How to manage children who ingest foreign bodies

What is the management of children who ingest foreign bodies? 

Children commonly ingest FBs due to their natural curiosity and play. Most ingested FBs pass spontaneously if they move beyond the gastroesophageal junction, are less than 5 cm in length, and are not very sharp (sewing needles).

Most sharp objects such as tacks, screws, and staples will safely pass surrounded by stool. Frequent radiographs for asymptomatic children are unnecessary for commonly ingested FBs. 

However, a heightened measure of caution should be exercised when the FB is a button battery or a magnet.

Button battery and magnet ingestions are on the rise as a result of their incorporation into many childhood toys. Button batteries are also present in small electronics, hearing aids, and musical greeting cards. Of particular concern are lithium batteries, which have an external current that can damage surrounding tissue.

Button batteries can become lodged against mucosa in the nose or esophagus and have the potential to cause necrosis, perforation, and life-threatening GI bleed. These nasal and esophageal button batteries should be removed immediately. Batteries in the stomach usually pass spontaneously without causing abdominal pain. 

A single magnet may cause little problem, but if more than one magnet is ingested, their attraction across bowel wall can cause necrosis leading to obstruction, volvulus, or perforation.

These patients can present with abdominal pain, vomiting, constipation, and peritoneal irritation. It is important to remember that on radiography, two attached magnets can appear as one on film.

The ingestion of a single magnet should be managed by a two-view radiograph, and if the patient is asymptomatic, he or she should be discharged with close follow-up in 3 days. A repeat radiograph should be considered to ensure movement along the GI tract.

Adequate discharge instructions should be given for symptoms suggestive of perforation or obstruction.

Children who ingest multiple magnets or one magnet in addition to a metallic object or have signs of intestinal obstruction with single magnet ingestion should be evaluated by a surgeon for endoscopic or operative removal because of the risks discussed. 

Sources

Schunk JE: Foreign body—Ingestion/aspiration. In Fleisher GR, Ludwig S, Henretig FM (eds): Textbook of Pediatric Emergency Medicine, 6th ed. Philadelphia, Lippincott Williams & Wilkins, 2010, pp 767-768, 777-779. 

Tavarez MM, Saladino RA, Gaines BA, Manole MD: Prevalence, clinical features and management of pediatric magnetic foreign body ingestions. J Emerg Med 2013;44:261-268.

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