Paediatric foreign body ingestion

Red flags

• Button batteries
  • Once reach the stomach = benign
  • Urgent removal in oesophagus
• Large objects
  • >6cm long and/or >2.5cm wide may become entrapped in pylorus
• Magnet + metal object or >1 magnet
• Lead-based objects
  • If fails to transit through stomach, may cause acute systemic lead absorption
• High-risk children
  • Previous GI surgery, tracheo-oesophageal fistulas or stenosing lesions

Assessment

• History
  • Object type and when ingested
  • High risk object?
  • History of cough, drooling, pain on swallowing, not eating/drinking, abdo pain or vomiting
  • Consider inhalation if hx of choking/coughing/respiratory distress
• Examination
  • Airway compromise
  • Oropharyngeal drooling/abrasions/lacerations/objects
  • Respiratory distress
  • Abdominal tenderness/obstruction/peritonism

Management

• X-ray is not always required
  • If reliable, well and no significant PMHx
• CXR/AXR if:
  • Suspected or known battery
  • Magnet
  • Other high-risk radio-opaque object
  • Unknown object
  • High risk or symptomatic child
  • **Note aluminium may not be radio-opaque but most other metals will

• Discharge if:
  • Well, pain free, no respiratory distress, can eat/drink, reliable history and low-risk object
  • Faecal examination is not recommended
• Interventions
  • Object in oropharynx – ENT
  • Button battery in oesophagus – Immediate removal
  • Multiple magnets/metal require early endoscopic removal
  • Sharp objects rarely penetrate the mucosal wall and require no intervention if otherwise well
  • Fishbones may lodge in tonsils and need removal
  • FB lodged in oesophagus, with child able to swallow saliva, can be watched for 24 hours. If does not pass, remove.
  • Larger objects (as above) require surgical/gastro opinion

Last Updated on November 20, 2021 by Andrew Crofton