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Swallowed Foreign Object

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Definition

  • Swallows a non-food solid object
  • Adult suspects an object was swallowed
  • Includes object found in the stool with no history of it being swallowed. Sometimes, a young child swallows an object when no one is around. Finding it in a stool is the first evidence that this has happened.

Types of Objects Swallowed by Children

  • Coins are the most common swallowed object. Usually safe except for quarters. Call your child's doctor to be sure.
  • Coin diameters are 18 mm (dime), 19 mm (penny), 21 mm (nickel) and 24 mm (quarter). Source: U.S. Mint.
  • Small blunt (non-sharp) objects. Toy parts, game parts, small buttons, rings, some earrings, paper clips, teeth. Usually safe if not sharp.
  • Button batteries (serious). Needs urgent removal. See below for details.
  • Magnets (serious). Needs urgent removal. See below for details.
  • Sharp or pointed objects (serious). Include needles, pins, pushpins, tacks, nails, screws, toothpicks, some earrings. Pine needles, bones, bottle caps, aluminum pull tabs are also considered sharp. Most need urgent removal. Sharp objects can become stuck and lead to a puncture in the digestive tract. Small pieces of glass generally pass without any symptoms.
  • Food Chunks. Large pieces of meat can get stuck on the way to the stomach. Mainly occurs in adults.

Button Batteries

  • Button batteries can cause low-voltage burns within 2 hours if stuck in the esophagus. The esophagus is the tube between the mouth and the stomach. A battery burn can lead to a puncture in this tube. Even "dead" batteries can be harmful if swallowed.
  • All these children need an urgent x-ray to see where the battery is. If the battery is hung up or stuck, it needs urgent removal.
  • Once it makes it to the stomach, it will usually safely pass. This may take a few days. These children need to be followed closely until the battery is passed.
  • If you have it at home, honey may be helpful in preventing this kind of injury. Caution: just for children 1 year and older. Dose: 10 mL (2 teaspoons) every 10 minutes until you can get to the ER.

Multiple Magnet Ingestion

  • When multiple magnets are swallowed, problems can occur. Magnets at different spots can become attracted to each other across the bowel wall.
  • The problems include a bowel puncture or blockage.
  • All children who are suspected of swallowing magnets need an urgent X-ray.

When to Worry

  • Objects 1 inch (25 mm) or larger often cause problems. Quarters (24 mm) are included. These larger objects can get stuck in the esophagus. The esophagus is the tube between the mouth and the stomach. Symptoms of a blocked esophagus are trouble swallowing and throat or chest pain. Your child may gag, vomit, drool, or spit. Also, your child may not want to eat or drink anything.
  • In addition to large objects, batteries, magnets and sharp objects can also cause problems.
  • Children younger than 2 years are at increased risk of objects getting stuck.

What Doctors Recommend for Smooth, Small Harmless Objects

  • If your child has no symptoms, doctors don't always agree on the best approach. They recommend one of the options below:
    • Option 1. Do nothing. No X-ray and no checking the stools. They assume the object is in stomach and will pass unless child develops symptoms. Examples are stomach pain or vomiting.
    • Option 2. Check all stools for the object. If object hasn't passed in the stool by 3 days (72 hours), get an x-ray (author's preference and used in this care guide).
    • Option 3. Get an x-ray on all patients. This can be done to be sure the object is in the stomach. For harmless objects, the x-ray can be delayed for 24 hours. Reason: object is more likely to reach the stomach after a night's sleep.
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When To Call

Call 911 Now

  • Trouble Breathing
  • Stridor (harsh sound with breathing in) is heard now
  • Wheezing (high-pitched purring or whistling sound when breathing out) is heard now
  • You think your child has a life-threatening emergency

Go to ER Now

  • Symptoms of blocked esophagus. These include: can't swallow like normal, drooling, spitting, gagging, or vomiting. Your child may not want to eat or swallow fluid or food.
  • Pain or feeling like object is stuck in throat, neck, chest or stomach
  • Sharp or pointed object
  • Button battery (saw or suspect child swallowed). Note: give honey if you have it. See First Aid.
  • Magnet (saw or suspect child swallowed it)
  • High-risk child (narrow esophagus) swallowed any coin or object
  • Child coughed up the object but continues to have coughing or wheezing
  • Your child can't swallow water or bread

Call Doctor or Seek Care Now

  • Object is 1 or more inches (25 mm) across and no symptoms
  • Age less than 2 years old
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Call Poison Center Now

  • Poisonous object suspected

Contact Doctor Within 24 Hours

  • All swallowed coins and no symptoms
  • Swallowed object hasn't passed after 3 days
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • You have other questions or concerns

Self Care at Home

  • Swallowed harmless, small object and no symptoms
  • Object Found in Stool
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Care Advice

Swallowed Harmless Small Object and No Symptoms

What You Should Know About Swallowed Objects:

  • Most small, smooth or blunt objects pass without problems into the stomach.
  • Since your child has no symptoms, the object should be in the stomach.
  • In general, anything that can get to the stomach will pass through the intestines.
  • Just to be sure it isn't stuck, perform a swallow test.

Swallow Test - Check Your Child's Ability to Swallow Food:

  • Give some water to drink.
  • If swallowed easily, give bread to eat. Reason: if bread becomes hung up, enzymes found in saliva (spit) can dissolve it.
  • If child swallows bread and water well, a normal diet is safe.

When to Check Stools for the Object:

  • For small smooth objects, checking the stools is not needed. Small means less than ½ inch (12 mm).
  • For larger objects or those that are not smooth, check the stools. Also, check the stools if you are concerned for any reason.
  • You can collect stools by having your child wear a diaper. Another way to do this is to have your child poop on a piece of paper.
  • Slice the poop with a knife. Do this until you find the object.

What You Should Expect:

  • Swallowed objects almost always make it to the stomach. Once there, they usually travel safely through the intestines. They are passed in a normal stool in 2 or 3 days.
  • There is nothing you can do to hurry this process.

Call Your Doctor If:

  • Your child can't swallow water and bread
  • Your child is gagging or doesn't want to eat or drink
  • Stomach pain, vomiting or bloody stools occur
  • Coughing occurs
  • Object hasn't passed within 3 days
  • Your child becomes worse

Object Found in Stool

What You Should Know About An Object Found in the Stool:

  • Sometimes, a young child swallows an object when no one is around.
  • Finding it in a stool is the first evidence that this has happened.
  • Your child should be safe to watch at home.

Check Your Floors and Carpets More Often:

  • Pick up any objects you find on the floor that could be swallowed.
  • Try to teach your child to only put food in the mouth.

Call Your Doctor If:

  • You have other questions or concerns

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Photos

First Aid Advice for Suspected Swallowed Button Battery

Give Honey.

  • Give the child honey now if you have it.
  • Dosage: 10 mL (2 teaspoons) every 10 minutes until you arrive at the ER.
  • Reason: honey can protect from some of the damage.
  • Exception: age less than 12 months.
  • Caution: don't let this delay your leaving for the ER.

Source: Schmitt Pediatric Guidelines
Used with Permission from Schmitt Pediatric Guidelines LLC.

Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2024. Schmitt Pediatric Guidelines LLC.
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