INGESTION OF METALLIC OBJECTS IN CHILDREN

• If a coin or other non-sharp metal object makes it to the stomach or small intestine, usually passes uneventfully
• If lodge in the esophagus, us. need to be removed endoscopically (if in distal esophagus, watchful waiting often appropritae)
• Sx of obstruction (drooling, respiratory distress, choking) should have obstructions removed emergently.
• However, in a retrospective study of 116 cases of coin ingestion with coin location in the esophagus, chance of spontaneous passage to the stomach was not dependent on initial location of the coin. Among pts with no h/o esophageal disease or surgery, with a single coin swallowed < 24h previously, and with no respiratory compromise, rate of spontaneous passage was about 30% (Arch. Ped. Adol. Med. 153:1073, 1999--AFP)
• There is no evidence that PO fluids or food promote passage of esophageal foreign bodies to the stomach
• For asymptomatic children, observation may be appropriate.
  • In a study in 60 children 10mo-55mo with h/o coin ingestion but no symptoms randomized to immediate endoscopic removal vs. observation with removal after 16h if necessary, the observation group had sig. longer hospital stay. 77% of the observation group eventually had endoscopy. 30% of the immediate-endoscopy group passed the coin spontaneously (Peds. 116:614, 2005--JW)