Pediatric foreign body - Revision history

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← Older revision		Revision as of 15:57, 19 March 2026
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	~~'''~~Pediatric foreign body~~'''~~ refers to the ingestion, aspiration, or insertion of a foreign object by a child, most commonly occurring in children aged 6 months to 3 years.<ref>Orsagh-Yentis D, McAdams RJ, Roberts KJ, McKenzie LB. Foreign-body ingestions of young children treated in US emergency departments: 1995-2015. ''Pediatrics''. 2019;143(5):e20181988.</ref> Foreign bodies may lodge in the airway, esophagus, gastrointestinal tract, [[Ear foreign body\|ear]], [[Nasal foreign body\|nose]], or [[Vaginal foreign body\|vagina]].		==Background==
			*Pediatric foreign body refers to the ingestion, aspiration, or insertion of a foreign object by a child, most commonly occurring in children aged 6 months to 3 years.<ref>Orsagh-Yentis D, McAdams RJ, Roberts KJ, McKenzie LB.
			*Foreign-body ingestions of young children treated in US emergency departments: 1995-2015. ''Pediatrics''. 2019;143(5):e20181988.</ref>
			*Foreign bodies may lodge in the airway, esophagus, gastrointestinal tract, [[Ear foreign body\|ear]], [[Nasal foreign body\|nose]], or [[Vaginal foreign body\|vagina]].


	~~==Background==~~
	* Foreign body ingestion and aspiration are among the most common pediatric emergencies		* Foreign body ingestion and aspiration are among the most common pediatric emergencies
	* Peak incidence is between 1 and 3 years of age<ref>Foltran F, Ballali S, Passali FM, et al. Foreign bodies in the airways: a meta-analysis of published papers. ''Int J Pediatr Otorhinolaryngol''. 2012;76 Suppl 1:S12-19.</ref>		* Peak incidence is between 1 and 3 years of age<ref>Foltran F, Ballali S, Passali FM, et al. Foreign bodies in the airways: a meta-analysis of published papers. ''Int J Pediatr Otorhinolaryngol''. 2012;76 Suppl 1:S12-19.</ref>

Ostermayer at 21:56, 16 March 2026

2026-03-16T21:56:19Z

← Older revision		Revision as of 21:56, 16 March 2026
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	* [[Retropharyngeal abscess]]		* [[Retropharyngeal abscess]]
	* [[Anaphylaxis]]		* [[Anaphylaxis]]
	* [[Globus sensation]]		* Globus sensation

	==Evaluation==		==Evaluation==

Ostermayer: Created page with "'''Pediatric foreign body''' refers to the ingestion, aspiration, or insertion of a foreign object by a child, most commonly occurring in children aged 6 months to 3 years.Orsagh-Yentis D, McAdams RJ, Roberts KJ, McKenzie LB. Foreign-body ingestions of young children treated in US emergency departments: 1995-2015. ''Pediatrics''. 2019;143(5):e20181988. Foreign bodies may lodge in the airway, esophagus, gastrointestinal tract, ear, Nasal..."

2026-03-16T21:55:56Z

Created page with "'''Pediatric foreign body''' refers to the ingestion, aspiration, or insertion of a foreign object by a child, most commonly occurring in children aged 6 months to 3 years.<ref>Orsagh-Yentis D, McAdams RJ, Roberts KJ, McKenzie LB. Foreign-body ingestions of young children treated in US emergency departments: 1995-2015. ''Pediatrics''. 2019;143(5):e20181988.</ref> Foreign bodies may lodge in the airway, esophagus, gastrointestinal tract, ear, Nasal..."

New page

'''Pediatric foreign body''' refers to the ingestion, aspiration, or insertion of a foreign object by a child, most commonly occurring in children aged 6 months to 3 years.<ref>Orsagh-Yentis D, McAdams RJ, Roberts KJ, McKenzie LB. Foreign-body ingestions of young children treated in US emergency departments: 1995-2015. ''Pediatrics''. 2019;143(5):e20181988.</ref> Foreign bodies may lodge in the airway, esophagus, gastrointestinal tract, [[Ear foreign body|ear]], [[Nasal foreign body|nose]], or [[Vaginal foreign body|vagina]].

