TY - JOUR T1 - <span hwp:id="article-title-1" class="article-title">Cough and you'll miss it</span><span hwp:id="article-title-1" class="sub-article-title inherited-article-title">Cough and you'll miss it</span> JF - Archives of disease in childhood - Education &amp; practice edition JO - Arch Dis Child Educ Pract Ed DO - 10.1136/archdischild-2019-318121 SP - edpract-2019-318121 AU - Seana Molloy AU - Gemma Batchelor AU - Luke McCadden AU - Rebecca Moore AU - Thomas Bourke AU - Andrew Thompson Y1 - 2019/10/29 UR - http://ep.bmj.com/content/early/2019/10/29/archdischild-2019-318121.abstract N2 - Foreign body aspiration is a potentially fatal occurrence, particularly in children less than 3 years of age. Predisposing factors include the tendency to put objects into the mouth, poor chewing ability, lack of posterior dentition and uninhibited inspirations when laughing or crying. Classically, the history opens with a witnessed choking episode which would raise a high level of suspicion in the clinician. Ideally, this would lead to an investigative cascade resultant in prompt diagnosis and removal of the object without significant sequelae. The clinical presentation, however, of an unwitnessed foreign body aspiration can be non-specific and subtle from acute shortness of breath and difficulty breathing to intractable cough, fever and chronic wheeze. It can masquerade as a reactive airway or primary infective pathology and delay crucial diagnosis. A high index of suspicion is therefore required when assessing a child with any of these complaints. Commonly aspirated substances include food particles, hardware and toys. Retained foreign bodies can lead to severe and dangerous long-term consequences including atelectasis, pneumothorax, pneumomediastinum or even death. The purpose of this case is to demonstrate the diagnostic dilemma when dealing with young children and the understated presentation of an unwitnessed aspiration of a foreign body. ER -