Pediatric Foreign Body Ingestion Follow-up

  • Author: Gregory P Conners, MD, MPH; Chief Editor: Richard G Bachur, MD   more...
 
Updated: May 11, 2011
 

Further Inpatient Care

  • Children who require endoscopic foreign body removal are usually taken directly to the operating room or endoscopy suite or are admitted preoperatively. These patients should be given nothing by mouth (NPO) and be given glucose-containing intravenous fluids until the procedure.
  • Preprocedure radiographs to verify the location of the foreign body are recommended, as some foreign bodies may pass into the stomach while awaiting endoscopy.
  • General anesthesia often is used for endoscopic foreign body removal. However, sedation performed by experienced personnel may be successful in selected cases.
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Further Outpatient Care

  • After an esophageal foreign body is removed, children with uncomplicated courses do not need to undergo further evaluation.
  • A healthy child with repeated foreign body impaction or impaction at an unusual site should be evaluated for an underlying esophageal disorder.
  • Most children with foreign bodies in the stomach or lower GI tract have no complications and may be safely discharged from the emergency department. Caregivers of discharged children should be alerted to return if signs or symptoms of the occasional complication (eg, abdominal pain or distention, hematochezia, unexplained fevers, constipation, vomiting) develop.
  • Patients with known abnormalities of the GI tract, previous problems with foreign bodies, or unusual foreign bodies may require special treatment.
  • In general, straining of the stool for the foreign body is unnecessary.
  • Except in special instances, serial radiographs to document progress are unnecessary. This would be most useful if the results would be used to direct therapy, such as prolonged gastric retention of zinc coins, which may be indications for gastroscopic removal. Button batteries remaining in the stomach for 4 or more days, especially if associated with symptoms or if the battery is ≥15 mm in diameter in a child younger than 6, should be considered for removal.[9]
  • The continued presence of a metallic foreign body may be documented by serial metal detector scans.
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Transfer

  • Most children do not require a removal procedure, and they may be treated at any facility capable of obtaining radiographs of children.
  • Children who require foreign body removal procedures should be referred to a facility with experienced personnel.
  • Familiarity with pediatric airway emergencies is essential.
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Deterrence/Prevention

  • Parents and other caregivers of children should be cautioned about leaving small objects where young children may find them and place them into their mouths. This is especially common at times of unusual activity, such as parties, holidays, when visitors are present in the home, or during travel.
  • Button batteries have become an increasingly common source of morbidity and even mortality as their use has increased in recent years. Special care must be exercised around their use in toys and other objects to which children have access, when they are discarded, and when stored around the home.[9, 22]
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Complications

  • Esophageal foreign bodies
    • Mucosal abrasion
    • Esophageal stricture/obstruction
    • Retropharyngeal abscess
    • Failure to thrive
    • Esophageal perforation may lead to mediastinitis, pneumothorax, pneumomediastinum, aortoesophageal fistula formation (and resulting hemorrhage), and tracheal compression.
  • Stomach/lower GI tract foreign bodies
    • Mucosal abrasion
    • Intestinal obstruction
  • Intestinal perforation may lead to peritonitis and sepsis.
  • Button (disk) batteries: Recent data suggest that ingestion of button batteries has become an increasingly important cause of morbidity and mortality in children, likely because of button batteries' increased availability and the increased production of electrical current in modern lithium batteries of ≥20 mm diameter. Children 4 years or younger who have swallowed lithium batteries ≥20 mm diameter are at greatest risk of complication.[9]
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Patient Education

For excellent patient education resources, visit eMedicine's Esophagus, Stomach, and Intestine Center. Also, see eMedicine's patient education article Battery Ingestion.

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Contributor Information and Disclosures
Author

Gregory P Conners, MD, MPH  Chief, Division of Emergency Medical Services, Children's Mercy Hospital; Vice Chair of Pediatrics for Emergency and Urgent Care; Professor of Pediatrics and Emergency Medicine, University of Missouri-Kansas City School of Medicine

Gregory P Conners, MD, MPH is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Jerry Balentine, DO  Professor of Emergency Medicine, New York College of Osteopathic Medicine; Executive Vice President, Chief Medical Officer, Attending Physician in Department of Emergency Medicine, St Barnabas Hospital

Jerry Balentine, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American College of Physician Executives, American Osteopathic Association, and New York Academy of Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH  Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

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A swallowed coin lodged at the thoracic inlet. Image courtesy of Gregory Conners, MD, MPH.
A swallowed radiolucent object (plastic guitar pick) is made visible in the upper esophagus after ingestion of barium. Image courtesy of Raymond K. Tan, MD, and Gregory Conners, MD, MPH.
Lateral radiograph demonstrating the distinctive two-step profile of a button (disk) battery in the esophagus.
Frontal view of same esophageal button (disk) battery; note distinctive double-circle appearance, useful to differentiate a button battery from a coin.
 
 
 
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