==Background==
* Foreign body ingestion and aspiration are among the most common pediatric emergencies
* Peak incidence is between 1 and 3 years of age<ref>Foltran F, Ballali S, Passali FM, et al. Foreign bodies in the airways: a meta-analysis of published papers. ''Int J Pediatr Otorhinolaryngol''. 2012;76 Suppl 1:S12-19.</ref>
* Male-to-female ratio is approximately 2:1<ref>Salih AM, Alfaki M, Alam-Elhuda DM. Airway foreign bodies: a critical review for a common pediatric emergency. ''World J Emerg Med''. 2016;7(1):5-12.</ref>
* '''Ingestion''' accounts for the majority of cases
** Coins are the most commonly ingested foreign body in the United States<ref>Conners GP. Pediatric foreign body ingestion: complications and patient and foreign body factors. ''Sci''. 2022;4(2):20.</ref>
** Most ingested objects (80-90%) pass spontaneously through the GI tract
* '''Aspiration''' is responsible for approximately 7% of accidental deaths in children under 3 years of age<ref>Passali D, Lauriello M, Bellussi L, Passali GC, Passali FM, Gregori D. Foreign body inhalation in children: an update. ''Acta Otorhinolaryngol Ital''. 2010;30(1):27-32.</ref>
** Organic material (nuts, seeds) most common in younger children
** Inorganic objects (toy parts, pen caps) more common in older children
* Risk factors include:
** Absence of molar teeth (unable to properly grind food)
** Immature swallowing coordination and laryngeal protective reflexes
** Tendency to explore the environment orally
** Eating while playing or running

==Clinical Features==

===Ingested foreign body===
* Often asymptomatic if object has passed beyond the esophagus
* [[Dysphagia]]
* Drooling
* Odynophagia
* Vomiting or refusal to eat
* Chest or abdominal pain
* Globus sensation
* If esophageal impaction: risk of airway obstruction, pooling of secretions

===Aspirated foreign body===
* Classic triad: acute [[choking]], [[cough]], and [[wheezing]]<ref>Zerella JT, Dimler M, McGill LC, Pippus KJ. Foreign body aspiration in children: value of radiography and complications of bronchoscopy. ''J Pediatr Surg''. 1998;33(11):1651-1654.</ref>
* Stridor (if laryngeal or tracheal)
* Unilateral decreased breath sounds
* Recurrent or persistent [[pneumonia]] (delayed presentation)
* Asymptomatic period may follow initial choking episode ("symptom-free interval")

===Ear foreign body===
* Ear pain, fullness, or [[hearing loss]]
* Otorrhea
* See [[Ear foreign body]]

===Nasal foreign body===
* Unilateral, foul-smelling nasal discharge
* Epistaxis
* See [[Nasal foreign body]]

==Differential Diagnosis==
* [[Croup]]
* [[Asthma]]
* [[Bronchiolitis]]
* [[Pneumonia]]
* [[Epiglottitis]]
* [[Peritonsillar abscess]]
* [[Esophagitis]]
* [[Retropharyngeal abscess]]
* [[Anaphylaxis]]
* [[Globus sensation]]

==Evaluation==

===Workup===
* '''Radiographs'''
** AP and lateral views of neck, chest, and abdomen for suspected ingestion or aspiration
** Coins in the esophagus appear as a round disc on AP view (en face) and a line on lateral
** [[Button battery ingestion]] appears as a "double contour" or "halo sign" on AP view — critical to distinguish from coin<ref>Litovitz T, Whitaker N, Clark L, White NC, Marsolek M. Emerging battery-ingestion hazard: clinical implications. ''Pediatrics''. 2010;125(6):1168-1177.</ref>
** Normal radiographs do not exclude foreign body (radiolucent objects such as fish bones, plastic, wood are not visible)
** Inspiratory/expiratory films or bilateral decubitus films may demonstrate air trapping in aspirated foreign body
* '''CT''' — consider if plain films are negative but clinical suspicion remains high
* '''Metal detector''' — can be used for rapid identification of metallic objects in the esophagus<ref>Lee JB, Ahmad S, Gale CP. Detection of coins ingested by children using a handheld metal detector: a systematic review. ''Emerg Med J''. 2005;22(12):839-844.</ref>
* '''Barium swallow''' — generally NOT recommended (risk of aspiration, coats mucosa making endoscopy more difficult)

