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2022
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https://journal.smdc.edu.pk/index.php/journal/article/download/127/74
https://journal.smdc.edu.pk/index.php/journal/article/view/127
INTRODUCTION:
Foreign body aspiration (FBA) is the inhalation of the edible, non-edible or pharyngeal/gastric contents into the larynx and lower respiratory passages,1 whereas choking refers to varying degree of airway obstruction due to an aero-digestive foreign body. The obstruction interferes with ventilation that leads to asphyxia and even death. Choking due to FBA causes almost 40% of accidental deaths in infants and substantial complications. Most commonly
aspirated items include food, coins, toys, and balloons.2
The major risk factors of FBA in children include incomplete dentition, playing, running, or laughing while eating and their curiosity to explore everything by putting it in mouth. Considering the consequences of FBA, it is important to initiate programs that raise awareness among parents about its risk factors and high incidence rates in young children and to equip the parents with basic measures to prevent it.3,4
Children younger than three years old have the highest prevalence of this disorder.5 Playing with small toys or eating peanuts were proposed as a potential cause of FBA. The vast majority of parents were unaware that FBA may be caused by eating peanuts or playing with small toys, or that their child's abrupt choking and coughing could be signs of FBA.6 It was found that the fatal and non-fatal cases of choking remained high in children.7 Marital status, gender, and educational attainment were found to be associated with knowledge about foreign body aspiration.8
FBA is a life-threatening yet preventable condition in pediatric age group that demands increased parent education and awareness since parents are the key persons who are involved in care and feeding of young children. Less awareness of parents regarding risk factors and prevention of FBA is an important determinant placing children at higher risk for FBA and associated complications. To date, there are no published reports on awareness among parents about FBA in children in our local setting. The scope of this study is to highlight the importance of equipping the parents with knowledge and guidelines for
proper feeding care which may be the most vital factor in reducing incidence of FBA.
METHODS:
It was a cross-sectional study, carried out at Pediatric & ENT department, Mayo Hospital, Lahore from January 2019 to September 2019. A sample size of 151 was estimated by using 95% confidence level, 8% absolute precision with expected percentage 47.4% of parents who knew that they should not give groundnuts/seeds or small toys to children <3 years 50%. Ethical permission was obtained from institutional review board of King Edward Medical University (No.1995/RC/KEMU). Informed written consent was obtained from all the study subjects. Parents having youngest child less than five years of age were included in the study. Convenient sampling technique was used. Parents whose children were severely ill (admitted in ICU or emergency) were excluded from the study. A self-designed questionnaire was used which was pre-tested before using for the present study. It included demographic profile (age, gender of parent, age of youngest child, number of kids, level of education of parents), questions regarding basic knowledge about foreign body (knows about common age group, foods that may cause FBA (carrot, seeds, walnut, hazelnut, grapes, cucumber, hard nuts), small toys, leaving kids unsupervised, let the child hold toy while crying, talking or laughing, knowledge about the prevention of FBA and first aid given after foreign body ingestion. Educational status was stratified into literate and illiterate, where illiterate means a person who could not read 3 lines written in national or regional language and has no formal schooling. The questionnaire was translated in urdu as well and data collector
explained the respondent and recorded the responses.
Statistical Analysis
Data was analyzed through SPSS version
26. Variables were presented as frequency and percentages. Chi square and phi test were applied. p value< 0.05 was considered as statistically significant.
RESULTS:
Out of 151 respondents 20 (13.2%) were fathers and 131(86.8%) were mothers. Among them 11(7.3%) were below 20 years, 135(89.4%) between 20-40 years and remaining 5(3.3%) were above 40 years of age. 145(96%) Parents had 5 or less children and 6 (4%) had more than 5 children. Age of the youngest child was <1yr in 57 cases, between1-3 years in 53 and 3-5 in 41 cases. Among parents 34(22.5%) were uneducated and 117(77.48%) were educated.
Among subjects 60(39.7%) had knowledge about most probable age of FBA. Regarding knowledge about signs and symptoms of FBA, 16(10.6%) knew about acute onset of cough, 10(6.6%) recognized hand clutched to throat as a sign, 15(9.9%) mentioned change in color as a sign, 16(10.6%) considered change in voice, 11(7.3%) appreciated vomiting as a symptom, 75(49.7%) appreciated breathlessness as a symptom and 18(11.9%) said that they have no idea about signs and symptoms of FBA.
