What is Pediatric Foreign Body Ingestion?
Kids often swallow things they shouldn’t. In the United States, coins are the most common non-food items that children swallow and doctors usually find out about. In other countries, food-related items like fish bones are more common. Young kids, teenage boys, and children with mental health problems are the most likely to swallow these foreign items. Even babies can swallow things, especially if their older siblings give them something.
Most of the time, whatever gets swallowed will pass through the digestive system without any problem. However, sometimes an object might cause health issues. This can happen if the object gets stuck because it’s too big or if it’s a small object like a pill that sticks to a wet surface. An object could also harm the inside layer of the digestive tract if it’s sharp or pointy, like a razor blade or pin. Some objects, such as a button battery or a medication patch, can cause a type of injury similar to a burn by releasing harmful substances.
What Causes Pediatric Foreign Body Ingestion?
When children unintentionally swallow or purposely eat foreign objects, it’s a common occurrence. This usually involves small items like toys, coins, or pieces of food. Kids who have psychological challenges are particularly vulnerable to consuming these objects.
Button/disc batteries, often found in toys and electronics, can pose a serious danger if they become lodged in the throat, nose, ear, or other body holes, even for a short time. The most dangerous are the larger, lithium-based batteries, but any type of these batteries can be harmful. It is crucial to get immediate medical attention if a child is suspected to have swallowed a button/disc battery. Specifically, if a battery is stuck in the throat, it needs to be removed right away. Doctors have guidelines to follow for these situations. The battery can usually be identified on an X-ray because it appears in two layers or has a “ring within a ring” look when seen from either end or from the front.
Small, high-powered magnets, like the ones found in some toys and games, can also lead to severe injury. If two or more magnets are swallowed, the strong pull between them can cause damage by tearing through the tissues in the stomach and intestines. A single swallowed magnet, along with another metal object like a button/disc battery, can also cause harm.
Children with pre-existing conditions related to their digestive system, such as prior surgery, narrowings, abnormal connections, pouches in the wall or malfunctioning of the digestive tract, these children have a greater chance of having a swallowed object get stuck at the site of the abnormality.
Risk Factors and Frequency for Pediatric Foreign Body Ingestion
Swallowing foreign objects is most common among kids aged six months to three years, as well as among people with mental health conditions. Different countries have different commonly swallowed items; in the U.S., coins are most commonly swallowed, while in other places, fish bones are often swallowed. Deaths from swallowing foreign objects do happen, but they’re very rare.
- Most incidents of swallowing foreign objects occur in children between six months to three years old.
- People with mental health challenges are also frequently involved in such incidents.
- In the U.S, coins are the most typically swallowed items.
- In other parts of the world, fish bones are commonly swallowed.
- Deaths resulting from swallowing foreign objects are unusual.
- In recent years, there have been more incidents of children under five years old swallowing magnets in the U.S.
Signs and Symptoms of Pediatric Foreign Body Ingestion
If you suspect someone, particularly a child, has accidentally swallowed a foreign object, it’s essential to check their breathing and throat right away. The object might get stuck in or harm the esophagus, causing chest pain or a feeling of something stuck in their throat. They might feel this more when swallowing. Some signs to look out for in younger kids could include drooling, gagging, vomiting, or refusing to eat. They might also cough up blood. If the object is in the stomach or intestines, they might have abdominal pain, vomit, or have blood in their stools. If the foreign body has been there for a while, they might have a fever or even lose weight. If the esophagus is fully blocked, the symptoms could be more severe.
However, it’s important to remember that sometimes, particularly in children, there might be no obvious signs or they might be tough to spot. This is because kids often swallow things without anyone seeing them do it. Therefore, always consider that seemingly random symptoms could be caused by a swallowed foreign object. In some cases, only half of the patients showed symptoms, even though doctors knew for certain that they had swallowed something.
If the swallowed foreign body contains nickel, people who are sensitive to that metal could also develop a rash or experience itchiness.
Testing for Pediatric Foreign Body Ingestion
If you swallow a foreign object, your doctor may need to decide on whether imaging tests are required after reviewing your symptoms in a physical exam, including a throat examination. Often, a basic X-ray can provide a clear enough image. Healthy children who’ve recently swallowed a low-risk item might simply need to be watched.
