Chapter 32 Foreign Body: Ingestion and Aspiration ) Foreign-body aspiration is typically seen in toddlers, although older infants may aspirate solid food particles or small objects placed within their reach Rarely, an older child may also aspirate food particles or other objects The aspiration of a small object or food substance may not be witnessed, and thus, may go unrecognized for weeks or months until persistent lower respiratory symptoms (e.g., persistent cough, wheezing, possibly recurrent fever) trigger a search for an underlying cause Evaluation often shows an area of consolidation and/or collapse on radiograph If aspiration history is not known and the patient is treated for routine pneumonia, the symptoms typically fail to resolve despite seemingly appropriate medical therapy TABLE 84.1 LIFE-THREATENING CAUSES OF WHEEZING Asthma Bronchiolitis Foreign-body aspiration Pulmonary hemorrhage Mediastinal tumor Congestive heart failure Chemical pneumonitis Anaphylaxis Recurrent aspiration of food or gastric contents is usually seen in infants younger than year of age, or in older patients with severe intellectual disability or neuromuscular disease Disordered swallowing and gastroesophageal (GE) reflux typically contribute in varying degrees to the recurrent aspiration that occurs in these patients Repeated aspiration is also seen in children with tracheostomies and in children with structural anomalies of the tracheolaryngeal complex or an H-type tracheoesophageal fistula, which is rare Patients with chronic recurrent aspiration may develop wheezing and respiratory distress in the absence of a well-defined episode of choking or severe coughing because many such patients have depressed cough reflexes or experience “microaspiration.” Fever often accompanies pulmonary aspiration, reflecting associated chemical inflammation or infection of the tracheobronchial tree Wheezing attributable to anaphylaxis is also of sudden onset and may be accompanied by one or more other clinical findings including urticaria, angioedema, stridor, hypotension, abdominal pain, vomiting, and diarrhea When