103 Parents had adequate knowledge regarding first aid. 100(66.2%) knew about slapping at the back and 3(2%) knew about abdominal thrust. 48(31.8%) parents said
they will seek medical care in such a situation.
Table 1: Basic knowledge regarding foreign body aspiration |
||
Knowledge about Risk Factors |
Frequency n (%) |
Frequency n (%) |
Foods child <3 years of age can eat independently? Carrot Seeds Almonds Hazelnut Grapes Cucumber Hard Nuts |
Yes
99(65.6%) 66(43.7%) 102(67.5%) 83(55%) 130(86.1%) 124(82.1%) 52(34.4%) |
No
52(34.4%) 85(56.3%) 49(32.5%) 68(45%) 21(13.9%) 27(17.9%) 99(65.6%) |
Child<3 years of age can play with very Small toys |
130(86.1%) |
21(13.9%) |
No supervision is needed while playing for a child <3 years of age |
12(7.9%) |
139(92.1) |
Crying child<3 years of age with small toy in hand is not recommended |
102(67.5%) |
49(32.5) |
Talking or laughing while eating is not recommended in child<3 years of age |
47(31.1) |
104(68.9) |
Table 2: Preventive practices of parents regarding foreign body aspiration |
||
Preventive Role of Parents |
n=151 |
Percentage |
I supervise him/her |
138 |
91.4% |
I feed him/her or allow eating in sitting position. |
130 |
86.1% |
I don't give him small objects. |
113 |
74.8% |
I don't give him grainy or solid foods as it is like peanuts etc |
100 |
66.2% |
Table 3: Association of knowledge factors with literacy regarding foreign body aspiration |
|||||||
Factors |
Response |
Illiterate n=34 |
Literate n=117 |
χ2 (p value) |
Phi (p value) |
95%CI Lower Upper |
|
Child< 3y can eat Carrot |
Yes |
20 |
79 |
.883 (.347) |
-.076 (.347) |
.313 |
1.50 |
|
No |
14 |
38 |
|
|
|
|
Child< 3y can eat Seeds |
Yes |
20 |
46 |
4.074 (.044)* |
.164 (.044)* |
1.01 |
4.79* |
|
No |
14 |
71 |
|
|
|
|
Child< 3y can eat Almonds |
Yes |
25 |
77 |
.716 (.398) |
.069 (.398) |
.615 |
3.38 |
|
No |
9 |
40 |
|
|
|
|
Child< 3y can eat Hazelnut |
Yes |
24 |
59 |
4.326 (.038)* |
.169 (.038)* |
1.03 |
5.37* |
|
No |
10 |
58 |
|
|
|
|
Child< 3y can eat Grapes |
Yes |
31 |
99 |
.947 (.330) |
.079 (.330) |
.519 |
6.805 |
|
No |
3 |
18 |
|
|
|
|
Child< 3y can eat Cucumber |
Yes |
30 |
94 |
1.118 (.290) |
.086 (.290) |
.588 |
5.730 |
|
No |
4 |
23 |
|
|
|
|
Child< 3y can eat Hard Nuts |
Yes |
5 |
47 |
7.566 (.006)* |
.224 (.006)* |
.093 |
.711* |
|
No |
29 |
70 |
|
|
|
|
Child< 3y can play with Small toys |
Yes |
29 |
101 |
.023 (.878) |
-.012 (.878) |
.310 |
2.72 |
|
No |
5 |
16 |
|
|
|
|
For Child< 3y No Supervision is required |
Yes |
7 |
5 |
9.585 (.002)* |
.252 (.002)* |
1.71 |
19.7* |
|
No |
27 |
112 |
|
|
|
|
For Child< 3y Crying with toy not recommender |
Yes |
4 |
45 |
8.566 (.003) |
-.238 (.003) |
.070 |
.646* |
|
No |
30 |
72 |
|
|
|
|
For Child< 3y Laughing/ talking while eating is not recommender |
Yes |
17 |
87 |
7.29 (.007) * |
-.220 (.007)* |
.156 |
.760* |
|
No |
17 |
30 |
|
|
|
|
Chi square test and Phi test applied. 95% CI also calculated, p-value <0.05 was considered statistically significant |
According to parents' education for FBA prevention is much needed. 8 (5.3%) of the parents suggested their knowledge should be improved through pamphlets, 52 (34.3%) through educational campaign, 40(26.5%) through electronic media, 28(18.5%) through education during maternity visits and 23(15.2%) suggested through all these means. Frequency & percentages of
knowledge regarding factors that may cause FBA is provided in Table 1.
