McKinney Oliver William, Heaton Paul Anthony, Gamble Jane, Paul Siba Prosad
University of Bristol, Bristol, England.
Yeovil District Hospital, Yeovil, Somerset, England.
Nurs Stand. 2017 Feb 1;31(23):42-52. doi: 10.7748/ns.2017.e10449.
Foreign body ingestion and foreign body aspiration commonly affect children. The most vulnerable age is between six months and four years, when children tend to explore new objects with their mouths. Many of these events remain asymptomatic, with the swallowed object passing through the gastrointestinal tract without causing harm. However, the frequency of serious complications as a result of the ingestion of hazardous objects has increased in recent years, in particular button batteries and magnets. To increase the likelihood of identifying foreign body ingestion and aspiration, healthcare professionals should maintain a high index of suspicion, be aware of the variation in presentations and include it as a differential diagnosis in children presenting with non-specific symptoms, such as fever, cough, drooling, dysphagia and abdominal pain. Management of most foreign body ingestions is conservative, using a 'watch-and-wait' approach. Children should be triaged as an emergency if they have signs or symptoms of airway obstruction or a history that indicates dangerous foreign body ingestion. Early recognition and management leads to improved outcomes for patients. Nurses have a vital role in providing education and practical advice to parents, which reduces the occurrence of these events. Stronger legislation is required to ensure manufacturers emphasise the potential dangers of certain products and design child-safe devices.
异物吞食和异物误吸在儿童中很常见。最易发生的年龄在6个月至4岁之间,此时儿童倾向于用嘴探索新物体。许多此类情况并无症状,吞下的物体可通过胃肠道而不造成伤害。然而,近年来,因吞食危险物品(特别是纽扣电池和磁铁)导致严重并发症的频率有所增加。为提高识别异物吞食和误吸的可能性,医护人员应保持高度的怀疑指数,了解临床表现的差异,并将其作为出现发热、咳嗽、流口水、吞咽困难和腹痛等非特异性症状儿童的鉴别诊断。大多数异物吞食的处理是保守的,采用“观察等待”方法。如果儿童有气道阻塞的体征或症状,或有表明吞食危险异物的病史,则应作为紧急情况进行分诊。早期识别和处理可改善患者的预后。护士在为家长提供教育和实用建议方面起着至关重要的作用,这可减少此类事件的发生。需要更强有力的立法来确保制造商强调某些产品的潜在危险,并设计儿童安全装置。