My Child Swallowed Something! What Should I Do?
Pediatric Foreign Body Ingestions | High-risk Ingestions | Low-risk Ingestions | Signs & Symptoms | What to Do
Children are naturally curious and often explore the world by putting objects in their mouths. This behavior, while developmentally normal, can sometimes lead to accidental ingestion of foreign bodies. Pediatric foreign body ingestions (PFBI) are a common concern in emergency medicine, and understanding how to diagnose and manage these cases is crucial for caregivers.
Pediatric Foreign Body Ingestions
Foreign body ingestion is a frequent reason for children to seek medical attention, often leading them to pediatric emergency departments. Each year, an estimated 100,000 to 200,000 visits are attributed to this chief complaint.
Most cases occur in children aged between 6 months and 3 years. The typical demographic shows a slight male skew (54% vs. 46%). Children older than 6 months but younger than 5 years are commonly affected, with an average age range of 6 to 36 months.
High-Risk Ingestions
Certain objects pose significant risks when ingested and require immediate medical attention due to the potential for severe complications. These high-risk objects ⁽¹⁾ include:
High Risk PFBI | Potential Complications |
Batteries, especially button batteries | Erosion, perforation |
Multiple or Neodymium Magnets | Obstruction |
Sharp Objects | Perforation |
Lead Paint/Imported Toys | Lead toxicity |
Animal Bones | Erosion, fistula |
Blunt Objects > 5 cm | Obstruction |
Laundry Detergent Pods/Caustic Materials | Erosion, mucosal injury |
Water beads | Obstruction |
Batteries
Batteries, especially button batteries, can cause severe damage to the gastrointestinal tract. The electrical current can create hydroxide ions, leading to tissue necrosis, erosion, and perforation.
Multiple or Neodymium Magnets
When more than one magnet is ingested, they can attract each other through the intestinal walls, causing obstruction, pressure necrosis, fistulas, or perforation.
Sharp Objects
Sharp objects like needles, pins, or glass can perforate the gastrointestinal tract, leading to severe complications that may require surgical intervention.
Lead Paint/Imported Toys
Ingesting objects coated with lead paint or certain imported toys can result in lead poisoning, which is particularly dangerous for young children.
Animal Bones
Animal bones, especially fish bones, can lodge in the gastrointestinal tract, causing erosion, fistulas, or perforation.
Blunt Objects > 5 cm
Blunt objects longer than 5 centimeters are at higher risk of causing intestinal obstruction and may not pass through the digestive system naturally.
Laundry Detergent Pods/Caustic Materials
Ingesting caustic substances such as laundry detergent pods can cause significant mucosal injury, leading to erosion and other serious complications.
Caustics refer to chemical substances that cause burns or corrosion upon contact with the skin, eyes, and mucous membranes (such as those lining the nose, mouth, throat, and lungs) (²).
Water Beads
Water beads can absorb bodily fluids and expand within the body, leading to blockages and potentially life-threatening harm ⁽³⁾. They may not be detectable on X-rays and pose a choking risk, particularly for children under 3 years old.
Despite being labeled "non-toxic," federal safety officials caution about the chemical acrylamide used in some water beads. In some products, the levels of acrylamide have exceeded the current U.S. safety standards.
Low-Risk Ingestions
The good news is that low-risk foreign bodies often (80-90% of the time) travel through the gut without complications ⁽⁴⁾. However, they still require monitoring. Low-risk ⁽¹⁾ objects include:
Single magnet
Coins
Blunt objects < 5 cm
Most jewelry
Nuts & bolts
Plastic toys
Hair products
Holiday decorations
Erasers
Food impaction (if tolerating secretions)
Objects past the duodenal curve
Clinical Presentation
The symptoms of foreign body ingestion can vary based on the size, shape, and location of the object within the gastrointestinal tract. Common signs and symptoms ⁽¹⁾ include:
Drooling: Indicates difficulty swallowing or discomfort.
Coughing: Especially if the object is in the esophagus or airway.
Gagging or choking: Immediate signs of ingestion.
Chest pain or discomfort: Especially if the object is lodged in the esophagus.
Abdominal pain: May indicate the object has passed into the stomach or intestines.
Vomiting: Can occur if the object causes an obstruction.
Although less common, other signs of PFBI include pain in the neck, stridor (a high-pitched, wheezing sound), and globus sensation or a feeling of a lump in the throat. For Preverbal children, consider PFBI if they exhibit irritability, fussiness, food refusal, postprandial emesis or vomiting after eating.
What to Do if You Suspect Your Child Swallowed Something
If you suspect your child swallowed something dangerous, stay calm and act quickly.
Stay Calm: Do not panic. Keeping a clear head will help you respond effectively.
Monitor Symptoms: Watch your child closely for any symptoms. If your child shows any severe symptoms like difficulty breathing, chest pain, or persistent coughing, call 911 immediately.
Do Not Treat at Home: Avoid trying to treat the situation yourself. Do not induce vomiting or give your child anything to eat or drink, except in specific situations.
If you believe your child has swallowed a battery, give them a tablespoon of honey every 10 minutes, but no more than 6 doses before you reach the emergency room. Honey can help create a protective barrier and reduce the risk of tissue damage.
Seek Medical Help: Always seek professional medical help immediately if your child swallows any foreign object.
Understanding the risk stratification of foreign body ingestions is vital for prompt and effective management. High-risk ingestions require immediate attention due to their potential for severe complications, while low-risk ingestions should still be monitored carefully. Early identification and intervention can prevent serious outcomes and ensure patient safety.
REFERENCES
[1] Gerdts, E., & Migliaccio, D. (2022, February 1). Diagnosing and managing pediatric foreign body ingestions: Part I. Relias Media. https://www.reliasmedia.com/articles/149000-diagnosing-and-managing-pediatric-foreign-body-ingestions-part-i
[2] Centers for Disease Control and Prevention. (2018, April 4). Caustics (Acids, Corrosive Agents). Centers for Disease Control and Prevention. https://emergency.cdc.gov/agent/caustics/index.asp
[3] Water beads: Harmful if swallowed, put in ears. HealthyChildren.org. (n.d.). https://www.healthychildren.org/English/safety-prevention/at-home/Pages/Water-Beads-Harmful.aspx
[4] Lee JH. Foreign Body Ingestion in Children. Clin Endosc. 2018 Mar;51(2):129-136. doi: 10.5946/ce.2018.039. Epub 2018 Mar 30. PMID: 29618175; PMCID: PMC5903088.
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