Coughing after eating peanuts

[tunibell1974]

Our 2.5-year-old daughter has no known food allergies. Recently, she had a coughing episode after the quick ingestion of 3 peanut M&Ms. She had a cold a few weeks ago, and has had a lingering cough ever since. I haven't been too concerned, since her whole school has had the same thing, and I know coughing in kids (and adults) can last for weeks. Still, it was a bad bout of coughing. The coughing fit came on about 10 minutes after eating the candy and followed a burst of energy (lots of running and jumping on the bed) and lasted 5-10 minutes. At no point did she have trouble breathing, although she sounded a little winded afterward, and her voice was small and raspy. We all headed to the car, where we drove around the hospital for about 30 minutes, waiting to see if anything else changed.

About 10 minutes after we started driving, she got her voice back full strength and started eating some crackers. We hung out near the hospital for over two hours, and nothing else manifested (no skin or gastrointestinal symptoms), so we went home.

But now I don't know what to think. Does this sound like an allergic reaction, or perhaps an aspiration of nut fragments? We're not sure what to think.

[National Jewish Health]

What you describe could be an allergic infection but your second suggestion, aspiration, is more likely.  Children under the age of 6 are quite prone to the aspiration of peanuts, with or without the chocolate coating, known as M & Ms and these should be avoided in that age group.  Aspiration is a common event.  The aspiration can lead to bronchitis or pneumonia, often with cough and the cough may persist for a long time.  Food is one type of foreign body that is aspirated.  Only 20% of all objects aspirated are show up directly on chest x-ray, also called radio-opaque, and 40% will have a normal chest x-ray.  The remainder of the x-rays, while not showing the foreign body itself, will show other signs of its presence such as pneumonia-like shadows, partial lung collapse or  hyper-expansion with air-trapping.  Given the information of likely aspiration, the radiologist will be much more likely to look for and find the often subtle signs of aspiration of a foreign body – a combination of suspicion and increased perception.

I suggest that you discuss the above with your daughter’s pediatrician without delay, preferably today.  It may be necessary for a pediatric pulmonary specialist to perform a fiberoptic bronchoscopy to identify and remove the object, be it a fragment or an entire M & M.

Good luck.

[tunibell1974]

Yikes! The coughing stopped after 10 minutes and hasn't happened again. She's been fine ever since the incident (about two weeks ago). Does she still need an x-ray???