Ingested foreign bodies in children

Last revised by Andrew Murphy on 14 Mar 2024

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 an x-ray of the chest and 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 is 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.

Most foreign bodies make it into the stomach and beyond with up to 80% passing spontaneously 1.  

Button battery ingestion is potentially fatal. Sodium hydroxide accumulates at the negative electrode as a consequence of tissue fluid hydrolysis. The resulting progressive ulceration can cause tracheo-esophageal fistula or death 5-7. The esophagus is particularly susceptible to damage due to weak peristalsis and to the narrow caliber which ensure continued close apposition of tissue to the battery. Esophageal button batteries should be removed endoscopically as an emergency 9. Early and frequent ingestion of honey prior to endoscopic removal has been found to provide a coating which decreases the incidence of mucosal injury and full thickness tissue necrosis 8.

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