Pediatric Foreign Body Ingestion Clinical Presentation

Updated: Nov 09, 2016
  • Author: Gregory P Conners, MD, MPH, MBA; Chief Editor: Timothy E Corden, MD  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. [16]
  • 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. [17]
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