Foreign Body Ingestion in Children

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Foreign body ingestion refers to when a child swallows an object that is not food. This is common in young children, especially those aged six months to five years, as they often explore their environment by placing objects in their mouths. Most foreign bodies pass through the gastrointestinal tract without causing harm, but some objects can become lodged, causing complications such as obstruction, perforation, or infection.

Aetiology

Commonly ingested objects include:

• Coins
• Small toys
• Batteries (especially button batteries)
• Magnets
• Jewellery (e.g., rings or earrings)
• Food items, such as bones or seeds

Pathophysiology

Once ingested, the foreign body typically travels through the gastrointestinal tract and is passed in the stool without causing harm. However, certain objects, such as sharp items, magnets, or batteries, can become lodged or cause damage:

• Batteries: Button batteries are particularly dangerous as they can cause tissue damage due to chemical leakage and electrical discharge, leading to burns and perforation.
• Magnets: Multiple magnets can attract each other across bowel loops, causing necrosis or perforation.
• Sharp objects: These can cause lacerations or perforation of the gastrointestinal tract.
• Obstruction: Large objects may become stuck, leading to obstruction, especially at anatomical narrowing points like the oesophagus, pylorus, or ileocecal valve.

Risk Factors

• Young age (6 months to 5 years)
• Exploratory behaviour (putting objects in the mouth)
• Developmental delay or behavioural disorders
• Access to small objects or hazardous items

Signs and Symptoms

• Most children are asymptomatic, especially if the object passes through the gastrointestinal tract.
• Oesophageal foreign body: Drooling, dysphagia (difficulty swallowing), gagging, chest pain, or refusal to eat.
• Gastrointestinal obstruction: Abdominal pain, vomiting, distension, or constipation.
• Respiratory symptoms: If the foreign body compresses the airway, the child may present with coughing, wheezing, or stridor.

Investigations

Most cases are diagnosed based on history and physical examination, but imaging may be required to confirm the location and type of foreign body:

• X-ray: Useful for detecting radiopaque objects (e.g., coins, batteries, and magnets). X-rays of the chest, abdomen, and neck may be needed.
• CT scan: In cases where the object is not visible on X-ray or if complications (e.g., perforation) are suspected.
• Endoscopy: May be required for both diagnostic and therapeutic purposes, especially for sharp or hazardous objects like batteries or magnets.

Management

Management depends on the type of foreign body, location, and symptoms:

Observation:

• If the object is small, blunt, and the child is asymptomatic, most cases can be managed conservatively by observing and waiting for the object to pass naturally in the stool. Parents can be advised to check the stools for the object.

Medical Intervention:

• Endoscopic removal: This is the preferred method for removing sharp objects, batteries, or objects that are stuck in the oesophagus.
• Button batteries: If lodged in the oesophagus, immediate removal is required due to the risk of severe tissue damage within hours. Batteries in the stomach may be observed but need close follow-up.
• Magnets: If multiple magnets are ingested, urgent endoscopic or surgical removal is required to prevent bowel damage.
• Surgical intervention: Surgery may be required if the foreign body causes perforation, obstruction, or cannot be removed endoscopically.

References

1. NICE (2024). Foreign Body Ingestion in Children: Diagnosis and Management Guidelines. Available at: NICE Guidance
2. BMJ (2023). Foreign Body Ingestion in Paediatrics: Clinical Management. Available at: BMJ
3. NHS (2023). Ingested Foreign Bodies in Children. Available at: NHS