What is Foreign Body Ingestion in Children? Symptoms, Causes, and Treatment Methods

Foreign Body Ingestion in Children

Foreign body ingestion in children is a pediatric issue that can be harmless or dangerous, requiring medical intervention. Infants and children are the age group most prone to swallowing foreign objects. Approximately 75% of clinical complaints involve children under four years of age. The ingestion of non-digestible objects can be more harmful and carry life-threatening risks. Swallowed objects can pass into the airways or the gastrointestinal (digestive) system. In most cases, the foreign body leaves the gastrointestinal system without causing any complications. However, some may become lodged in anatomically narrow areas such as the esophagus, causing obstruction, injury, and trauma. While some children show no symptoms, others may develop mild but specific findings.

The management of the case depends on the patient's symptoms, the location of the object, the risk of injury, the size of the object, and the material it is made of. Infants who are crawling and walking have narrower esophageal and intestinal lumens. Therefore, they can be considered higher-risk and more vulnerable patients. In a patient suspected of having swallowed a foreign body, the airway is evaluated first, and respiratory distress is relieved. Maintaining a clear airway can reduce the risk of life-threatening complications.

What is Foreign Body Ingestion in Children?

Foreign body ingestion in children is a common problem during the exploratory developmental stage. These are clinically common cases and can lead to serious complications. Children interacting with the outside world inevitably touch objects and put them in their mouths. Especially in children between 6 months and 6 years of age, placing objects in the mouth and going unnoticed can lead to this problem. Swallowed objects can become lodged in any part of the gastrointestinal tract, such as the esophagus or stomach. The most common complication of foreign body ingestion in children is esophageal obstruction.

Swallowed objects often pass through the gastrointestinal tract harmlessly, but in some cases, the objects may be toxic, cause damage while passing through the gastrointestinal tract, or become stuck. Objects that can lodge in various tissues may attempt to embed themselves by eroding tissue walls, leading to the displacement of tissues from their cavities. The structure and positioning of the objects can manifest symptoms of varying severity. Previous surgical interventions in the gastrointestinal system, stenotic lesions, and abnormalities such as tracheoesophageal fistulas can increase the risk of complications. Swallowed foreign bodies are frequently coins, needles, buttons, batteries, screws, toy parts, magnets, fish bones, and various household items.

What Symptoms Occur in a Child Who Has Swallowed a Foreign Body?

While respiratory symptoms are more likely to occur in infants and young children, gastrointestinal findings may appear in older children. The most common site of impaction is the upper part of the esophagus. In approximately 75% of cases, the foreign body becomes lodged here. Less frequently, impaction can occur in the lower esophageal segments and other parts of the digestive tract. Foreign bodies that pass through the esophagus can pass through the digestive system without complications and be excreted in the stool. In less than 10% of patients, impaction may occur in the intestines. A foreign body lodged in the esophagus can cause the following symptoms:

Coughing and wheezing,

Excessive drooling,

Gag reflex,

Vomiting,

Fever,

Blood in saliva,

Sensation of a foreign body in the throat,

Shortness of breath,

Chest pain,

Rapid and shallow breathing,

Pain during swallowing,

Difficulty swallowing,

Refusal to eat,

Vomiting blood,

Irritability,

Inflammation of the tissues around the heart, aorta, and lungs.

Objects that pass through the esophagus may not cause symptoms until complications such as intestinal obstruction or abnormal perforation of the intestine occur. Objects that become lodged in the stomach and intestines and perforate these areas can cause the following findings:

Abdominal pain,

Bloody stools,

Weight loss,

Abdominal tenderness,

Abdominal bloating.

Ingestion of magnets and batteries can be life-threatening. Objects containing nickel can cause side effects such as rashes and itching in people with allergies or sensitivities.

Why Do Children Swallow Foreign Bodies?

Foreign body ingestion by infants and children usually occurs accidentally. Especially young children tend to put objects in their mouths while exploring objects and their environment. During the developmental period, this behavior is normal and expected. Additionally, infants with less developed teeth may frequently put objects in their mouths, rub them against their palate, and swallow them. For this reason, the probability of foreign body ingestion is higher compared to older children. At the same time, older children with neurodevelopmental disorders are also at risk of foreign body ingestion due to various behavioral patterns. In older children without any health problems, there may be suspicions of attention-seeking behaviors or psychological abnormalities. Swallowing multiple objects and recurrence is a rare situation. When foreign body ingestion in children is a recurring behavior, it may indicate neglect, problems in the home environment, developmental delays, and behavioral issues. Having diagnosed gastrointestinal anomalies and previous complications due to foreign body ingestion can lead to serious health problems when a foreign body enters the body again.

How is Foreign Body Ingestion Diagnosed?

