Pediatric Foreign Body Ingestion Clinical Presentation

Updated: Oct 04, 2018
  • Author: Gregory P Conners, MD, MPH, MBA, FAAP, FACEP; Chief Editor: Dale W Steele, MD, MS  more...
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Presentation

History

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  • Children commonly come to medical attention after a caregiver witnesses the ingestion of a foreign body or after a child reports an ingestion to a caregiver.

  • Alternatively, the child may present because of signs or symptoms of a complication of ingestion.

  • Occasionally, the caregiver discovers a foreign body that has passed in the stool and brings the child in for evaluation.

  • Children with significant complications of foreign body ingestion may be initially asymptomatic.

  • Children may have vague symptoms that do not immediately suggest foreign body ingestion.

  • When caring for children, always keep the possibility of foreign body ingestion in mind.

  • Esophageal foreign body symptoms

    • Dysphagia

    • Food refusal, weight loss

    • Drooling, gagging

    • Emesis/hematemesis

    • Foreign body sensation

    • Chest pain, sore throat

    • Stridor, cough

    • Unexplained fever

    • Altered mental status

  • Stomach/lower GI tract foreign bodies

    • Abdominal distention/pain, vomiting

    • Hematochezia

    • Unexplained fever

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Physical

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  • Specific physical examination findings are unusual.

  • Physical findings may suggest complications of foreign body migration, such as peritoneal irritation or rales.

  • Abrasions, streaks of blood, or edema in the hypopharynx may be evidence of proximal swallowing-related trauma. Inspection of the oropharynx may occasionally reveal an impacted foreign body. [17]

  • Drooling or pooling of secretions suggests an esophageal foreign body but may be due to an esophageal abrasion as a result of a swallowed foreign body.

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Causes

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  • Most cases occur as children discover and place small objects in their mouths.

  • Foreign body ingestion, especially if a repeated problem, may suggest a chaotic home environment and neglect.

  • Children with known GI tract abnormalities or previous complications of foreign body ingestion are more likely to have complications.

  • Older children may be seeking attention or be manifesting psychological abnormalities.

  • Ingestion of unusual foreign bodies may suggest an underlying abnormality. For example, an association exists between toothbrush ingestions and bulimia in teenaged girls. [18]

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