Pediatric lower airway conditions: Clinical

The lower airways include the trachea, bronchi, bronchioles and lungs and can be affected by a number of distinct pathologies in children.

Let’s start with foreign body aspiration, which is where young toddlers might get something like a small coin or a peanut, lodged in their respiratory tract.

Most of the time, the foreign body goes into the right mainstem bronchus because it’s wider and more vertical than the left.

In general, if the blockage affects a larger airway or causes a more complete blockage of an airway, then it causes more severe symptoms.

Typically, children have a sudden onset of shortness of breath, along with coughing, gagging, choking, or drooling.

On auscultation, breath sounds are diminished in blocked area.

If there’s partial obstruction of the extrathoracic portion of the trachea, that can cause inspiratory stridor.

If there’s expiratory wheezing, that means that there’s partial obstruction of either the intrathoracic trachea, bronchi, or bronchioles. And that wheezing will be localized to the blocked area.

If there are no sounds like this on auscultation, it may be because there’s a complete obstruction of an airway.

If a foreign body aspiration is suspected, it’s important to do a neck or chest radiograph.

Objects like coins and batteries are radiopaque, and will be visible. Whereas objects like a piece of food are radiolucent, so they don’t show up.

Fortunately, there are still indirect signs of the obstruction that can be seen on a chest Xray. In a complete obstruction, there’s atelectasis distal to the obstruction.

In a partial obstruction, there’s focal hyperlucency and reduced pulmonary markings distal to the obstruction, due to air trapping. In other words, the foreign body acts like a one way valve that allows air to enter, but not escape.

If there’s a lot of air trapping, it can cause a mediastinal shift away from the affected side.