What should I do if my baby accidentally swallows a foreign object?

Author: Cao Jinjun Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine

Reviewer: Xie Wei, deputy chief physician, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine

"Doctor, doctor, my child accidentally swallowed a coin, please save him! Save him!" Anxious mother Zhang rushed into the pediatric emergency room while shouting for help, holding her child. Similar scenes are often seen in the pediatric emergency room of the hospital every year. From the parents' helpless behavior, we can see more expressions of regret and anxiety. How to make timely, correct and effective on-site first aid in such emergencies and minimize the harm to children is knowledge that every parent must master. With this purpose, it is necessary for us to fully understand the causes, hazards, on-site disposal, necessary inspections and other first aid knowledge of babies swallowing foreign objects by mistake from the following aspects.

What is a foreign body in the digestive tract?

Foreign bodies in the digestive tract refer to various objects that cannot be digested and are not excreted in time and remain in the digestive tract. Common foreign bodies include coins, button batteries, toys and parts, hairpins, pins, screws, marbles, broken bones, lumps of food, corrosive liquids, etc. Depending on the type of foreign body, the complications and hazards are also different.

Figure 1 Copyright image, no permission to reprint

Why are accidental swallowing more common in children and foreign objects more likely to be retained?

Children are naturally curious, like to explore, and have poor safety awareness, so swallowing foreign objects is more common among children. Studies have reported that 75% of children under the age of 5 swallow foreign objects accidentally, and there are many complications, which can even be life-threatening.

Among the foreign bodies swallowed accidentally, complications caused by esophageal foreign bodies are the most common. This is related to the fact that foreign bodies are easily retained in the physiological narrowing of the esophagus and cannot pass smoothly. Complications after foreign body retention are more likely to occur in young children with thinner esophagus, congenital gastrointestinal malformations, and after esophageal surgery.

What symptoms will children show after swallowing foreign objects? What harm will it cause?

Most children do not show any abnormal discomfort after swallowing foreign objects, but some symptoms are often related to related complications.

1. Esophageal foreign body obstruction: refusal to eat, difficulty swallowing, nausea, and vomiting.

2. Esophageal perforation: swelling of the neck accompanied by redness and tenderness of the skin.

3. Tracheal compression: chest pain, inspiratory dyspnea, three-point concave sign, wheezing or stridor in the throat.

4. Gastrointestinal perforation: peritoneal irritation signs (abdominal tenderness, rebound pain, muscle tension).

5. Gastrointestinal bleeding: vomiting blood accompanied by black or bloody stools.

For most children who can pass foreign objects from the digestive tract smoothly, it usually does not cause much harm. However, if it is discovered late or the foreign objects (such as pins, broken bones, batteries, corrosive liquids) are easy to damage internal tissues of the body, it can cause more serious complications.

What should we do if our baby swallows a foreign object?

If parents see their baby swallowing a foreign object, or the baby tells you that he/she has swallowed a foreign object, they should pay attention to the type and symptoms of the foreign object, as well as the specific time of swallowing. If it is a battery, corrosive liquid, etc., please bring the instructions for the swallowed object with you, take the child to the hospital as soon as possible, and inform the attending doctor of the relevant information in a timely manner.

What examinations do I need to do after bringing my baby to the hospital?

After arriving at the hospital, the medical staff will ask about the situation of swallowing foreign bodies, such as the specific time of swallowing and symptoms, and conduct a specialist physical examination. Taking advantage of the fact that some foreign bodies cannot be penetrated by X-rays, an X-ray examination will be arranged (the figure below is an X-ray of some swallowed foreign bodies), but a negative result cannot completely rule out foreign bodies that can be penetrated by X-rays, and some will recommend a CT scan to determine the location of the foreign body. For some complications such as peritonitis, an abdominal B-ultrasound examination will be arranged.

Figure 2 Copyright image, no permission to reprint

Do foreign objects swallowed by babies need to be removed immediately?

Most foreign bodies do not need to be removed because they can be excreted with the stool. However, 10% to 20% require gastrointestinal endoscopy and 1% require surgical removal. The choice of method depends on the following points.

1. The size, type and quantity of foreign objects swallowed.

2. The location of the foreign body in the digestive tract.

3. Whether there are clinical symptoms and how long the foreign body remains in the body (>1 to 2 weeks; if the foreign body is stuck in the esophagus, it must be removed immediately under endoscopy).

4. Foreign objects that can easily damage or severely damage the body usually need to be removed immediately. Harmful objects include batteries, sharp, long (≥6cm), large (diameter ≥2.5cm) and lead-containing objects that can cause poisoning.

5. In case of complete obstruction, perforation, fistula formation, related serious complications, or failure of endoscopic removal, surgical removal as soon as possible is recommended.

6. For blunt foreign bodies that have passed through the duodenum, if there is no improvement in symptoms or imaging findings for more than 7 days, or if they cannot be removed endoscopically, surgical intervention is recommended.

7. For sharp foreign bodies that have passed through the duodenum, if there is no improvement in symptoms or imaging findings for more than 3 days, or if they cannot be removed endoscopically, surgical intervention is recommended.

8. For drug packages that cannot be excreted naturally or cause intestinal obstruction, active surgical intervention is recommended.

Due to the unpredictability and suddenness of foreign bodies in children's digestive tract, if not handled in time or improperly, it will cause serious consequences or secondary injuries to children, increasing the burden on the family and society. Therefore, early detection, early diagnosis and early treatment are particularly important. I hope that all parents will strengthen their children's daily education in this area. At the same time, for children under 5 years old who are prone to foreign bodies, try to control the items around them to prevent children from contacting high-risk foreign bodies. Once foreign bodies are accidentally ingested, it is recommended to stay calm as much as possible, reduce operations that cause secondary injuries to children, understand the necessary information in detail, and arrange medical treatment in time to avoid serious complications.

References

Pediatric Collaboration Group of the Chinese Society of Digestive Endoscopy, Pediatric Digestive Endoscopy Committee of the Chinese Medical Association Endoscopy Physicians Branch. Guidelines for the Management of Foreign Bodies in the Digestive Tract of Children in China (2021)[J]. Electronic Journal of Chinese Gastrointestinal Endoscopy.DOI: 10.3877/cma.j.issn.2095-7157.2021.04.002

UpToDate: Patient education: Swallowing foreign bodies (The Basics), Foreign bodies in the esophagus and gastrointestinal tract of children.