Age based evaluation of nut aspiration risk
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(2020) 49:73
ORIGINAL RESEARCH ARTICLE
Open Access
Age based evaluation of nut aspiration risk Jill N. D’Souza1*, Taher S. Valika2,3 , Bharat Bhushan2 and Jonathan B. Ida2,3
Abstract Objective: To identify an age at which initiation of whole nut into the pediatric diet could be considered safe, by evaluating the age distribution of children undergoing bronchoscopy with removal of nut or seed material from the airway. Method: A retrospective chart review over a ten-year period identifying children age 0–18 that have undergone bronchoscopy with retrieval of airway foreign bodies. A statistical analysis of demographic data was carried out to identify age distribution of aspiration events. Results: Sixty-four cases of foreign body aspiration were identified, of which 43 (67%) were of organic origin, specifically nuts. A Fisher’s exact test was carried out on the cumulative percentage of organic foreign body aspirations to identify the age distribution of nut aspiration events. A statistically significant decrease in organic foreign body aspirations occurred at approximately 36 months of age (p = 0.004). Conclusion: Foreign body aspiration is a leading cause of accidental injury or death in children. Nut and other small organic foreign bodies account for a significant portion of accidental aspiration events, however, no guidelines exist regarding appropriate age of whole nut introduction into the diet. Our study suggests that 90% of pediatric nut aspiration events occur under the age of 36 months. We suggest supervised introduction of whole nuts between the ages of 3 and 4 years. Official guidelines regarding this should be considered by professional pediatric societies. Level of evidence: 4 Keywords: Pediatric, Airway, Foreign body, Bronchoscopy, Aspiration, Peanut
Introduction A 2017 New York Times article highlighted the importance of exposing children to peanuts in their diet “early and often;” however, it did not specify the fact that the recommended peanut exposure should be in the form of powder or paste [1]. Pediatric aspiration of airway foreign body is the admitting diagnosis to US hospitals for approximately 2000 children annually [2]. The mortality rate has been reported as ranging between 0.3 and 2.5% [2, 3]. While prior studies have data revealing age-based information about nut aspiration, there is no study in the literature focused specifically on examining age-based characteristics of nut aspiration [4–6]. In particular, there is no current evidence-based * Correspondence: [email protected] 1 Division of Pediatric Otolaryngology – Head and Neck Surgery, Children’s Hospital New Orleans, Louisiana State University, New Orleans, LA, USA Full list of author information is available at the end of the article
guidelines regarding introduction of whole nuts into the pediatric diet, but rather is left to parental discretion, without guidance from proper professional healthcare societies. Airway foreign body aspiration is a major concern in the pediatric patient presenting with sudden onset coughin
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