The variety of non-food items that children place into their mouths is alarming. Coins, batteries, magnets, needles, pins, tacks, glass, wood, earrings, rings and toy or game pieces are some of the more popular items. What could they be thinking? Children between the ages of 6 months and 4 years have the highest incidence of foreign body ingestion. This can be due to their natural curiosity, and what better way to explore these interesting objects than by placing them in their mouths?
If a foreign body is unintentionally swallowed, it is important for the caregiver to remain calm. The child may or may not be very anxious after realizing he or she has swallowed something that is not food.
If objects present an immediate obstruction to the windpipe, immediately call 911 for symptoms of severe respiratory distress, such as wheezing (a high-pitched whistling sound), stridor (a harsh, raspy, gasping sound when breathing in) or if the child is unable to speak, cry or cough.
Symptoms that require immediate evaluation in an emergency room include: drooling, gagging, spitting, chest pain or the sensation of an object being stuck in the throat. The caregiver should not attempt to forcefully remove an object in the esophagus as this may cause further injury. Syrup of ipecac should not be given to induce vomiting because this is not effective in removing foreign bodies from the esophagus or stomach.
Children may not have symptoms initially following foreign body ingestion or may have vague symptoms, especially when the parent does not know that foreign body ingestion has occurred. These symptoms occur when the object has moved past the esophagus and include: unexplained fever, abdominal distention or pain, nausea, vomiting, rectal pain or rectal bleeding. Again, if your child experiences one or more of these symptoms related to foreign body ingestion, seek medical evaluation.
Regardless of symptoms, certain foreign objects require immediate evaluation following ingestion. These include: sharp objects, coins quarter-sized or larger, batteries of any type, magnets and poisonous objects. Children who swallow coins smaller than a quarter that do not pass within 24 hours need an X-ray to determine the location of the coin, and further evaluation is needed if the coin does not pass within three days.
The good news is that most ingested foreign bodies will pass harmlessly through the gastrointestinal tract and be present in the child’s stool within three days. It is important to check every stool because if one stool is missed and it contains the foreign body, the parent may seek medical evaluation unnecessarily.
It is always helpful to err on the side of caution with small children. A safe environment free of small objects will decrease the likelihood of children ingesting a foreign object. Be aware of your child’s surroundings, and keep those enticing non-food items out of their reach as much as possible.
This article was written by Kit Schmitz, RN, an Answer Line nurse at St. Louis Children’s Hospital.