- Typical nasal foreign bodies (Beads, toy parts, paper, food — most common ages 2–5 years (AAP, ENT UK))
- Clinical suspicion (Unilateral foul-smelling discharge, epistaxis, or obstruction — examine both nares (AAP, NICE, ENT UK))
First-line therapy
ED removal — non-sedated • procedure
Duration: Same visit · Visible FB in cooperative child — positive pressure, suction, hook, or forceps; limit attempts (AAP, ENT UK)
- • Assessment: unilateral discharge, epistaxis, or obstruction — high suspicion in toddlers; examine both nares.
- • ED removal if visible FB, cooperative child, appropriate tools — oxymetazoline ± lidocaine spray for visualization.
- • Positive pressure ("mother's kiss") for smooth objects; hook/forceps/suction for others.
- • Limit to 1–2 skilled attempts — repeated failure increases trauma and posterior displacement.
- • Do NOT attempt if battery, magnet, sharp object, or posterior location — refer ENT.
No routine antibiotics • —
Duration: Not indicated · Antibiotics only if secondary infection develops after removal (AAP, ENT UK)
- • Successful removal: saline spray, brief observation, discharge instructions — no antibiotics.
- • ENT referral: failed removal, battery/magnet/sharp FB, posterior location, uncooperative child.
- • Secondary infection: persistent purulent discharge with fever >10 days — treat per sinusitis principles.
Clinical notes
- • Assessment: unilateral foul discharge, epistaxis, or obstruction — examine both nares; high suspicion in toddlers (AAP, ENT UK).
- • ED removal: visible FB + cooperative child — mother's kiss for smooth objects, instruments for others; max 1–2 attempts (ENT UK).
- • Contraindications to ED removal: button battery, magnet, sharp/posterior FB, failed prior attempts — urgent ENT (AAO-HNS, NICE).
- • Post-removal: saline spray, observe for bleeding; no routine antibiotics (AAP, ENT UK).
- • Red flags: battery/magnet suspected, septal perforation signs, uncontrolled epistaxis, toxic rhinitis — urgent ENT (ENT UK, NICE).
- • AAP — Foreign bodies of the nose (2024)
- • ENT UK — Paediatric nasal foreign body guideline (2024)
- • NICE — Serious illness recognition principles (2021)
