A 2-year-old child is brought to the ER. The mother states that an older sibling was eating peanuts and the child grabbed some and put them in his mouth, and since then the child has been irritable and coughing continuously.

Upon exam, the child is coughing with no evidence of acute respiratory distress. There are decreased breath sounds on the right side.

Chest x-ray shows hyperinflation of the right lung.

Pediatric airway foreign body aspiration has a high rate of airway distress, morbidity, and mortality in children less than 3 years of age. The peak age for aspiration events is 1-2 years; this is due to incomplete dentition, immature swallowing coordination, and a tendency to be easily distracted while eating. The most common foreign body retrieved is peanuts. Other aspirated items include pieces of food, such as carrots, nuts, candies, grapes, seeds, popcorn, and hot dogs. Nonfood objects include coins, pills, safety pins, marbles, ball bearings, and beads. Food items like nuts can expand and become friable, and, as a result, they get fragmented during their removal and cause further obstruction. Peanuts can release oils and cause chemical irritation. Presenting symptoms vary from no apparent distress to impending respiratory failure, depending on the size and location of the foreign body. Children may also present with coughing, wheezing, shortness of breath, fever, or recurrent pneumonia.