A Review of Pediatric Foreign Body Ingestion and Management

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Pediatric foreign body (FB) ingestion is a common problem throughout the world. The type of FB that is ingested, the anatomical location of the FB, and the time to medical presentation are all factors that determine how the child will be treated. Unfortunately, there is not a universally implemented algorithm on how to deal with this concern. We review the literature and discuss the different types of foreign bodies that are ingested as well as highlight the differences and similarities in their management plans. We also present a possible algorithm to the approach of the pediatric patient with a concern for FB ingestion.

Section snippets

Coins

Coin ingestions accounted for more than 21 000 emergency department visits in 1997,15 making them the most commonly ingested FB in countries where fish does not represent a large proportion of the diet. In these countries, coin ingestions are second to fish bone ingestions.12

There is still some debate as to how to investigate children that ingest coins. Some have suggested that an x-ray may not be necessary, stating that a handheld metal detector may be sufficient to detect the presence/absence

Batteries

Batteries are a common household item that children have ready access to. Hearing aid batteries were the most commonly ingested type in one pediatric study, with almost one third of these batteries having come from the child's own device.24 Recent data indicates a growing prevalence of button battery ingestion, with a nearly 7-fold increase in the incidence of ingestions associated with major or fatal outcomes, and with the majority of adverse outcomes occurring in children less than 4 years of

Sharp Objects

Commonly ingested sharp objects in the pediatric population include fish bones, chicken bones, pins, needles, tooth picks, nails, and even sharp toys. These objects will often get stuck in the tonsil, causing focal pain, odynophagia, and drooling (Figure 2). A single straight pin will usually pass without any concern as they normally travel blunt end first as they traverse the GI tract, thus, following Jackson's axiom that, “advancing points perforate and trailing points don't.”32 Despite this,

Magnets

Magnets are another common household item that children have easy access to because they can be found in toys, jewelry, and on just about any refrigerator door in North America. It is important to know the number of magnets that have been swallowed because the ingestion of a single magnet does not carry the same risk as ingesting more than one magnet. Ingestion of a single magnet could be considered similarly to swallowing any smooth small object such as a coin. But the diagnosis of a

Treatment Options

Although endoscopy is the criterion standard for removal of foreign bodies from the esophagus, there are other techniques that are discussed in the literature, such as the Foley and bougienage techniques as well as the magnet probe.

In the Foley technique, a Foley catheter is passed beyond the coin/FB and the balloon is inflated with a radiopaque dye and then pulled out under fluoroscopy. At the centers where Foley catheter removal is the standard of care,45 this technique has a high rate of

Summary

There are a number of variables involved in deciding how to treat a child who presents with concerns for a possible FB ingestion. A review of the literature reveals that there is no universally implemented approach to this problem,5, 7, 13, 14 and there are frequently differing opinions on how to treat the same problem.

Differences aside, there are some general principles that are adhered to throughout the literature. The type and location of FB and, most importantly, whether the child is

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