Delayed diagnosis of foreign body aspiration in children: complications and treatment

<bold>Background:</bold> A delayed diagnosis of foreign body (FB) aspiration (FBA) in children can lead to complications such as infection, irreversible damage to airways and even death. FB removal can be challenging due to swelling and inflammation of airways in these cases. <bold>Aims and objectives:</bold> Describe the characteristics of 11 patients with a delayed diagnosis of FBA, part of whom we pretreated with steroids and antibiotics. <bold>Methods:</bold> Retrospective case series of patients presented in our center with a delay of 2 weeks or more between FBA and bronchoscopy. <bold>Results:</bold> We assessed 11 cases, delay in diagnosis ranged from 2 weeks to 9 months. Before FBA was diagnosed, frequent complaints were persistent cough (n=9), recurrent respiratory infections (n=7) and fever (n=6); patients were treated with short-acting beta-agonists (n=7), antibiotics (n=6) and fluticasone metered dose inhalation (n=3). Initial FB removal was not successful in 4 patients due to mucosal swelling, bleeding and granulation tissue. After a prolonged course of steroids and antibiotics (7-14 days) FB could be removed. In total, 7 patients were pretreated with steroids and antibiotics. Long-term complications included: bronchial stenosis (n=3), bronchiectasis (n=1) and death (n=1). <bold>Conclusions:</bold> A delayed diagnosis of FBA was associated with persistent respiratory complaints, unnecessary treatment, lung damage and even death, highlighting the importance of early recognition and treatment. Our experiences emphasize the utility of a prolonged course of steroids and antibiotics as a preparatory measure for FB removal in case of a delayed diagnosis. The accumulation of additional cases will contribute to best practices in managing FBA in children.