Pediatric Foreign Body Ingestion Follow-up

Updated: Nov 09, 2016
  • Author: Gregory P Conners, MD, MPH, MBA; Chief Editor: Timothy E Corden, MD  more...
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Follow-up

Further Outpatient Care

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  • 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. [13]
  • The continued presence of a metallic foreign body may be documented by serial metal detector scans.
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Further Inpatient Care

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  • 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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Transfer

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  • 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

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  • 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. [13, 28]
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Complications

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  • 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. [13]  A study by Lee et al that included 5 cases of pediatric lithium battery ingestion, found that all cases had moderate to major complications to their esophagus or gastric mucosa, even in children who did not exhibit symptoms post ingestion. Urgent removal within 24 hours is recommended for even the asymptomatic child with a known lithium battery ingestion. [29]  
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Patient Education

For excellent patient education resources, visit eMedicineHealth's Digestive Disorders Center. Also, see eMedicineHealth's patient education article Battery Ingestion.

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