Children sometimes swallow things such as coins, small toys or beads. Most objects that children swallow are harmless, and are passed through the digestive system and out with the faeces (poo) without any problem.
Sometimes, swallowed objects get stuck in the oesophagus (food pipe) and may not pass into the stomach. In these cases, a doctor will need to remove the object
Foreign body ingestion is a common clinical problem. Those at increased risk include children, older people, people who have an intellectual disability, patients with psychiatric pathologies, prisoners/inmates, and those with underlying gastrointestinal (GI) mechanical obstruction.
Most ingested foreign bodies will pass through the GI tract without symptoms and cause only minor mucosal injury. However, 10% to 20% of cases will require some kind of non-operative intervention, and 1% or less of cases may develop complications (e.g., bowel obstruction, perforation, severe haemorrhage, abscess formation, or septicaemia) and require further surgical interventions.
Despite the technical challenge, fibre-optic endoscopy is considered the first line of intervention for removal of foreign bodies. It is also considered the safest and most reliable method of diagnosis and treatment of GI foreign bodies.
Other non-operative techniques for foreign body removal include: rigid endoscopy, Foley catheters, and esophageal bougienage. Laparoscopic or open surgery is the last resort when other techniques have failed
The majority of children who have swallowed a foreign body are relatively asymptomatic, so special attention is required for concerning symptoms and for those objects that carry the risk of potential complications.
The initial evaluation should assess for signs of airway compromise or esophageal obstruction, as well as for the ingestion of specific objects that would require emergent care. Stridor or wheezing may indicate a tracheal foreign body or tracheal compression caused by an object lodged in the esophagus. The inability to handle secretions suggests a near or complete esophageal obstruction. Severe neck pain, swelling, or crepitus in the neck may signal perforation of the esophagus by a sharp object.
In the absence of these acute symptoms, immediate attention should be given to accurately identifying the object in question. Button batteries are of particular concern and can be emergent if lodged in the esophagus, even without signs of distress. Since the majority of children with suspected foreign body ingestion are asymptomatic at presentation, every effort should be made to obtain an accurate history as to the timing, quantity, and type of object believed to be ingested. The remainder of the physical exam should focus on signs of intestinal obstruction or perforation, such as abdominal distention, guarding, and tenderness.
Signs and symptoms of swallowed objects
Most children have no symptoms after swallowing an object, and the object will not cause any problems.
Occasionally, the swallowed object can become stuck in the esophagus. Take your child to a doctor or hospital emergency department if they have:
- trouble swallowing food
- Pain in the chest or neck.
Very rarely, the object can become stuck in the stomach or intestines. Take your child to a doctor or hospital emergency department if they have:
- ongoing vomiting
- abdominal (tummy) pain
- blood in their vomit or poo
- A fever.
If your child is coughing or is having difficulty breathing, the object may be in their airway or lungs. You should call an ambulance immediately if your child is having trouble breathing.
Care at home
If doctors are unable to see a swallowed object on an X-ray and your child has no worrying symptoms, it is OK to take your child home. Observe them for any developing symptoms and take your child back to hospital if they have:
- abdominal pain
- ongoing vomiting
- blood in their vomit or faeces
After going home, most children will not need any follow up or further X-rays. There is no need to examine your child’s faeces to find the swallowed object.
If your child has swallowed a harmless object and is showing no symptoms, there is no need to seek medical advice unless you are concerned about your child.