Near-fatal Food Aspiration in a Young Child With Down Syndrome

Objective: To highlight the multifactorial risks of food aspiration in children with Down syndrome (DS), including anatomical, functional, and behavioral vulnerabilities, through a case of near-fatal choking. Method: We describe a case involving a 4-year-old boy with DS who presented with near-asphyxiation after aspirating a large piece of fried chicken. The patient's medical history, clinical findings, imaging results, and treatment course were reviewed. Results: The patient exhibited delayed language development, absent protective airway reflexes, impulsive eating behavior, and possible streptococcal tonsillitis. A large food bolus was visualized in the upper airway but could not be removed because of agitation. Spontaneous coughing expelled the object, and the patient recovered fully after a course of antibiotics. Imaging confirmed the obstruction, and group A Streptococcus was detected on a throat swab. Conclusion: This case underscores the need for proactive feeding and swallowing assessments, especially during transitions to self-feeding in children with DS. Individualized preventive strategies, including caregiver education and early behavioral assessment, are critical to reducing aspiration-related morbidity in this vulnerable population.