BACKGROUND: Foreign body aspiration (FBA) is a major pediatric emergency causing severe airway obstruction and potential fatal outcomes. This study examined 20 years of pediatric FBA cases at a pulmonary institute in Rabka, Zdrój, Poland, analyzing demographics, foreign body characteristics, and outcomes. METHODS: We retrospectively analyzed 256 pediatric FBA cases from 2001 to 2021, collecting data on patient demographics, aspiration circumstances, foreign body types and locations, radiographic findings, bronchoscopy outcomes, and complications. Statistical significance was p < 0.05. RESULTS: Children aged 13 months to 3 years represented 64.8% of cases, with males comprising 60.9%. Most incidents (56.6%) occurred during feeding, with nuts being the most common foreign bodies. Radiographic findings showed air trapping (32.4%), atelectasis (18.4%), and no changes in 16.4%. Rigid bronchoscopy was successful with minimal complications, while flexible bronchoscopy alone worked in 9.38% of cases, requiring conversion to rigid in 19.14%. Respiratory cultures performed in 72.3% of cases identified pathogens in 54.7%, mainly Haemophilus influenzae and Staphylococcus aureus. Complications occurred in 12.89%, primarily pneumonia (3.91%), granuloma (2.73%), and bronchiectasis (2.34%). CONCLUSION: Timely bronchoscopy minimizes FBA complications. This study emphasizes preventive measures in feeding practices and the importance of caregiver education to improve outcomes.