My Child Swallowed a … !

More than 70,000 pediatric foreign body ingestions occur each year. Learn what to do if this happens to your child.
Ingestionsmall
Pediatric Surgical Associates

Many of us have experienced the temporary panic of watching our child struggle after swallowing something that “didn’t go down the right way.” Whether the result of consuming a drink too quickly or breathing in while eating a snack, your child starts coughing and sputtering as their watery eyes look at you for help. Most of the time, it’s just an episode of a few seconds. …The drink goes down or the food comes up, and then he or she is fine.

But every once in while something gets stuck! That’s when Pediatric Surgical Associates gets a call.

The medical term for this common problem is “foreign body ingestion” or “foreign body aspiration.” Foreign body ingestion means something went down the esophagus (the tube that connects the mouth to the stomach), and aspiration means something went down the trachea (airway or breathing tube). In either case the “something” can get stuck and must be removed.

Let’s talk about ingestion

Seventy thousand pediatric foreign body ingestions occur each year. Most foreign body ingestions occur in toddlers and preschool-aged children, who inquisitively explore the world around them, often with their mouths. An intriguing object is discovered, mouthed and inadvertently swallowed. Children most commonly swallow coins (which comprise 80 percent of foreign bodies lodged in the esophagus), but other objects we regularly remove include magnets, batteries, small toys, buttons and jewelry.

Although caregivers sometimes see the child swallow the object, as many as half of these cases are not witnessed. These children might suddenly start drooling or throwing up continually, refuse to eat or complain of achy pain in the chest. Many will have respiratory symptoms like coughing or wheezing. They also might not; some children initially show no symptoms whatsoever!

What happens if your child swallows something and seems fine? It is likely that the foreign body has traversed the esophagus and made it to the stomach. Foreign bodies in the stomach and intestine can almost always be left alone, because the child will usually pass it without complication. There are exceptions to that rule. If your child swallows a button-style battery, it is possible he or she will develop an internal burn since the current of those batteries runs continuously. If your child were to swallow multiple magnets, it is possible the magnets could connect and pinch whatever tissue is in the way.

If you are concerned your child may have swallowed a foreign body but seems fine, don’t panic; just call the doctor to be safe. If your child has any of the symptoms described above after a witnessed foreign body ingestion, take them to one of the two pediatric emergency departments here in Charlotte for evaluation.

Now for aspiration

Most foreign body aspirations occur in children younger than 4. Though very often the item is a piece of food (think peanuts and popcorn), we see many interesting non-food items (air-soft pellets, jewelry, beads). Older kids and adults suffering from foreign body aspiration inhale thumbtacks, pen tops, guitar picks, screws and nails — things they were holding in their mouths while their hands were otherwise occupied.

When a child “aspirates” or inhales something, he or she will likely choke on it temporarily, then cough and wheeze. This almost always happens by accident while the child is talking, moving, coughing, singing or sighing. Sometimes the child will have immediate symptoms like noisy breathing. Foods such as nuts or rice may cause trouble several days later after the they absorb enough fluid and increase in size.

Pediatric surgeons remove foreign bodies of the esophagus and airway using a scope under sedation in the operating room. This is typically a brief (less than 10-minute) out-patient procedure (most children go home immediately afterward).  In all cases of suspected foreign body ingestion or aspiration, the most important thing you can do is try not to panic and document or retrace what happened before, during and after your child swallowed or inhaled the object. Ask yourself these questions and write down as much as you know or can find out:

  • Was your child alone or accompanied when it happened?
  • What did your child consume? If you are not sure, look around for what might be missing or out of place.
  • What happened immediately after? Did your child turn blue for a short time? How long did the cough persist? Did your child vomit? Did his or her voice change?

Foreign body ingestion and aspiration sound scary, and in some cases these conditions can be serious. But most of the time, we can identify foreign bodies on an x-ray and use minimally invasive methods to remove them quickly and easily. Always err on the side of caution and call the doctor if you have any concerns about an ingested or aspirated foreign body. And if you do need surgery, we’re here.


Dr. Graham Cosper is a board-certified Pediatric Surgeon with Pediatric Surgical Associates in Charlotte. His findings on foreign object ingestion and aspiration were recently published in "Current Treatment Options in Pediatrics" (Graham H. Cosper & Angela M. Kao, Springer, April 2017). For more information on keeping your child safe and well, visit pedsurgical.com.