A Review of Pediatric Foreign Body Ingestion and Management
Section snippets
Coins
Coin ingestions accounted for more than 21 000 emergency department visits in 1997,15 making them the most commonly ingested FB in countries where fish does not represent a large proportion of the diet. In these countries, coin ingestions are second to fish bone ingestions.12
There is still some debate as to how to investigate children that ingest coins. Some have suggested that an x-ray may not be necessary, stating that a handheld metal detector may be sufficient to detect the presence/absence
Batteries
Batteries are a common household item that children have ready access to. Hearing aid batteries were the most commonly ingested type in one pediatric study, with almost one third of these batteries having come from the child's own device.24 Recent data indicates a growing prevalence of button battery ingestion, with a nearly 7-fold increase in the incidence of ingestions associated with major or fatal outcomes, and with the majority of adverse outcomes occurring in children less than 4 years of
Sharp Objects
Commonly ingested sharp objects in the pediatric population include fish bones, chicken bones, pins, needles, tooth picks, nails, and even sharp toys. These objects will often get stuck in the tonsil, causing focal pain, odynophagia, and drooling (Figure 2). A single straight pin will usually pass without any concern as they normally travel blunt end first as they traverse the GI tract, thus, following Jackson's axiom that, “advancing points perforate and trailing points don't.”32 Despite this,
Magnets
Magnets are another common household item that children have easy access to because they can be found in toys, jewelry, and on just about any refrigerator door in North America. It is important to know the number of magnets that have been swallowed because the ingestion of a single magnet does not carry the same risk as ingesting more than one magnet. Ingestion of a single magnet could be considered similarly to swallowing any smooth small object such as a coin. But the diagnosis of a
Treatment Options
Although endoscopy is the criterion standard for removal of foreign bodies from the esophagus, there are other techniques that are discussed in the literature, such as the Foley and bougienage techniques as well as the magnet probe.
In the Foley technique, a Foley catheter is passed beyond the coin/FB and the balloon is inflated with a radiopaque dye and then pulled out under fluoroscopy. At the centers where Foley catheter removal is the standard of care,45 this technique has a high rate of
Summary
There are a number of variables involved in deciding how to treat a child who presents with concerns for a possible FB ingestion. A review of the literature reveals that there is no universally implemented approach to this problem,5, 7, 13, 14 and there are frequently differing opinions on how to treat the same problem.
Differences aside, there are some general principles that are adhered to throughout the literature. The type and location of FB and, most importantly, whether the child is
References (48)
Management of foreign bodies of the upper gastrointestinal tract
Gastroenterology
(1988)Management of foreign bodies of the upper gastrointestinal tract: update
Gastrointest Endosc
(1995)Management of ingested foreign objects and food bolus impactions
Gastrointest Endosc
(1995)- et al.
Guideline for the management of ingested foreign bodies
Gastrointest Endosc
(2002) - et al.
Localizing ingested coins with a metal detector
Am J Emerg Med
(1999) - et al.
Chronic esophageal foreign bodies in pediatric patients: a retrospective review
Int J Pediatr Otorhinolaryngol
(2004) - et al.
Zinc toxicity from massive and prolonged coin ingestion in an adult
Am J Med Sci
(2008) - et al.
Mercury absorption following button battery ingestion
J Pediatr Surg
(1992) - et al.
Button battery ingestion: hazards of esophageal impaction
J Pediatr Surg
(1999) - et al.
Techniques of foreign body removal in infants and children
Tech Gastroint Endos
(2002)
Toy magnet ingestion in children: revising the algorithm
J Pediatr Surg
Small bowel complication caused by magnetic foreign body ingestion of children: two case reports
J Pediatr Surg
Gastroduodenal fistula caused by ingested magnets
Gastrointest Endosc
Mischievous magnets: unexpected health hazard in children
J Pediatr Surg
Orogastric magnet removal of ingested disc batteries
J Pediatr Surg
Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System
Am J Emerg Med 2001
Management of ingested foreign bodies in childhood and review of the literature
Eur J Pediatr
Oesophageal foreign bodies in children
J Nepal Med Assoc
Foreign body ingestion and aspiration
Pediatr Rev
Management of ingested foreign bodies in children
J Okla State Med Assoc
Gastrointestinal foreign bodies
Pediatr Ann
Mechanisms of unexpected death in infants and young children following foreign body ingestion
J Forensic Sci
Pediatric foreign bodies and their management
Curr Gastroenterol Rep
Foreign body ingestion in children
Am Fam Phys
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Utilization of a handheld metal detector protocol to reduce radiation exposure in pediatric patients with esophageal coins
2018, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :Ingested foreign bodies can remain lodged in the esophagus or go on to pass into the stomach and spontaneously through the remainder of the gastrointestinal tract [3,4]. Patients with esophageal foreign body may present with signs and symptoms of drooling, coughing, choking, vomiting, dysphagia, stridor, chest/neck pain or may be relatively asymptomatic [5]. Complications of the retained esophageal coin include esophageal perforation and development of mediastinitis, abscess, fistula formation, or bleeding [2].
Emergency department consultations due to foreign body ingestion
2017, Anales de PediatriaCost varies with procedure type in pediatric GI foreign bodies
2017, Journal of Pediatric SurgeryAn unusual presentation of fish bone ingestion in an adolescent girl – A case report
2016, Egyptian Journal of Ear, Nose, Throat and Allied SciencesCitation Excerpt :Common foreign bodies in children are coins but others like buttons, batteries, safety pins, marbles and bottle tops are also reported whereas among adults common foreign bodies are dentures, metallic wires or bones.3 Most commonly the ingested FB is lodged at palatine tonsils, base of tongue and upper third of the esophagus.4 FB ingestion may result in serious life threatening complications like pharyngoesophageal perforation, aortoesophageal fistula, carotid artery rupture and deep neck space infection.5
Common carotid perforation secondary to an ingested fish bone in a child. Case report
2016, Journal of Pediatric Surgery Case Reports