asphyxiation by an inhaled foreign body is a leading cause of accidental death among children younger than 4 years . in a recent series of 103 children with foreign body aspiration ( fba ) ,
64% of the patients were boys and the majority ( 73% ) was younger than 3 years of age .
the most common symptoms were sudden choking crisis ( 74% ) and paroxysms of cough ( 73% ) .
the most sensitive and specific clinical features were choking ( 86% ) and witnessed aspiration episode ( 89% ) , respectively .
available chest radiographs revealed radio - opaque objects in 27% of patients . in another series ,
fba was suspected by the parents in 59% of patients while witnessing of choking episode was the most important historical event to pinpoint an early diagnosis of fba in children .
most aspirated foreign bodies are organic materials ( 81% ) , nuts , peanuts ( 59% ) , seeds , and fruits being the most common .
although jellies may also be aspirated in the lungs of small children consuming sweets , there are no reports describing characteristics of gummy or jelly sweets fba in the literature . today , haribo0 is the biggest manufacturer of gummy and jelly sweets in the world , with its products mainly consisting of gummi bears , other jelly sweets and liquorice .
we present a case of chewing gummi bear particles aspiration in a 5-year - old child .
this is the first time that an extended  haribo lung  is described after a  secret
a previously healthy 5-year - old girl presented with a 24-hour history of sore throat , chest pain , and shortness of breath at the pediatric intensive care unit , university hospital , heraklion , greece . on physical examination
a posteroanterior chest radiograph revealed right lung collapse and emphysema of the left lung , with tracheal deviation and mediastinal shift [ figure 1 ] .
thoracic computed tomography scanning showed extensive multiple obstructions of the distal airways of the right lung which were initially suggestive of disseminated fba [ figure 2 ] .
emergency bronchoscopy was performed and multiple small chewing gummi bear ( haribo ) particles impacted in the orifices of the right main bronchus and right lobar and segmentalinic bronchi were successfully removed and aspirated .
next day chest radiograph result was normal and the patient was discharged uneventfully without any complication .
chest radiograph showing tracheal deviation ( black arrows ) , mediastinal shift ( white arrow ) , left - sided hyperinflation , and low lung volumes and diffuse haziness on the right consistent with atelectasis ct scan displays multiple obstructed lobar and segmentalinic bronchi ( black arrows ) in the atelectatic right lung .
sudden onset of cough ( 72% ) , dyspnea ( 64% ) , and wheeze ( 60% ) are the predominant symptoms and signs .
the majority of foreign bodies ( 88% ) lodge in the bronchial tree ( right - sided 52% ) , with the remainder catching in the larynx or trachea .
only 11% of the foreign bodies are radio - opaque on radiograph , with chest radiographs being normal in 17% of children .
obstructive emphysema ( 53% ) and normal chest radiograph ( 34% ) are the most frequent radiological findings .
clinical and radiological findings of pneumonia and atelectasis are significantly more common in the groups with negative bronchoscopy or with delayed diagnosis .
however , in toddlers with unexplained acute respiratory distress with refractory parenchymal infiltrates , unrecognized fba should be considered .
although rigid bronchoscopy is the traditional diagnostic  gold standard ,  the use of computerized tomography , virtual bronchoscopy , and flexible bronchoscopy is increasing .
aspiration of gummi bears may cause a silent choking episode leading to life threatening severe respiratory complains , even in children older than 4 years . in a recent healthy lifestyle in europe by nutrition in adolescence ( helena ) cross - sectional survey girls selected more fruit juice , water , herbal infusions , and sweets .
gummy and jelly sweets have become a clear favorite , attracting a loyal fanbase which is constantly growing throughout the world .
the chewing gummi bear ( haribo , bonn , germany ) , a dancing bear molded from fruit gum [ figure 3 ] , has inspired a million different variant innovations in size , animal , shape , color , and flavor .
this is the first time that a lung filled with gummi bears is described after fba in a child ( medline search ) .
the gummi / gummy bear is a dancing bear molded from fruit gum foreign body asphyxiation and ingestion needs a focus on education of parents and child caregivers regarding age , appropriate food , risk of play with small items , but also of older children consuming gummy or jelly sweets .
legislation for gummy sweets could be extended to children up to the age of 6 years , and to similar products marketed for children .
in conclusion , we have reported our experience with a first case of a haribo lodged in the right main bronchus and right lobar and segmentalinic bronchi .
aspiration of gummy or jelly sweets may cause a silent choking episode leading to life threatening severe respiratory complains .
clinicians should keep a high index of suspicion for  silent asphyxia episodes  in children consuming gummy or jelly sweets , even in those older than 4 years old .
labels on these products should now include warnings for the danger of suffocation in all age 's children .
 inhalation of foreign bodies , a leading cause of accidental death , is most common in preschool children . in this article 
 we report our experience with a 5-year - old greek girl who presented with a 24-hour history of sore throat , chest pain , and shortness of breath . 
 emergency bronchoscopy was performed and multiple small chewing gummi bear ( haribo ) particles impacted in the orifices of the right main bronchus and right lobar and segmentalinic bronchi were successfully removed and aspirated . 
 aspiration of gummi bears , which is for the first time reported , may cause a silent choking episode leading to life - threatening bronchi obstruction at multiple sites , even in children older than 4 years . 