===Diagnosis===
* Diagnosis is often based on history (witnessed event, acute choking)
* High index of suspicion in young children with unexplained respiratory symptoms, dysphagia, or recurrent pneumonia
* Up to 40% of cases may have no witnessed aspiration event
* Bronchoscopy is both diagnostic and therapeutic for airway foreign bodies

==Management==

===Immediate airway management===
* If '''complete airway obstruction''':
** Infant (<1 year): 5 back blows followed by 5 chest thrusts
** Child (>1 year): abdominal thrusts (Heimlich maneuver)
** If object is visible, remove with Magill forceps — do NOT perform blind finger sweep
** If unable to ventilate: attempt [[intubation]] (may push object distally, converting to partial obstruction)
** Last resort: [[Cricothyrotomy]] (needle or surgical) or [[tracheostomy]]
* See [[Aspirated foreign body]]

===Esophageal foreign body===
* '''[[Button battery ingestion]] in esophagus''' = '''EMERGENT removal within 2 hours'''<ref>Kramer RE, Lerner DG, Lin T, et al. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. ''J Pediatr Gastroenterol Nutr''. 2015;60(4):562-574.</ref>
** Can cause liquefactive necrosis, perforation, and fistula formation within hours
** Administer honey (10 mL every 10 min if age >12 months) or sucralfate as temporizing measure while awaiting endoscopy<ref>Anfang RR, Jatana KR, Engel RM, et al. Use of honey to mitigate lithium coin battery injury: a laboratory study. ''Laryngoscope''. 2019;129(10):2237-2243.</ref>
** Contact [[Poison control]] (National Battery Ingestion Hotline: 1-800-498-8666)
* '''Multiple magnets or magnet + metallic object''' = '''Emergent endoscopic removal'''
** Can cause pressure necrosis, fistula, perforation, and bowel obstruction between loops<ref>Nugud AA, Tzivinikos C, Assa A, et al. Pediatric magnet ingestion, diagnosis, management, and prevention: an ESPGHAN position paper. ''J Pediatr Gastroenterol Nutr''. 2023;76(4):523-532.</ref>
** Single magnet ingestion can typically be observed if asymptomatic
** Confirm single magnet with lateral radiograph (multiple magnets may stack)
* '''Sharp or pointed objects in esophagus''' = '''Urgent endoscopic removal'''
* '''Coins or blunt objects in esophagus'''
** Observe for up to 12-24 hours (may pass spontaneously in ~30% of cases)<ref>Waltzman ML, Baskin M, Wypij D, Mooney D, Jones D, Fleisher G. A randomized clinical trial of the management of esophageal coins in children. ''Pediatrics''. 2005;116(3):614-619.</ref>
** [[Esophageal foreign body removal with foley catheter|Foley catheter removal]] may be considered for smooth, blunt objects impacted <24 hours
** Endoscopy if object does not pass or if symptomatic

===Gastric and intestinal foreign body===
* Most blunt objects that reach the stomach will pass without intervention
* Indications for endoscopic removal from the stomach:
** Objects >2.5 cm in diameter or >6 cm in length
** Sharp objects
** [[Button battery ingestion]] remaining in stomach >48 hours (controversial; some experts advocate earlier removal)
** Symptomatic patients
* Expectant management with serial imaging for small, blunt, asymptomatic objects
** Repeat imaging if object has not passed within 4 weeks

===Ear and nasal foreign body===
* See [[Ear foreign body]] and [[Nasal foreign body]]
* '''[[Button battery ingestion]] in ear or nose''' = '''Emergent removal'''
* Multiple removal techniques available (irrigation, suction, alligator forceps, balloon catheter, "parent's kiss")