Frequency & percentages of steps that parents practice in order to prevent FBA are presented in Table 2. Association of knowledge factors with literacy has been presented in Table 3.
Literate parents were significantly different from illiterate parents in knowing that <3 yrs
old child should not eat seeds, Hazel nuts, hard nuts, Supervision is required for the child and child should not laugh or talk while eating (p value < 0.05).
DISCUSSION:
FBA is a serious condition that affects children and needs to be treated right away to prevent complications and permanent lung damage. The majority of childhood accidental deaths are caused by tracheobronchial foreign body aspiration, which is a life-threatening emergency.9, 10
In our study our questions were focused on children < 3 years of age as this is the commonest age group. Similarly, studies reported that prevalence, morbidity and mortality of FBA are high among younger children < 3years of age and were even a more common cause of accidental death in infants.10,11 In a study conducted at ENT department of Mayo Hospital Lahore, out of
583 patients received with FBA, 401(68.78%) were below 10 years of age wherein 110(19.89) patients were 3 years old.5
Our study focused on checking knowledge regarding food items to be offered to children. Parental knowledge was not adequate. A study conducted in hospital settings found that majority of foreign bodies were organic in nature. Better prognosis was observed in cases where symptoms and signs were present, location of FB was accessible or FBA was witnessed, all of them led to access medical care timely.11,12
In our study parents' knowledge regarding small toys was assessed which was not adequate. Similarly, In a comparative study carried out in Saudi Arabia one third of the parents in both studied groups did not
recognize small toys or peanuts as a cause of FBA.6 A study suggested parents should be educated to raise their awareness of tracheobronchial FBA and should refrain from giving their children small objects that could potentially obstruct the airways. If FBA is suspected, the child must be shifted to the hospital immediately. Parental neglect may be significant factors in the delay of a child's diagnosis.12 Delay in receiving treatment leads to more complications, morbidity & mortality.13 In contrary to our study, another study carried out in Nigeria showed that there was good parental knowledge regarding FBA and 47.4% knew that they should not give groundnuts/seeds or small toys to children <3 years.8
In our current study parents did not identify all the symptoms and signs of FBA. Likewise, another study showed a higher percentage of parents unaware of the symptoms of foreign body aspiration. Authors mentioned that FBA presents clinically with a wide array of signs and symptoms. Amongst them, cough and wheezing are the most common symptoms followed by breathlessness. FBA should also be considered in children presenting with atypical or prolonged pulmonary symptoms. If it goes undiagnosed, it may lead to chronic and irreversible lung injury. One of the factors contributing towards complications is that parents were unaware of clinical signs of FBA, such as sudden choking and coughing.14 In another study regarding clinical presentation of FBA, 14% and 27% of mothers did not know that sudden choking and coughing were symptoms suggesting FBA, respectively.6 According to the National Safety Council, in 2016 the rate of fatal choking in American children <5 years of age in the general
population was 0.43 per 100,000. However, a previous study analyzed the rate of non- fatal choking in children under the age of 14 to be 20.4 per 100,000 populations.7
In our study parents suggested different means should be utilized to impart necessary education among the population. A large number of participants indicated that electronic media including internet and television should be used, almost half were in favor of educational campaigns, some suggested education through medical personnel and others suggested all of these. A study concluded that school children also had inadequate knowledge just like mothers regarding FBA and among them only a small number had been trained in first aid.15 Another study suggested that Prevention is the most important key step that needs to be considered. Despite all such measures, even if FBA is found to occur, parents must be educated about its prompt management and first aid step at secondary prevention level.12 Researchers found that sending parents of children seen at a paediatric otolaryngology clinic a short video intervention via email link improved their understanding of choking risks and how to avoid them. Parents may be more receptive to hearing about ways to prevent choking at an otolaryngology clinic.16 Studies suggested that parents should be trained in first aid to prevent dire consequences.17,18 In a comparative study newer mobile application-based education proved to be more effective than booklets & CDs.1 Public education campaigns, modifications in product design, medical staff education and improvements in relevant medical equipment were proposed as preventative measures for aspiration and its consequences in a research.9,10
