(1021) Oh Nuts! Age-Specific Differences in Pediatric Foreign Body Aspiration

Introduction: Aspiration of foreign body (AFB) is a common indication for pediatric bronchoscopy. As guidelines support early introduction of nut products to reduce allergy risk, the potential effect on rates of AFB in children is unknown. This study examined age-related differences in AFB, with particular focus on frequency of nut aspiration.

Methods: A single institution retrospective review of children undergoing bronchoscopy for AFB removal (01/01/2019-1/20/2026) was performed. Age, sex, race, and foreign body types were noted. Foreign bodies were classified as food or objects, and patients were stratified into two groups, 4 years old and under, and over 4 years old. Group comparisons were conducted using Fisher’s exact tests.

Results: 39 children undergoing bronchoscopy for suspected AFB were included, where 30/39 (76.9%) were ≤ 4 yrs old, and 9/39 (23.1%) were >4 yrs old. The presence of AFB did not differ significantly by age group (p=1.00), with 18/30 (43.3%) of those ≤4 yrs old had AFB findings, and 6/9 (66.7%) of those >4 yrs old. However, children ≤4 yrs old were significantly more likely to aspirate food (p=.048), where 13 food AFBs were found in children ≤4 yrs old (43.3%), and 1 food AFB (11.1%) in those >4 yrs old. 9 (69.2%) of the 13 food items found in those ≤4 yrs old were whole nuts. In contrast, children > 4 yrs old were significantly more likely to aspirate non-food objects (p=.010), with 5 (55.6%) object AFB found in those >4 yr old versus 5 (16.7%) object AFBs found in those ≤4 yr old. The most common indication for bronchoscopy for AFB was a witnessed apparent aspiration, documented in 19/39 cases. Symptoms observed in both groups include cough (18/39, 46.2%), wheezing (8/39, 20.5%), drooling (7/39, 17.9%), and stridor (6/39, 15.4%).

Conclusions: These findings emphasize the need for caution when offering nuts or other hard solids to children < 4 yrs, and support the development of targeted public health guidance about safe age limits for raw nut ingestion to reduce AFB risk.