Diagnosis of foreign body ingestion begins with taking a history, followed by a physical examination. The patient should first be checked for airway, circulation, and breathing. Information such as the presence of symptoms, the type of foreign body swallowed, and when it was swallowed is important. During the physical examination, conditions such as whether the airway is clear, vital signs, and the patient's general condition are examined. Complete obstruction of the esophagus can lead to the accumulation of saliva or drool, which can endanger the airways. Plain radiography, i.e., X-ray, allows for the imaging of various organs such as the airway, esophagus, and stomach. It can show the location, number, size, and shape of any foreign body. Metallic objects can be imaged more easily. Coins, batteries, and glass fragments can be observed on an X-ray. Plastic objects and pieces of meat may not be clearly visible but may give an irregular appearance. Contrast X-rays, computed tomography (CT), and MRI can be used to better image these objects. If the location of the foreign body is in an area accessible by endoscopic interventions, the endoscopic removal method can be used.

How is a Child Who Has Swallowed a Foreign Body Treated?

If the swallowed foreign body is small and stationary, it does not require major interventions in asymptomatic and healthy children. Generally, non-surgical methods such as imaging and observation of the object are carried out. In such cases, the risk of tissue injury or obstruction may increase if there are gastrointestinal diseases and structural anomalies. Emergency medical intervention may be required to remove the object from the body. Depending on the location and material of the foreign body, a decision for endoscopy or surgery may be made. Approximately 10-25% of children who swallow foreign bodies require endoscopic intervention. Batteries and magnets, in particular, are objects for which endoscopy or surgery is preferred. Large objects that obstruct the esophagus are cases that require endoscopy. It helps in the safe removal of sharp, pointed, or other high-risk objects lodged in the esophagus or stomach. Ingestion of button batteries is removed urgently due to the risk of organ perforation and tissue necrosis. If more than 12 hours have passed since ingestion, the battery is expected to pass into the intestine. In asymptomatic cases, the progression of the battery is monitored for 7-14 days, and surgical intervention is planned as soon as symptoms develop. Laxatives, muscle relaxants, and inducing vomiting are not recommended as part of the treatment.

Frequently Asked Questions

If a child who has swallowed a foreign body shows any mild or severe symptoms, they should be taken to a doctor immediately. Various symptoms such as gagging, vomiting, fever, wheezing, coughing, bloody saliva, chest and abdominal pain, rapid and shallow breathing, difficulty swallowing, shortness of breath, excessive drooling, and vomiting blood can be indicators of foreign body ingestion. These symptoms may require emergency medical help. In children, serious injuries can occur when disk and button batteries are swallowed and become lodged in the nasal cavity, external ear canal, esophagus, and other openings. In particular, swallowing a magnet along with a battery can cause serious complications. Ingestion of multiple button-type batteries can have effects such as burns, strictures, scarring, necrosis, and fistula formation in adjacent tissues. The appearance of any symptoms in children who have swallowed a foreign body may require emergency intervention. Symptoms such as fever, vomiting, blood in saliva, wheezing and coughing, difficulty swallowing, shortness of breath, chest pain, bloody vomiting and defecation, gagging, and abdominal pain are findings that arise due to foreign body ingestion. Swallowed foreign bodies can be excreted with stool when they do not get stuck or lodged anywhere in the body. Generally, non-toxic foreign bodies can reach the intestines to be excreted from the body after passing through the esophagus and stomach. Less commonly, they can cause obstruction in the intestines. An object that enters the throat is associated with the respiratory tract. When a foreign body enters the throat, the airways can become blocked, breathing can stop, and a life-threatening situation can arise in the future; however, a swallowed object does not directly block the airways as it progresses through the esophagus. Nevertheless, it can cause symptoms that make breathing difficult. Generally, in asymptomatic children, i.e., those who show no symptoms, foreign bodies can pass through the esophagus, stomach, and intestines on their own. In healthy patients, the progression of the foreign body in the gastrointestinal system is monitored, and medical intervention may be required the moment symptoms appear. Endoscopy is mandatory in approximately 10-25% of foreign body ingestion cases. Ingestion of magnets and batteries, as well as sharp and high-risk objects, often requires endoscopy. Large and obstructive objects in the esophagus, stomach, and intestine may make endoscopy necessary. Permanent damage is not common in most foreign body ingestion cases. Some objects, such as lithium-based batteries, can be associated with high tissue damage. Additionally, small but high-powered magnets can lead to injuries in the digestive tract. In the case of multiple magnet ingestion, attraction between tissues and erosion of the intervening tissues can cause damage. If endoscopic intervention to remove the magnet cannot be performed immediately, tissue damage around the battery can cause the damage to worsen.

If you think your child has swallowed a foreign body, it is vital to consult a specialist without delay.

Prof. Dr. Engin Tutar and our expert pediatric health team are by your side with fast diagnosis and effective treatment processes.

You can contact us to make an appointment or to get information.