regulations for toy design, mandating that toys with small parts include a warning against use by children under 3. This initiative has substantially reduced toy-related injuries to below 3-4% in Europe and North America. Nevertheless, attention to this threat remains crucial for several reasons.
Firstly, certain commonly used objects, both food and non-food, have not exhibited a consistent decline in choking incidents over recent decades, including hot dogs and peanuts, with the latter accounting for approximately 60% of choking injuries. Secondly, emerging threats associated with specific product categories necessitate tailored efforts to formulate appropriate prevention guidelines. Thirdly, foreign body injuries impose a substantial burden on the healthcare system, indicating that activities aimed at reducing incidence rates could yield cost savings in overall healthcare expenditure.
SPECIFIC THREATS
Certain foreign bodies demand special consideration due to their potentially harmful effects and the urgency for prompt removal. Button batteries, commonly used in electronic devices and toys, have emerged as particularly dangerous foreign bodies. These batteries, containing heavy metals and corrosive substances, can lead to mucosal damage, ulceration, perforation, or stricture formation if retained in the gastrointestinal tract. Prompt retrieval within 8-12 hours is imperative to mitigate the risk of perforation. Families should be educated about the repercussions of ingesting batteries and the importance of immediate referral to emergency services to avoid unnecessary complications.
Ingested dried vegetables, especially beans, peas, and nuts, pose risks of swelling and inducing an inflammatory reaction within hours, potentially leading to asphyxia and complicating extraction. The ingestion of sharp and pointed objects constitutes an emergency due to the risk of esophageal perforation, prompting consideration for warnings on packaging to reduce associated event rates.
Magnets in the gastrointestinal tract can attract each other strongly, posing the potential for perforation, fistula, ulceration, and even death. Complications often arise from delays in patient referral or misdiagnosis. The nonspecific symptoms, often resembling a flu-like syndrome, underscore the importance of directing information to families and emergency doctors to minimize delays in both patient referral and diagnosis.
ROLE OF FAMILIES IN PREVENTION
The European Registry of Foreign Body Injuries highlights that incorrect or distracted adult supervision is a common cause of injury mechanisms. An informative campaign directed toward families, emphasizing the significance of active attention when a young child is manipulating objects, could prove beneficial. Data from the Susy Safe database further indicates the presence of a parent or caregiver in less than 49% of injury cases, with the child eating in 34% and playing in 59% of cases.
TECHNIQUES FOR FOREIGN BODY REMOVAL
Increasing evidence suggests that appropriate endoscopic treatments can mitigate the consequences of foreign body injuries. Recognizing the steep learning curve in employing such techniques, centralization of care for these potentially lethal injuries is proposed. Establishing a network of specialized centers, akin to the organization of organ transplantation and trauma care, presents a potential solution, ensuring prompt access to specialized care while facilitating the swift removal of foreign bodies.
Manuel Carta
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