Foreign body ingestion in children
Just the thought of foreign body (FB) ingestion is a nightmare for parents. However, it is common especially in children between the ages of 6 months to 3 years old. 80-90% of cases pass through the gastrointestinal tract without any issue but 10-20% requires endoscopic removal and 1% require open surgery.
How would i know if my child ingested a FB?
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History of coughing, drooling of saliva, pain on swallowing, reduced oral intake, abdominal pain or vomiting, melaena or gastrointestinal bleeding.
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If evidence of coughing, choking, respiratory distress - consider inhalation of FB.
A gastrointestinal tract obstruction or impaction by a FB depends on the physical property, size, shape and composition of the object.
Common FB ingested by children:
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Coins - tops the chart as the most common ingested FB
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Button batteries
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Magnet
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Small Toys
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Fish bones - the most common food related FB
What are high risk FBs?
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Button batteries lodged in the oesophagus need immediate removal as it can injure the surrounding mucosa and cause mild burn in the tract , however once they enter the stomach, they are less concerning.
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Large objects (>6 cm long and/or >2.5 cm wide) may become entrapped at the pylorus. Superabsorbent polymers may also cause impaction.
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Magnet + a Metal object or >1 Magnet ingestion can cause serious and potentially life-threatening complications.
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Lead based objects that fail to transit through the stomach may cause acute systemic lead absorption
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Multicomponent objects may break apart and progress separately in the gastrointestinal tract (e.g. Toys with lights, motors and batteries) and may require removal.
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High risk children with pre-existing gastrointestinal tract abnormalities such as congenital malformations (repaired or unrepaired), eosinophilic oesophagitis and neuromuscular disease.
It is rare for sharp objects to penetrate the mucosal wall of the GI tract, and these require no intervention if the child is otherwise well.
When should you seek treatment immediately?
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Your child shows symptoms
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Your child has ingested a toxic FB
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You need immediate facilitated emergency removal
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The FB is stuck in the oesophagus
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Your child has significant past medical history and /or behavioral issues that leads to indigestion
What will the doctor do?
Your doctor will ask for a brief and concise history on what had occurred and what FB did your child, how long has it been since he/she ingested it, what were the symptoms (if any), and what other medical illness or condition they have.
They will then do a quick inspection to evaluate the airway and carry out a physical examination to determine the location of the FB and condition of your child.
An investigation is done when there is an indication. It is not frequently done in asymptomatic patients without any issues. An x-ray would give an idea on where the FB might be. If the location is in the esophagus, a removal with an endoscopy might suffice (taking into consideration the type, size and composition of the FB).
Our take home message:
Watch your child carefully and avoid giving them small objects to play with or do not leave them lying around in the house.
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Reference:
Picture credit:
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https://www.nytimes.com/2019/04/12/parenting/children-foreign-objects.html
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https://www.webmd.com/first-aid/ss/slideshow-swallowed-objects
