The simple bread tag - a menace to society?

Foreign bodies are potentially life-threatening when inhaled by a child, depending on where they lodge. Symptoms can range from acute upper airway obstruction to mild, vague respiratory complaints. Between 80% and 90% of inhaled foreign bodies occlude the bronchi, while the larynx is a less common site. The commonest inhaled paediatric foreign bodies are organic, e.g. seeds or nuts. Plastic foreign bodies are less common and more difficult to diagnose. They are generally radiolucent on lateral neck radiographs and are often clear and thin. We report three cases of an unusual plastic laryngeal foreign body, the bread tag. Plastic bread tags were first reported in the medical literature as an ingested gastrointestinal foreign body in 1975. Since then, over 20 cases of gastrointestinal complications have been described. We report what is to our knowledge the first paediatric case of an inhaled bread tag, and also the first case series, briefly discuss the symptoms and options for removal of laryngeal foreign bodies, and highlight the dangers of the apparently harmless bread tag. Images of the bread tags in situ and after their removal are included.