===Airway foreign body===
* Rigid bronchoscopy is the gold standard for removal in children<ref>Fidkowski CW, Zheng H, Firth PG. The anesthetic considerations of tracheobronchial foreign bodies in children: a literature review of 12,979 cases. ''Anesth Analg''. 2010;111(4):1016-1025.</ref>
* Flexible bronchoscopy may be used as an adjunct
* Consider ENT and/or anesthesia consultation
* Post-removal: consider [[dexamethasone]], bronchodilators, and/or [[racemic epinephrine]]

==Disposition==
* '''Admit/OR''' if:
** Esophageal [[button battery ingestion]] (emergent OR)
** Multiple magnet ingestion with concern for impaction
** Sharp esophageal foreign body
** Airway foreign body requiring bronchoscopy
** Symptomatic patient with signs of perforation, obstruction, or respiratory compromise
* '''Discharge''' if:
** Asymptomatic with blunt object beyond the esophagus
** Successful removal of foreign body with asymptomatic post-removal observation
** Provide strict return precautions: abdominal pain, vomiting, bloody stools, fever
** Caregiver education on prevention (keep small objects out of reach, age-appropriate foods)
* '''Follow-up'''
** Serial imaging for retained gastric/intestinal foreign bodies if not removed
** Return for repeat radiograph if object not passed within 4 weeks

==See Also==
* [[Aspirated foreign body]]
* [[Ingested foreign body]]
* [[Ear foreign body]]
* [[Nasal foreign body]]
* [[Vaginal foreign body]]
* [[Soft tissue foreign body]]
* [[Button battery ingestion]]
* [[Esophageal foreign body removal with foley catheter]]

==External Links==
* [http://www.poison.org/battery National Capital Poison Center – Button Battery Ingestion Guidelines]
* [https://naspghan.org NASPGHAN – North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition]

==References==
<references/>

[[Category:Pediatrics]]
[[Category:ENT]]
[[Category:GI]]

← Older revision		Revision as of 09:30, 22 March 2026
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	* Peak incidence is between 1 and 3 years of age<ref>Foltran F, Ballali S, Passali FM, et al. Foreign bodies in the airways: a meta-analysis of published papers. ''Int J Pediatr Otorhinolaryngol''. 2012;76 Suppl 1:S12-19.</ref>		* Peak incidence is between 1 and 3 years of age<ref>Foltran F, Ballali S, Passali FM, et al. Foreign bodies in the airways: a meta-analysis of published papers. ''Int J Pediatr Otorhinolaryngol''. 2012;76 Suppl 1:S12-19.</ref>
	* Male-to-female ratio is approximately 2:1<ref>Salih AM, Alfaki M, Alam-Elhuda DM. Airway foreign bodies: a critical review for a common pediatric emergency. ''World J Emerg Med''. 2016;7(1):5-12.</ref>		* Male-to-female ratio is approximately 2:1<ref>Salih AM, Alfaki M, Alam-Elhuda DM. Airway foreign bodies: a critical review for a common pediatric emergency. ''World J Emerg Med''. 2016;7(1):5-12.</ref>
	* ~~'''~~Ingestion~~'''~~ accounts for the majority of cases		* Ingestion accounts for the majority of cases
	** Coins are the most commonly ingested foreign body in the United States<ref>Conners GP. Pediatric foreign body ingestion: complications and patient and foreign body factors. ''Sci''. 2022;4(2):20.</ref>		** Coins are the most commonly ingested foreign body in the United States<ref>Conners GP. Pediatric foreign body ingestion: complications and patient and foreign body factors. ''Sci''. 2022;4(2):20.</ref>
	** Most ingested objects (80-90%) pass spontaneously through the GI tract		** Most ingested objects (80-90%) pass spontaneously through the GI tract
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	===Workup===		===Workup===
	* ~~'''~~Radiographs~~'''~~		* Radiographs
	** AP and lateral views of neck, chest, and abdomen for suspected ingestion or aspiration		** AP and lateral views of neck, chest, and abdomen for suspected ingestion or aspiration
	** Coins in the esophagus appear as a round disc on AP view (en face) and a line on lateral		** Coins in the esophagus appear as a round disc on AP view (en face) and a line on lateral
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	** Normal radiographs do not exclude foreign body (radiolucent objects such as fish bones, plastic, wood are not visible)		** Normal radiographs do not exclude foreign body (radiolucent objects such as fish bones, plastic, wood are not visible)
	** Inspiratory/expiratory films or bilateral decubitus films may demonstrate air trapping in aspirated foreign body		** Inspiratory/expiratory films or bilateral decubitus films may demonstrate air trapping in aspirated foreign body
	* ~~'''~~CT~~'''~~ — consider if plain films are negative but clinical suspicion remains high		* CT — consider if plain films are negative but clinical suspicion remains high
	* ~~'''~~Metal detector~~'''~~ — can be used for rapid identification of metallic objects in the esophagus<ref>Lee JB, Ahmad S, Gale CP. Detection of coins ingested by children using a handheld metal detector: a systematic review. ''Emerg Med J''. 2005;22(12):839-844.</ref>		* Metal detector — can be used for rapid identification of metallic objects in the esophagus<ref>Lee JB, Ahmad S, Gale CP. Detection of coins ingested by children using a handheld metal detector: a systematic review. ''Emerg Med J''. 2005;22(12):839-844.</ref>
	* ~~'''~~Barium swallow~~'''~~ — generally NOT recommended (risk of aspiration, coats mucosa making endoscopy more difficult)		* Barium swallow — generally NOT recommended (risk of aspiration, coats mucosa making endoscopy more difficult)

