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Answer to the 3 year old with Cough and Fever:

                               Foreign Body Aspiration (FBA)

The 3 year old girl aspirated a piece of hot dog at her right and left main stem bronchi. It was removed by rigid bronchoscope. In less than a week she was fine and was sent home.

FBA into the airway (tracheobronchial tree) is a common problem in children that can result into a chronic illness or even death. Most children who aspirate a foreign body are under 4 years old.

In most cases of FBA there is a choking episode followed by recurrent spasmodic coughing and gagging. Many times this choking episode is not witnessed by the parent. Then the child will persist to have frequent coughing or develop pneumonia.

The physical examination of a child with FBA might include difficulty of breathing, wheezing, retraction, stridor, bloody sputum, or reduced breath sounds on one side of the chest.

Chest X ray, CT, or MRI will help in the diagnosis of FBA.

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From Pubmed.com

Pediatrics. 2003 Mar;111(3):687-9.  

Aspiration of fruit gel snacks.

Qureshi S, Mink R.

Division of Pediatric Critical Care, Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA 90509, USA. soneaq@worldnet.att.net

Aspiration of a foreign body is common in children and can cause upper airway obstruction, leading to significant morbidity or mortality. We report 3 cases of aspiration of a popular fruit-flavored gel snack that led to cardiopulmonary arrest and death in 1 case and respiratory failure in 2 other cases. There is increasing concern about the safety of this gel snack and its risk of aspiration, even in older children. Pediatricians should advise parents and children about the dangers of eating this candy during their health maintenance visits.
 

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Leo Leonidas, MD, FAAP, Assistant Clinical Professor in Pediatrics, Tufts University School of Medicine, Boston; Attending Pediatrician, Eastern Maine Medical Center, Bangor, Maine.

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