A 4-year-old with unilateral purulent nasal discharge and a suspected nasal foreign body; what is the most appropriate initial action?

• A. Attempt removal at the clinic
• B. Reassurance
• C. Start antibiotics
• D. Refer to ENT

Answer: (A)

The main idea is to remove the suspected foreign body promptly in the clinic under direct visualization. When a child presents with unilateral purulent nasal discharge and a high likelihood of a nasal foreign body, taking it out addresses the source of obstruction and infection right away, which can resolve the discharge and prevent complications such as persistent rhinitis or sinus involvement. Start with careful visualization and gentle suction or appropriate instrument use, ideally after reducing mucosal swelling with a topical decongestant. If removal is not easily achievable, if the object isn’t visible, if the child won’t tolerate the procedure, or if the object is high-risk (for example, a battery or a sharp item), refer to ENT for removal with proper equipment and anesthesia as needed. Reassurance alone won’t treat the foreign body, and antibiotics aren’t first-line unless there’s a secondary, confirmed infection or after removal if symptoms persist.