Parental knowledge regarding small toys and holding toys while crying was not up to the mark in our study. Toys where provided happy moments to kids and help them in development, if not supervised or use as per age precaution may be ingested or aspirated and cause severe complications. Parents must be educated and vigilant in preventing such events.19 Another study mentioned that evaluation of parental knowledge will help us direct the type and extent of resources that need to be utilized in order to enhance parental knowledge and contribute to community by lowering frequency of hospital admissions and mortality related to this condition. Inability to recognize a foreign body aspiration in children and subsequent delay in administration of first aid treatment in them leads to dire consequences. This presses the importance of imparting education among parents that prepares them to recognize and manage such events thereby decreasing morbidity and mortality associated with it.20 Multiple platforms including electronic media, print media, education through campaigns or medical personnel can be engaged in achieving an optimum awareness among the parents. Literate parents had significantly different knowledge regarding prevention of FBA in our study and in published literature.21 Another study found that marital status, gender, and the level of education were found to be statistically associated with knowledge of FBA.8
Strengths of the present study is to bring attention to the neglected topic. Recommendations of the current study are to plan interventional studies on community level where after recording baseline knowledge educational intervention must be done and followed up for the knowledge and
practice improvement. Educational counseling may be done in prenatal visits.
Limitations of our study were single centre, small sample size, non-probability sampling.
CONCLUSION:
Our study reflected that a significant number of parents lack basic and essential knowledge for prevention, recognition & management of foreign body aspiration in children.
Conflicts of interest
Authors declared no conflict of interest.
Contributors
FS: Design of the work, data analysis, write up, final revision and approval.
HJ: Data collection, data entry, write up and interpretation of data for the work.
SI: Revising it critically for important intellectual content, literature search
SS: Investigation, literature search, final revision and approval.
All authors approved the final version and signed the agreement to be accountable for all aspects of work.
Grant support and financial disclosure
Authors declared no specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Data sharing statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
REFERENCES:
-
Behboudi F, Pouralizadeh M, Yeganeh MR, Roushan ZA. The effect of education using a mobile application on knowledge and decision of Iranian mothers about prevention of foreign body aspiration and to relieve choking in children: A quasi-experimental study. J. Pediatr. Nurs. 2022; 62: e77-e83. doi:10.1016/j.pedn.2021.07.007
-
Ding G, Wu B, Vinturache A, Cai C, Lu M, Gu H. Tracheobronchial foreign body aspiration in children: A retrospective single-center cross-sectional study. Medicine. 2020; 99(22): e20480.doi: 10.1097/MD.0000000000020480
-
Wu X, Wu L, Chen Z, Zhou Y. Fatal choking in infants and children treated in a pediatric intensive care unit: A 7- year experience. Int J PediatrOtorhinolaryngol. 2018; 110: 67-69. doi: 10.1016/j.ijporl.2018.04.026
-
Gurevich Y, Sahn B, Weinstein T. Foreign body ingestion in pediatric patients. Current opinion in pediatrics. 2018; 30(5): 677- 682.doi:10.1097/MOP.0000000000000670
-
Khan T, Mahboob H, Tahir I, Nasir M, Ali A, Abbas I, et al. Foreign Bodies Presentation at Otorhinolaryngology Emergencies in A Tertiary Care Hospital. Annals of KEMU. 2018; 24(S): 893-896. doi:10.21649/akemu.v24iS.2601
-
Al-Qudehy Z, Al-Sheif H, Al-Qudaihi G. Parental knowledge of foreign body aspiration: A comparative study between Saudis and other nations. J Otolaryngol ENT Res. 2015; 2(1): 00008.