	===Diagnosis===		===Diagnosis===
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	===Immediate airway management===		===Immediate airway management===
	* If ~~'''~~complete airway obstruction~~'''~~:		* If complete airway obstruction:
	** Infant (<1 year): 5 back blows followed by 5 chest thrusts		** Infant (<1 year): 5 back blows followed by 5 chest thrusts
	** Child (>1 year): abdominal thrusts (Heimlich maneuver)		** Child (>1 year): abdominal thrusts (Heimlich maneuver)
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	===Esophageal foreign body===		===Esophageal foreign body===
	* ~~'''~~[[Button battery ingestion]] in esophagus~~'''~~ = ~~'''~~EMERGENT removal within 2 hours~~'''~~<ref>Kramer RE, Lerner DG, Lin T, et al. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. ''J Pediatr Gastroenterol Nutr''. 2015;60(4):562-574.</ref>		* [[Button battery ingestion]] in esophagus = EMERGENT removal within 2 hours<ref>Kramer RE, Lerner DG, Lin T, et al. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. ''J Pediatr Gastroenterol Nutr''. 2015;60(4):562-574.</ref>
	** Can cause liquefactive necrosis, perforation, and fistula formation within hours		** Can cause liquefactive necrosis, perforation, and fistula formation within hours
	** Administer honey (10 mL every 10 min if age >12 months) or sucralfate as temporizing measure while awaiting endoscopy<ref>Anfang RR, Jatana KR, Engel RM, et al. Use of honey to mitigate lithium coin battery injury: a laboratory study. ''Laryngoscope''. 2019;129(10):2237-2243.</ref>		** Administer honey (10 mL every 10 min if age >12 months) or sucralfate as temporizing measure while awaiting endoscopy<ref>Anfang RR, Jatana KR, Engel RM, et al. Use of honey to mitigate lithium coin battery injury: a laboratory study. ''Laryngoscope''. 2019;129(10):2237-2243.</ref>
	** Contact [[Poison control]] (National Battery Ingestion Hotline: 1-800-498-8666)		** Contact [[Poison control]] (National Battery Ingestion Hotline: 1-800-498-8666)
	* ~~'''~~Multiple magnets or magnet + metallic object~~'''~~ = ~~'''~~Emergent endoscopic removal~~'''~~		* Multiple magnets or magnet + metallic object = Emergent endoscopic removal
	** Can cause pressure necrosis, fistula, perforation, and bowel obstruction between loops<ref>Nugud AA, Tzivinikos C, Assa A, et al. Pediatric magnet ingestion, diagnosis, management, and prevention: an ESPGHAN position paper. ''J Pediatr Gastroenterol Nutr''. 2023;76(4):523-532.</ref>		** Can cause pressure necrosis, fistula, perforation, and bowel obstruction between loops<ref>Nugud AA, Tzivinikos C, Assa A, et al. Pediatric magnet ingestion, diagnosis, management, and prevention: an ESPGHAN position paper. ''J Pediatr Gastroenterol Nutr''. 2023;76(4):523-532.</ref>
	** Single magnet ingestion can typically be observed if asymptomatic		** Single magnet ingestion can typically be observed if asymptomatic
	** Confirm single magnet with lateral radiograph (multiple magnets may stack)		** Confirm single magnet with lateral radiograph (multiple magnets may stack)
	* ~~'''~~Sharp or pointed objects in esophagus~~'''~~ = ~~'''~~Urgent endoscopic removal~~'''~~		* Sharp or pointed objects in esophagus = Urgent endoscopic removal
	* ~~'''~~Coins or blunt objects in esophagus~~'''~~		* Coins or blunt objects in esophagus
	** Observe for up to 12-24 hours (may pass spontaneously in ~30% of cases)<ref>Waltzman ML, Baskin M, Wypij D, Mooney D, Jones D, Fleisher G. A randomized clinical trial of the management of esophageal coins in children. ''Pediatrics''. 2005;116(3):614-619.</ref>		** Observe for up to 12-24 hours (may pass spontaneously in ~30% of cases)<ref>Waltzman ML, Baskin M, Wypij D, Mooney D, Jones D, Fleisher G. A randomized clinical trial of the management of esophageal coins in children. ''Pediatrics''. 2005;116(3):614-619.</ref>
	** [[Esophageal foreign body removal with foley catheter\|Foley catheter removal]] may be considered for smooth, blunt objects impacted <24 hours		** [[Esophageal foreign body removal with foley catheter\|Foley catheter removal]] may be considered for smooth, blunt objects impacted <24 hours
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	===Ear and nasal foreign body===		===Ear and nasal foreign body===
	* See [[Ear foreign body]] and [[Nasal foreign body]]		* See [[Ear foreign body]] and [[Nasal foreign body]]
	* ~~'''~~[[Button battery ingestion]] in ear or nose~~'''~~ = ~~'''~~Emergent removal~~'''~~		* [[Button battery ingestion]] in ear or nose = Emergent removal
	* Multiple removal techniques available (irrigation, suction, alligator forceps, balloon catheter, "parent's kiss")		* Multiple removal techniques available (irrigation, suction, alligator forceps, balloon catheter, "parent's kiss")

