- After observing two infants in the early
stages of choking, I wish to draw attention
to yawning as a symptom of pharyngeal
impaction.
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- In the first infant, aged 11 months, an
acute episode of obstruction occured immediately
after biting into a piece of raw apple. The
infant cried and arched his back, obviously in
pain, gagged, and also yawned repeatedly.
There was a brief episode of stridor. After 10
min the infant regurgitated several pieces of
apple, the largest being about 1 cm long. He was
subsequently free of distress and able to
swallow food. An x-ray showed slight opacity of
the left lung, and at bronchoscopy a small piece
of apple was aspirated from that lung.
-
- In the other infant, aged 8 months, the
episode was less acute and developed after the
infant was given a biscuit. She began to gag and
make swallowing motions and, again, yawned
repeatedly. After regurgitation of mostly
liquid matter the yawning ceased, and after a
further 10 min the swallowing ceased and the
child appeared perfectly normal.
-
- In both these cases the yawning was
marked and continual until the obstruction was
relieved, suggesting that it represents
vagal stimulation arising from the pharynx.
Recognition of the symptom could be important,
especially if a physician is telephoned by a
mother saying she doesn't know what is wrong
with her baby - he seems distressed and keeps
yawning. It would be easy to say, "He is just
tired-put him to bed."
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