Pediatric Foreign Body Ingestion Workup

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

Laboratory Studies

  • Children with foreign body ingestion typically do not require laboratory testing.
  • Laboratory studies may be indicated for workup of specific complications, such as potential infection.
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Imaging Studies

  • Chest/abdominal radiography
    • Most foreign bodies ingested by children are radiopaque (in contrast to inhalation, in which most are radiolucent).
    • If the swallowed object may be radiopaque, a single frontal radiograph that includes the neck, chest, and entire abdomen is usually sufficient to locate the object. Subsequent, focused radiographs may then be used to more fully evaluate the patient, as noted below.
    • If the object is below the diaphragm, further radiographs are generally unnecessary (in the absence of previous GI disorders, such as repaired pyloric stenosis).
    • If the object is in the esophagus, frontal and lateral chest radiographs are necessary to precisely locate and better identify the object and to be sure that the foreign body is not, in fact, two adherent objects. Lateral views of button (disk) batteries reveal a distinctive 2-step border, as opposed to the smooth borders of most coins (although this may also be the result of 2 adherent coins of different size[13] ). Frontal views may suggest a corresponding ring just inside the outermost ring of the battery.
    • Coins and similarly shaped objects in the chest may be localized to either the esophagus or the airway by their position on a frontal radiograph. With rare exceptions, coins in the esophagus appear in the coronal orientation (ie, coin seen as a disk on frontal view), while coins in the trachea appear in the sagittal orientation (ie, coin seen from the side on frontal view).
    • If the ingested object is radiolucent, the object's location may be inferred from effects (eg, airway compression) seen on plain radiographs. However, such findings are not reliable.
    • Radiolucent objects in the esophagus may be better visualized by repeating the study after having the child drink a small amount of dilute contrast. This should not be done if endoscopy is planned. Special care must be taken if the esophagus could possibly be obstructed or perforated.
    • When a foreign body is strongly suspected on clinical grounds, visualization by endoscopy, which has the added advantage of allowing removal of the object, may be the most efficient method of management.
  • CT scan or MRI is rarely indicated but may enhance the detection of foreign bodies or complications (eg, perforations) in special cases.
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Other Tests

  • Metal detectors
    • The use of handheld metal detectors to identify the location of ingested metallic objects (especially coins) has proven sensitive and specific.[14] In the case of aluminum (eg, flip top of a soda can), a metal detector may be more sensitive since aluminum is often radiolucent.[15] The operator should have experience with this modality before using it for patient care.
    • Patients with coins localized to the abdomen may be safely observed. However, patients with coins localized in the esophagus probably should have confirmatory plain radiographs.
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Procedures

  • Endoscopy
    • Endoscopy (esophagoscopy) may be diagnostic and therapeutic.
    • Children who require extensive radiologic investigation may be best served by referral to a pediatric gastroenterologist or surgeon for endoscopy, which is safe and highly effective.
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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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