Fever and central cyanosis are less common. Only rarely do children with a positive history have a totally normal exam. Adult symptoms are generally similar to those in children but pulmonary symptoms, including pulmonary edema, predominate. In children, the primary factors leading to aspiration are underlying curiosity about the world and the oral phase of children between the ages of 1-3 years. Loose, small objects and food found around the household increase risk.
Older siblings feeding younger children is an important historical clue.
Objects that tend to stay in the mouth for prolonged periods of time, such as gum, sunflower seeds or hard candy also increase risk. Eating while lying supine, especially just prior to falling asleep, increases risk of aspiration. Peanuts and vegetable matter are the most commonly aspirated objects in children. Baby powder can be a particularly dangerous aspiration. There may be a symptom-free period before suffocation occurs.