As its name suggests, this means a strange, strident noise which occurs when the infant breathes. It may be most apparent when he cries. It may be present from birth, stemming from a congenital looseness of vocal cords of the larynx. It frequently persists for six to eighteen months, often without any other symptoms. This could be quite alarming to a parent suddenly faced with the infant making these unusual noises, it certainly is frightening. Sometimes the infant may be quiet when resting, but upon exertion or crying, the noise suddenly becomes apparent. Often if there is superimposed respiratory infection, it worsens. Sometimes it may be due to a foreign object the child has swallowed, and it has become lodged in the respiratory passageways.
Babies with a defect of the larynx usually show the symptoms. It is self limiting, and seems to correct itself in due course; however a full examination is desirable. Once a cause is identified there is a good chance of correcting the problem. I must emphasize that foreign object may be a serious cause. We shall look at them separately as they may be life endangering.
Shelled peanuts are one of the most common and dangerous objects, but the list is endless. Pins, plastic pieces from toys and dolls, buttons, sunflower seeds, bits of vegetable, shells, beads, ball-bearings, marbles, feathers, pebbles, are common starters, but nearly any small object the child handles is a possible troublemaker. The child plays with the item, and then places it in the mouth. It slips into the respiratory tract, at which point there is much coughing and spluttering and gagging and choking. There is usually considerable breathing distress, but when it slips into the larger airways this stops, and the so-called “silent period” ensues.
Locked away in the breathing system, the foreign object starts to cause localized irritation. Also, it may block off a large segment of the lung, causing it to collapse, leading to a condition called atelectasis. Various symptoms may continue. If a large part is involved, there may be breathlessness and cyanosis (blueness of the face). There may be a wheeze or hoarseness, depending on the location of the offending object. I well recall a little fellow who inhaled the whistle element of a toy he had. Each time he breathed out, air passed through the whistle and he automatically whistled! It usually causes a great deal of harm. Infections set up, abscesses may develop and the child may become gradually worse. As I have already pointed out, death could well ensue.
Symptoms are virtually nonexistent. Later on the same little boy developed various strange symptoms, none of which responded to treatment. Then one night he died. No, he was not one of my patients, just a close friend living in another state, but it did press home in my mind the seriousness of simple foreign bodies, and that mothers must be alert to the possibilities. Every home abounds with a striking array of possible troublemakers. Certainly and herein lies the problem.
It’s usually fairly apparent what has happened. First, parents should try to remain calm and not panic. The more emotionally upset they become, the less value they are to their child, who needs prompt help. It’s quite clear that most children will not choke to death within minutes. This gives time in which to take appropriate steps. As an immediate measure, placing the child’s head down and administering sharp blows over the involved part of the chest with the cupped hand may initiate a cough that may dislodge the item and allow it to be brought up. Do this once or twice, but if it fails, do not persist, for it may aggravate symptoms.
This all takes time, and without special instruments the doctor may not be able to do much in the home. Ideally, take the child to the emergency ward of the nearest large public hospital as quickly as possible. Speak reassuringly to keep the patient’s spirits up. Usually, with expert attention, the foreign object can be located rapidly and removed. It requires specialized equipment and the skill of a doctor trained in this specialized, delicate field. An instrument called a laryngoscope, or a bronchoscope, allows the doctor to see deeply into the airways. Once the object is seen it may be grasped with special clips and removed. Sometimes, if breathing difficulty is endangering life (and this is unusual), a tracheotomy may be necessary. This provides an artificial entry for air through an incision in the trachea, the firm air pipe in the neck. There is also the Heimlich maneuver which is claimed to give good results, provided the person carries it out correctly.
Do you have any general recommendations for parents so that they may avoid running into trouble with their children with foreign objects? Always be aware of the risks involved. Try to keep small, potentially dangerous items away from young children, especially those aged three years and under. Peanuts are one of the worst offenders. Do not have these available, even at parties. Make a point of educating the children from an early age not to run around with food or objects in their hands or mouth. It does not take too much parental effort to educate children in this direction.