Updates in Pediatric Gastrointestinal Foreign Bodies

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Key points

  • Foreign body ingestions are common in children, especially children younger than 5 years.

  • Foreign bodies should be evaluated by radiograph so that high-risk foreign bodies are not misdiagnosed.

  • Coins are the most commonly retained foreign body in children and may be managed conservatively in otherwise healthy, asymptomatic patients.

  • Button batteries, high-powered magnets, sharp objects, and caustic liquids carry the risk of serious clinical complications and should be evaluated and managed

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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References (86)

  • B.E. Wildhaber et al.

    Ingestion of magnets: innocent in solitude, harmful in groups

    J Pediatr Surg

    (2005)
  • G.P. Conners

    Esophageal coin ingestion: going low tech

    Ann Emerg Med

    (2008)
  • J.L. Arms et al.

    Safety and efficacy of a protocol using bougienage or endoscopy for the management of coins acutely lodged in the esophagus: a large case series

    Ann Emerg Med

    (2008)
  • S.E. Morrow et al.

    Balloon extraction of esophageal foreign bodies in children

    J Pediatr Surg

    (1998)
  • M.W. Gauderer et al.

    The 'penny pincher': a new technique for fast and safe removal of esophageal coins

    J Pediatr Surg

    (2000)
  • J.Z. Jona et al.

    The contraindications for blind esophageal bouginage for coin ingestion in children

    J Pediatr Surg

    (1988)
  • J. Butterworth et al.

    Toy magnet ingestion in children: revising the algorithm

    J Pediatr Surg

    (2007)
  • J.C. Brown et al.

    Hidden attraction: a menacing meal of magnets and batteries

    J Emerg Med

    (2012)
  • W. Denney et al.

    Children will eat the strangest things: a 10-year retrospective analysis of foreign body and caustic ingestions from a single academic center

    Pediatr Emerg Care

    (2012)
  • A.C. Bronstein et al.

    2011 annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 29th annual report

    Clin Toxicol (Phila)

    (2012)
  • R.I. Paul et al.

    Foreign body ingestions in children: risk of complication varies with site of initial health care contact

    Pediatrics

    (1993)
  • M.C. Uyemura

    Foreign body ingestion in children

    Am Fam Physician

    (2005)
  • M. Kay et al.

    Pediatric foreign bodies and their management

    Curr Gastroenterol Rep

    (2005)
  • M. Timmers et al.

    Foreign bodies in a pediatric emergency department in South Africa

    Pediatr Emerg Care

    (2012)
  • M.L. Waltzman

    Management of esophageal coins

    Curr Opin Pediatr

    (2006)
  • B. Rempe et al.

    An evidence-based review of pediatric retained foreign bodies

    Pediatr Emerg Med Pract

    (2009)
  • H. Hesham A-Kader

    Foreign body ingestion: children like to put objects in their mouth

    World J Pediatr

    (2010)
  • S. McCormick et al.

    Children and mini-magnets: an almost fatal attraction

    Emerg Med J

    (2002)
  • S. Chandra et al.

    Magnet ingestion in children and teenagers: an emerging health concern for pediatricians and pediatric subspecialists

    J Pediatr Gastroenterol Nutr

    (2012)
  • S.Z. Hussain et al.

    Management of ingested magnets in children

    J Pediatr Gastroenterol Nutr

    (2012)
  • S. Liu et al.

    Gastrointestinal damage caused by swallowing multiple magnets

    Front Med

    (2012)
  • A. Chinski et al.

    Foreign bodies in the oesophagus: the experience of the Buenos Aires Paediatric ORL Clinic

    Int J Pediatr

    (2010)
  • S.W. Heim et al.

    Foreign bodies in the ear, nose, and throat

    Am Fam Physician

    (2007)
  • A. Arana et al.

    Management of ingested foreign bodies in childhood and review of the literature

    Eur J Pediatr

    (2001)
  • L.O. Diniz et al.

    Causes of esophageal food bolus impaction in the pediatric population

    Dig Dis Sci

    (2012)
  • B. Rybojad et al.

    Esophageal foreign bodies in pediatric patients: a thirteen-year retrospective study

    ScientificWorldJournal

    (2012)
  • M.C. Louie et al.

    Foreign body ingestion and aspiration

    Pediatr Rev

    (2009)
  • L. Donnelly et al.

    The multiple presentations of foreign bodies in children

    Am J Roentgenol

    (1998)
  • M. Teng et al.

    Subungual wooden splinter visualized with bedside sonography

    Pediatr Emerg Care

    (2012)
  • D.I. Friedman et al.

    The utility of bedside ultrasound and patient perception in detecting soft tissue foreign bodies in children

    Pediatr Emerg Care

    (2005)
  • P. Spina et al.

    Usefulness of ultrasonography in gastric foreign body retention

    Pediatr Radiol

    (2000)
  • H. Moammar et al.

    Sonographic diagnosis of gastric-outlet foreign body: case report and review of literature

    J Family Community Med

    (2009)
  • J.M. Bernstein et al.

    Lodged oesophageal button battery masquerading as a coin: an unusual cause of bilateral vocal cord paralysis

    Emerg Med J

    (2007)
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    Disclosures: None.

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