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	==Disposition==		==Disposition==
	* ~~'''~~Admit/OR~~'''~~ if:		* Admit/OR if:
	** Esophageal [[button battery ingestion]] (emergent OR)		** Esophageal [[button battery ingestion]] (emergent OR)
	** Multiple magnet ingestion with concern for impaction		** Multiple magnet ingestion with concern for impaction
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	** Airway foreign body requiring bronchoscopy		** Airway foreign body requiring bronchoscopy
	** Symptomatic patient with signs of perforation, obstruction, or respiratory compromise		** Symptomatic patient with signs of perforation, obstruction, or respiratory compromise
	* ~~'''~~Discharge~~'''~~ if:		* Discharge if:
	** Asymptomatic with blunt object beyond the esophagus		** Asymptomatic with blunt object beyond the esophagus
	** Successful removal of foreign body with asymptomatic post-removal observation		** Successful removal of foreign body with asymptomatic post-removal observation
	** Provide strict return precautions: abdominal pain, vomiting, bloody stools, fever		** Provide strict return precautions: abdominal pain, vomiting, bloody stools, fever
	** Caregiver education on prevention (keep small objects out of reach, age-appropriate foods)		** Caregiver education on prevention (keep small objects out of reach, age-appropriate foods)
	* ~~'''~~Follow-up~~'''~~		* Follow-up
	** Serial imaging for retained gastric/intestinal foreign bodies if not removed		** Serial imaging for retained gastric/intestinal foreign bodies if not removed
	** Return for repeat radiograph if object not passed within 4 weeks		** Return for repeat radiograph if object not passed within 4 weeks