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Foreign body ingestions are common in children, especially children younger than 5 years.
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Foreign bodies should be evaluated by radiograph so that high-risk foreign bodies are not misdiagnosed.
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Coins are the most commonly retained foreign body in children and may be managed conservatively in otherwise healthy, asymptomatic patients.
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Button batteries, high-powered magnets, sharp objects, and caustic liquids carry the risk of serious clinical complications and should be evaluated and managed
Updates in Pediatric Gastrointestinal Foreign Bodies
Section snippets
Key points
Age-appropriate behaviors
Most foreign body ingestions in children are unintentional. Approximately 98% of swallowed foreign objects are swallowed accidentally.6 According to NPDS data, the peak age for foreign body ingestion is in the preschool years, and more than 73% of the foreign bodies ingested in 2011 occurred in children younger than 5 years.2 Other studies performed outside the United States have also confirmed the peak incidence of foreign body ingestion is in children between the ages of 6 months and 6 years,
Cause
Common objects swallowed in children include coins, magnets, batteries, small toys, pieces of plastic, jewelry, buttons, bones, or pieces of food (Box 1).6, 12, 19, 20, 21, 22 Coins are the most common foreign object that is retained in the esophagus, comprising up to 80% of impacted foreign bodies.19 In cultures in which fish is a large part of the diet, fish bones are a frequent cause of foreign body ingestion.12 Although most children who swallow a foreign body are otherwise healthy, some
Clinical manifestations
In most ingested foreign bodies, the patient is asymptomatic. One retrospective review found that 50% of children with confirmed foreign body ingestions were asymptomatic.22 When symptoms are present, they are often nonspecific and are based on the foreign body type, location of the obstruction, size of the object, and duration of the impaction. Common signs and symptoms include dysphagia, vomiting, drooling, gagging, coughing, respiratory distress, and food refusal. Other symptoms include
Diagnostic evaluation
Because most children with an esophageal foreign body are initially asymptomatic, a chest radiograph with both frontal and lateral views should be obtained in all cases of suspected foreign object ingestion. In addition, radiographs of the soft tissues of the neck and abdomen should be considered to provide a complete view from the mouth to the anus. Limiting the evaluation to a chest radiograph alone may result in the failure to detect multiple foreign bodies, objects higher than the thoracic
Management
Once a foreign body ingestion is diagnosed, it must be decided whether or not intervention is necessary and what degree of urgency is indicated. Management decisions are influenced by several factors, including the patient’s age and clinical condition, the size and shape of the foreign object, the type of object ingested, the anatomic location where the object has become embedded, and the removal techniques readily available. Most swallowed objects pass through the GI tract without
Coins
Coins are frequently ingested by children and are the most common foreign object to be retained in the esophagus. The most commonly swallowed coins are pennies, followed by quarters, nickels, and dimes.1 Symptoms of coin ingestion vary depending on where the coin is located. Children with a coin in the proximal esophagus may present with symptoms of airway obstruction, such as cough, stridor, and respiratory distress. Children with a coin in the middle or distal esophagus may present with chest
Complications
Of the more than 100,000 foreign bodies ingested each year, approximately 1500 of the patients who ingest them die. It has been previously reported that 80% to 90% of ingested foreign objects pass spontaneously through the GI tract and less than 1% cause severe complications requiring surgical intervention. However, all swallowed foreign bodies should be considered as potential medical emergencies, because of the risk of aspiration and subsequent airway obstruction. Common foreign bodies with a
Summary
Although most ingested foreign bodies in children pass spontaneously, certain foreign bodies can be harmful. In particular, button batteries, magnets, caustic liquids, and sharp objects pose a significant risk for complications and should have emergent evaluation and removal. Lower-risk foreign bodies, such as coins that have passed into the stomach, may be managed conservatively.
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Disclosures: None.