Management of Wheezing in a Child with History of Choking

Clinical Presentation and Diagnosis

• A history of choking followed by chronic wheezing is pathognomonic for foreign body aspiration until proven otherwise, with cough occurring in up to 88% of cases and wheezing in 45% 1
• A negative history does not rule out foreign body aspiration, as the event may be unwitnessed 1
• A normal chest X-ray does NOT exclude foreign body aspiration 1
• Children witnessed to choke while having small particles in their mouths who subsequently develop wheezing or coughing should undergo prompt evaluation, considering the high likelihood of foreign body aspiration 1

Important Clinical Considerations

• Never perform blind finger sweeps, as they may push foreign bodies further into the airway 2
• Do not be falsely reassured by normal radiographs—clinical history takes precedence 1