2015 HSC Section 1 Book of Articles

home environment, parents and caregivers should be educated about the signs and symptoms of aspiration, as well as the importance in taking swift action to present their children to healthcare professionals for timely eval- uation. 16 While most children are successfully dis- charged to home in good condition, a small but nonnegligible number of patients suffer catastrophic anoxic brain injury and death. Acknowledgments Work was completed at both David Geffen School of Medi- cine at UCLA, Los Angeles, California, and Harvard Medi- cal School, Boston, Massachusetts. BIBLIOGRAPHY 1. Sidell DR, Kim IA, Coker TR, Moreno C, Shapiro NL. Food choking haz- ards in children. Int J Pediatr Otorhinolaryngol 2013;77:1940–1946. 2. From the Centers for Disease Control and Prevention. Nonfatal choking- related episodes among children—United States 2001. JAMA 2002;288: 2400–2402. 3. Black RE, Johnson DG, Matlak ME. Bronchoscopic removal of aspirated foreign bodies in children. J Pediatr Surg 1994;29:682–684. 4. U.S. Department of Health & Human Services–Agency for Healthcare Research and Quality. Appendix B: Healthcare Cost and Utilization Pro- ject (HCUP): National Healthcare Disparities Report, 2008. March 2009. Rockville, MD.Available at: http://www.ahrq.gov/research/findings/ nhqrdr/nhdr08/methods/HCUP.html. Accessed August 1, 2014. 5. Shah RK, Patel A, Lander L, Choi SS. Management of foreign bodies obstructing the airway in children. Arch Otolaryngol Head Neck Surg 2010;136:373–379. 6. Carroll CL, Zucker AR. The increased cost of complications in children with status asthmaticus. Pediatr Pulmonol 2007;42:914–919. 7. Allareddy V, Nalliah RP, Rampa S, Kim MK. Firearm related injuries amongst children: estimates from the nationwide emergency department sample. Injury 2010;43:2051–2054. 8. Dikensoy O, Usalan C, Filiz A. Foreign body aspiration: clinical utility of flexible bronchoscopy. Postgrad Med J 2002;78:399–403. 9. Laks Y, Barzilay Z. Foreign body aspiration in childhood. Pediatr Emerg Care 1988;4:102–106. 10. Lima JA. Laryngeal foreign bodies in children: a persistent, life- threatening problem. Laryngoscope 1989;99:415–420. 11. Foltran F, Ballali S,Passali FM, Kern E, Morra B, Passali GC, et al. For- eign bodies in the airways: a meta-analysis of published papers. Int J Pediatr Otorhinolaryngol 2012;76(suppl 1):S12–S19. 12. Senkaya I, Saqdic K, Gebiekin C, Yilmaz M, Ozkan H, Cenqiz M. Manage- ment of foreign body aspiration in infancy and childhood: a life- threatening problem. Turk J Pediatr 1997;39:353–362. 13. Righini CA, Morel N, Karkas A, Reyt E, Ferretti K, Pin I, Schmerber S. What is the diagnostic value of flexible bronchoscopy in the initial inves- tigation of children with suspected foreign body aspiration? Int J Pediatr Otorhinolaryngol 2007;71:1383–1390. 14. Martinot A, Closset M, Marquette CH, Hue V, Dechildre A, Ramon P, et al. Indications for flexible versus rigid bronchoscopy in children with suspected foreign-body aspiration. Am J Respir Crit Care Med 1997;155: 1676–1679. 15. Korlacki W, Korecka K, Dzielicki J. Foreign body aspiration in children: diagnostic and therapeutic role of bronchoscopy. Pediatr Surg Int 2011; 27:833–837. 16. Singh H, Parakh A. Tracheobronchial foreign body aspiration in children. Clin Pediatr (Phila) 2014;53:415–419. doi: 10.1177/0009922813506259. Epub 2013. 17. American Academy of Pediatrics. Prevention of choking among children. Pediatrics 2010;2009–2862. DOI: 10.1542/peds.2009–2862.

Both food and nonfood items pose choking hazards in the pediatric population secondary to this cohort’s underdeveloped anatomy and swallowing function. With regard to nonfood products, formal legislation to help prevent FBAs has been established through the Federal Hazardous Substances Act to regulate the packaging, labeling, and manufacturing of these items. 1 The Con- sumer Product Safety Commission regulates the manu- facturing and labeling of toys, helping to decrease the dangers associated with bronchial aspiration of toy parts. Similar guidelines do not exist for food products, although there has been work directed to establish such measures. To date, there is no official federal legislation regu- lating the production and labeling of food products. Lob- bying efforts have resulted in the Food Choking Prevention Act (introduced to Congress in 2005) requir- ing the Commissioner of Food and Drugs to educate parents of young children and to designate a week of increased dissemination of choking information to the public. The American Academy of Pediatrics released a policy statement (Prevention of Choking Among Chil- dren) in 2010 with recommendations for government agencies, manufacturers, parents, teachers, and health- care professionals to help prevent FBA. 17 Some of these include placing warning labels on high-risk foods, recall of foods that are known to be potentially hazardous, edu- cation of cardiopulmonary resuscitation and choking first-aid techniques to parents and child care providers, and redesigning of existing foods to minimize their chok- ing risk. 17 Standardized safety guidelines for the produc- tion and packaging of commonly implicated objects, as well as developing public health initiatives to raise awareness about the dangers of bronchial FBA, will help protect children from potentially catastrophic events. CONCLUSION Foreign body aspiration events affect thousands of pediatric patients and their families annually, and the incurred charges contribute to the socioeconomic bur- den. 5 Preventative measures are key. 1,11 Currently, increasing efforts are underway to promote public health initiatives and government legislation that help regulate the manufacturing and labeling of both food and nonfood objects that pose potential aspiration risks. 1 Educating primary care physicians, caregivers, and parents about appropriate eating habits, as well as the risks associated with particular foods, can help prevent many of these events. Because most deaths due to FBAs occur in the

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