When a husband loses his wife and likewise, they are called widows. When a child loses either of the parents, he or she is called an orphan. But when a parent loses a child, no term exist to qualify their loss.
When a doctor witnesses the death of a child from something as small as a bead that gets stuck in the throat, or a button, coin, and a host of other synthetic materials that children playfully put in their mouth or nostrils, it is heart wrenching. This is more so because the healthcare system in Nigeria is under-equipped, doctors are mostly over-worked and there are host of other factors that can tip the scales of the outcome of an easily treatable but potentially killable condition. We will discuss a case here with tips on how parent can prevent these welcomed foreigners from exposing us to the grief of parenthood.
After completing this article, we expect readers should be able to:
- Recognize the symptoms of their wards that have swallowed or inhaled foreign bodies.
- Know where to seek appropriate management.
- Maintain a high level of suspicion for aspirated foreign bodies, recognizing that delays in diagnosis can lead to increased complications.
A 5-year-old boy was brought into a healthcare facility for new-onset wheezing. He had a low-grade fever and was coughing but didn’t have any nasal discharge. He had obvious difficulty in breathing as evident by the effort his entire chest and neck muscles (the accessory muscles of respiration) was assisting him to stay alive.
Toddlers (Age 1-5) explore the world with their mouths, tend to eat and run, and have a less developed chewing ability thus are the most common age group seen for foreign body complaints. This condition is also more common in males compared to female. Foods are the most frequently aspirated items especially round foods such as peanuts, followed by small toys, beads from rosaries and for hair styling and sharp metallic objects such as pins which can lodge anywhere.
The initial medical response that any medical facility will offer is to assess the severity of the symptoms and alleviate the symptoms of the child. This is usually done by giving supportive therapy (Oxygen, nebulized salbutamol), steroids, antibiotics and IV fluids may be started. This particular child in spite of several treatments, continued to wheeze. The oxygen saturation of the child kept fluctuating between 79 and 90. The doctor ordered for a chest X-ray and other investigations.
Children who have foreign bodies in the airway present for varying reasons. Parents may seek medical attention after a witnessed choking episode, but more often, the children present some time after the event has occurred. Frequently and unfortunately, some patients have a preceding diagnosis of asthma or pneumonia as the explanation for their recurring symptoms, making the history potentially misleading. Questions regarding potential choking episodes must be asked for any young patient presenting with new-onset wheezing and for those who fail to respond to therapy for asthma or pneumonia, Failure to consider foreign body inhalation is a key reason that most airway foreign bodies evade detection and bring about a very avoidable misery.
The child’s mother disappeared! The child was brought back three days later, in the evening obviously severely distressed. She did not do the investigations the doctor ordered. Emergency treatment was commenced on the child and an emergency chest x-ray was done which was normal.
A doctor is not an oracle! When they require you to do investigations, it is because they love you. Because food items are the commonest causes of foreign body aspiration, unfortunately, majority can’t be seen by plain C-Xrays. Although other positive findings may be observed from the x-ray (hyperinflation, lung collapse), don’t be alarmed if a doctor requests for a CT scan! The truth however is that time is ticking and the child isn’t responding encouragingly to the traditional treatment that would have been sufficient for similar causes of the condition.
It became obvious that the child would need mechanical ventilation and urgent bronchoscopy done. These services are only offered in premium hospitals and are quite expensive. The child was referred after frantic calls were made to tertiary hospitals that most often don’t have bed spaces to accommodate such child. This child died in the early hours of the morning in the ambulance that was transporting him.
Being a doctor is like being a goal keeper. We are haunted by the goals we didn’t stop much more than the saves! The doctor that attended to this child cried like a baby and in discussing with other doctors about her travails, it was discovered that countless children have been lost this way. Some doctors reported a child that choked to death due to groundnut that got stuck in the throat; one reported a child that aspirated tiger nuts (ofio, haaya) and many more.
Parents must always be alert and pay rigorous attention to their wards. They must be able to balance between being an alarmist and nonchalance. The following pointers should be taken.
- Children must always be monitored and rigorously inspected
- When you suspect something is seriously wrong, you are often right
- Medical investigations and treatments are expensive. You must have health insurance or be willing to spend cash.
- People pay millions to have children; you should be ready to spend millions to save them
- Always communicate objectively with your doctor, whatever information or requirement they ask of you is for your own benefit
- When a doctor is alarmed, then you should know you need all the help you can get. Prayer alone is not sufficient. You must be pro-active to salvage an already dire situation
- If you depend on the public health system, bureaucracy or the lack of effective utilization of it may override the promptness required for emergency conditions. Always have a premium back-up private hospital or offer to utilize the private wards of the tertiary hospital.
Check this site regularly as we continue the series on common respiratory conditions: We will be writing about how to save a choking child next!
Note: The information offered here is not a substitute to seeking your doctor’s advice and does not contain a discussion of an unapproved/investigative use of a commercial product/device. For further information, enquires, or assistance, fill the form below. For emergency inquiries, you can call the telephone lines on this page.