Most metal objects, like coins and batteries, can easily be seen on a regular X-ray. Sometimes metal detectors can also be used especially in cases where we know coins have been swallowed. Interestingly, during tests for other symptoms such as a cough, fever or unintentional weight loss, doctors may sometimes discover an unexpected swallowed item.
Most glass pieces can usually be seen on an X-ray. However, certain objects, like big chunks of meat or plastic toys, might not show up. Although in some cases, you may still be able to see their edges or other unusual shapes on the X-ray. For these more difficult to see swallowed items, additional imaging methods like special X-rays with contrast dye or MRI might be needed. Yet, sometimes doctors may proceed with a treatment like a procedure called endoscopy to remove the object, without needing further imaging.
Treatment Options for Pediatric Foreign Body Ingestion
Most children who accidentally swallow a foreign object do not need a complex medical procedure to remove it. Healthy kids who have swallowed items that pose little risk will typically be fine. It’s crucial for parents or caretakers to keep an eye out for signs or worsening symptoms that might arise.
The objects that get stuck in the esophagus, the tube that connects your throat to your stomach, are often taken out using a procedure that involves a scope to see inside your body. Some items, mainly if they’re stuck in the lower part of the esophagus near the stomach, might pass down to the stomach by themselves after a few hours. This is usually safe for items like coins and other small, harmless objects in children who have regular digestive systems and are unlikely to face more complications as the object passes through the rest of the digestive system. Some centers might remove small objects in the esophagus, like coins, using a “bougie” or a balloon catheter – essentially long, thin devices to dislodge the object. But using these devices requires considerable expertise.
This scope-based procedure, known as an endoscopy, is also generally used to get rid of large, sharp, or high-risk items from the stomach. For objects in the lower part of the digestive system—or if it’s dangerous to let the object continue through the digestive system—the experts may suggest a surgical approach.
Using medicine to manage a swallowed object is not advisable. Substances like those to make you vomit, relax your muscles, or soften meat are not typically suitable and can even be risky when dealing with esophageal foreign bodies in children. Although laxatives are sometimes used to help get the object out of the intestines, there is no definitive evidence to prove this practice is effective.
What else can Pediatric Foreign Body Ingestion be?
When a child consumes something they shouldn’t, there are a number of health conditions that doctors need to consider or rule out. These include:
- Esophagitis (inflammation of the esophagus)
- Pyloric stenosis (narrowing of the opening from the stomach to the small intestine)
- Laryngitis (inflammation of the larynx, or voice box)
- Pharyngitis (inflammation of the throat)
- Globus sensation (feeling of having a lump in the throat)
- Esophageal rupture (tearing of the esophagus)
What to expect with Pediatric Foreign Body Ingestion
The results and general outlook for children who swallow foreign objects are usually positive. Most can pass the object naturally without needing any medical procedures. However, some objects, like button batteries and magnets, can carry higher risks and cause complications, and in rare cases, can even be fatal.
There have also been reports of allergic reactions to zinc, which can be found in some foreign objects. If an object gets stuck in the esophagus, it can cause serious complications, like an infection in your chest (mediastinitis), a hole in your esophagus (perforation), or air trapped in your chest (pneumomediastinum). Of these, button batteries are the most harmful and need to be removed right away as soon as they’re identified.
Procedures to remove swallowed objects can also have risks, either related to the anesthesia or from the procedure itself.
Possible Complications When Diagnosed with Pediatric Foreign Body Ingestion
The main problem when kids swallow foreign objects is often obstruction of the esophagus, which is essentially the food pipe. In some situations, these ingested objects might wear away at the digestive tract, leading to complications because of perforation (holes created in the digestive tract) or movement of that object to other body parts. These complications only happen in rare instances:
- Perforation or tear in the esophagus or stomach
- Pneumothorax (collapsed lung)
- Mucosal erosion (damage to the tissue lining the digestive tract)
- Aortoenteric fistula (an abnormal connection between the aorta and intestines)
- Pressure necrosis (death of tissue due to sustained pressure)
- Failure to thrive in a child due to a decrease in eating
