Ingested foreign bodies in children are common as the world is a curious place to young children, who will put anything and everything into their mouth, and will often inadvertently swallow.
The usual practice is for plain films of the chest and/or abdomen to identify a foreign body.
The peak incidence of foreign body ingestion is between six months and six years 1.
Approximately 50% of children will be asymptomatic 2.
Coins are the most commonly ingested foreign body 3, along with toys, batteries, bones, and almost anything that can fit into a child's mouth.
Standard radiographic investigation of foreign bodies in children should include plain radiographs of the neck, thorax and entire abdomen 4. In one study ~65% of ingested foreign bodies were radiodense 2.
As a rule of thumb, coins visualized in the sagittal plane (acquired while entering through vocal cords) on anteroposterior radiographs are in the trachea, whereas coins in the esophagus will have a coronal orientation on frontal chest radiographs.
An important alternative to consider when assessing coin-like objects are button batteries. These are very similar in appearance to coins, but typically have a slight step in profile with an inner ring when viewed en face.
Treatment and prognosis
Most foreign bodies make it into the stomach and beyond with up to 80% passing spontaneously 1.
Button batteries can be potentially fatal when in contact with surrounding tissue as they can generate an electric current that will lead to the formation of sodium hydroxide resulting in severe, potentially fatal mucosal damage 5-7. They are an emergency and should be removed as soon as possible 9.
If endoscopic removal is not available, early and frequent ingestion of honey until endoscopic removal of the button battery has been found to significantly decrease the rates of outward mucosal injury and full thickness tissue necrosis 8.
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- 7. Sahn B, Mamula P, Ford CA. Review of foreign body ingestion and esophageal food impaction management in adolescents. J Adolesc Health. 2014;55 (2): 260-6. doi:10.1016/j.jadohealth.2014.01.022 - Pubmed citation
- 8. Anfang RR, Jatana KR, Linn RL, Rhoades K, Fry J, Jacobs IN. pH‐neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury. NA Laryngoscope, 2019; 129:49–57.
- 9. Leinwand K, Brumbaugh DE, Kramer RE. Button Battery Ingestion in Children: A Paradigm for Management of Severe Pediatric Foreign Body Ingestions. (2016) Gastrointestinal endoscopy clinics of North America. 26 (1): 99-118. doi:10.1016/j.giec.2015.08.003 - Pubmed