CHAPTER 32 ■ FOREIGN BODY: INGESTION AND ASPIRATION AUN WOON (CINDY) SOON, SUZANNE M SCHMIDT Young children are at increased risk for foreign-body aspiration or ingestion due to their inquisitive nature and tendency to explore objects with their mouths According to the American Association of Poison Control Centers’ National Poison Data System, 67,771 foreign-body exposures were reported in children years of age and younger in the United States in 2016 Emergency room encounters for foreign-body ingestions in children less than years of age are on the rise, increasing 91.5% from 1995 to 2015 Once an object or food is in a child’s mouth, it can be ingested, or it can lodge in the pharynx or respiratory tract Often, a “choking episode” will clear the foreign body; however, serious sequelae of an aspirated object can range from an acute life-threatening event to a slowly evolving pneumonia The severity of an ingested foreign body is determined by the nature of the object (e.g., blunt, long, sharp, battery, magnetic) and its location in the gastrointestinal (GI) tract Generally, most ingested foreign material is well tolerated, and passes unnoticed in the stool PATHOPHYSIOLOGY There are three main pathophysiologic considerations for aspirated and ingested foreign bodies: the anatomic determinants of lodgment site, the physical properties of the foreign body (size, shape, and composition), and the local tissue reaction to the foreign body The respiratory tract gradually narrows distal to the larynx, whereas the GI tract has multiple sites of anatomic or functional narrowing An ingested foreign body may lodge in the esophagus, may be unable to pass through the pylorus, or may become impacted in the duodenum, appendix, ileocecal valve, or other location of congenital or acquired narrowing The nature of the foreign body and the ability of the tissue to distend influence the site of lodgment within the respiratory or GI tract Depending on the shape of the object and the location in the airway, an aspirated object may minimally, intermittently, or completely impede airflow The composition of the foreign body also determines the local tissue reaction and the evolution of complications A button battery can erode through the esophageal wall rapidly, compared with the slower tissue reaction to a coin In the bronchial tree, the fatty oils in some aspirated foods (e.g., peanuts) create a more severe inflammatory reaction than a