-
Cramer N, Jabbour N, Tavarez MM, Taylor RS. Foreign Body Aspiration. 2022. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.
-
Mahmud A, Mohammed Y, Aluko A. Knowledge of foreign-body aspiration in children among caregivers in Kano Nigeria. African Journal of Trauma. 2017; 6(2): 42- 46. doi: 10.4103/ajt.ajt_11_18
-
Brkic F, Umihanic S, Altumbabic H, Ramas A, Salkic A, UmihanicS,,et al. Death as a consequence of foreign body aspiration in children. Medical Archives. 2018; 72(3): 220-223. doi: 10.5455/medarh.2018.72.220- 223
-
Montana A, Salerno M, Feola A, Asmundo A, Di Nunno N, Casella F, et al. Risk Management and Recommendations for the Prevention of Fatal Foreign Body
Aspiration: Four Cases Aged 1.5 to 3 Years and Mini-Review of the Literature. Int J Environ Res Public Health. 2020; 17(13):
-
Na'ara S, Vainer I, Amit M, Gordin A. Foreign Body Aspiration in Infants and Older Children: A Comparative Study. Ear Nose Throat J. 2020; 99(1): 47-51. doi: 10.1177/0145561319839900
-
Cui Y, Cui X, Yu T, Zhu Z, Wang X. Importance of patient history in diagnosis of foreign body aspiration in children: Two case reports. Medicine. 2019; 98(17). e15326 doi:
10.1097/MD.0000000000015326
-
Antón-Pacheco JL, Martín-Alelú R, López M, Morante R, Merino-Mateo L, Barrero S, et al. Foreign body aspiration in children: treatment timing and related complications. Int. J. Pediatr. Otorhinolaryngol. 2021; 144: 110690. doi: 10.1016/j.ijporl.2021.110690
-
Goyal S, Jain S, Rai G, Vishnu R, Kamath GS, Bishnoi AK, et al. Clinical variables responsible for early and late diagnosis of foreign body aspiration in pediatrics age group. J. Cardiothorac. Surg. 2020; 15(1): 1- 6. doi: 10.1186/s13019-020-01314-9
-
Alshehri KA, Alharbi AA, Yaghmoor BE, Salman AK, Alaydarous SA, Abdalwassie LK, et al. Awareness of the first aid management of foreign body aspiration among students: A cross-sectional study. J Educ Health Promot. 2019; 8: 220. doi: 10.4103/jehp.jehp_306_19.
-
Bentivegna KC, Borrup KT, Clough ME, Schoem SR. Basic choking education to
improve parental knowledge. Int. J. Pediatr. Otorhinolaryngol. 2018; 113: 234-239. doi: 10.1016/j.ijporl.2018.08.002
-
Habeeb KA, Alarfaj G. Saudi parents awareness regarding burn, choking, and drowning first aid in children. J Family Med Prim Care. 2020; 9(3): 1370-1375. doi: 10.4103/jfmpc.jfmpc_1064_19
-
Mohammed HO, Wassif GO, Hakim SA, Moustafa ME. Frequency of unintentional home injuries in children under five years and its relation with environmental risk factors, Cairo, Egypt. Egypt J Community Med. 2019; 37(3): 93-102. doi: 10.21608/ejcm. 2019.43376
-
Lin A, Chan LCN, Hon KLE, Tsui SYB, Pang KKY, Cheung HM, Leung AKC. Magnetic Foreign Body Ingestion in Children: The Attractive Hazards. Case Rep Pediatr. 2019; 2019: 3549242.
-
Elfeshawy R, ElSobky FA, Mohamed FK, Darweesh HA. Effect of health education program-based on a health belief model on mothers' knowledge and practices regarding choking prevention and management for their children. Tanta Med. J. 2022; 25(2): 235-257.doi: 10.21608/TSNJ.2022.243373
-
Almutairi AT, Alharbi FS. Parental knowledge and practices toward foreign body aspiration in children in the Al Qassim region of Saudi Arabia. J Family Med Prim Care. 2021; 10(1): 199-204. doi: 10.4103/jfmpc.jfmpc_1500_20
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Article Title | Authors | Vol Info | Year |