Foreign body ingestion


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    This guideline has been adapted for statewide use with the support of the Victorian Paediatric Clinical Network

  • See also:

    Foreign Body inhalation
    Acute upper airway obstruction                           

    Key Points

    1. The majority of ingested foreign bodies (FBs) are low risk objects and can be managed without imaging or intervention
    2. Button battery and magnets are high risk objects and require imaging
    3. Larger size objects may cause complication, and require a surgical review

    Background

    • Children of all ages can ingest a FB, however incidence is highest amongst those aged 6 months to 4 years
    • Older children with underlying psychiatric problems may intentionally ingest FBs and require a mental health review
    • FB obstruction or impaction will depend on the physical properties of the object, including size, shape and composition.

    Red Flags

    Button batteries lodged in the oesophagus need immediate removal, however once in the stomach they are benign

    Large objects >6 cm long and/or wider than 2.5 cm may become entrapped at the pylorus

    Magnet + Metal object or >1 Magnet ingestion can cause serious and potentially life-threatening complications

    Lead based objects failing to transit through the stomach may lead to acute systemic lead absorption. 

    High risk children with pre-existing GI abnormalities including previous surgery, tracheoesophageal fistulas or stenosing lesions

    Assessment

    History:

    • Clarify as much as possible what type of object was swallowed and timing of ingestion
    • Identify potential for any high-risk objects (see above)
    • History of coughing, drooling of saliva, pain on swallowing, reduced oral intake, abdominal pain or vomiting
    • If evidence of coughing, choking, respiratory distress then consider inhalation. See  Foreign Body inhalation CPG.

    Examination:

    • Tender abdomen on palpation, signs of peritonitis or obstruction.

    Management

    Investigations

    • X-rays can be avoided in an asymptomatic child, with a reliable history and without a significant past medical history
    • Consider imaging in the following: suspected or known button battery, magnet/s, other high risk radiopaque object, unknown object, high risk or symptomatic child
    • In smaller children a single film to include both chest and abdomen is often adequate
    • Note: The majority of metallic objects will show up on X-ray with the exception of aluminium

    Treatment

    A child may be discharged without investigation or treatment if he/she:

    • Looks well
    • Is pain free
    • Has no respiratory distress
    • Is able to eat and drink

    and there is a reliable history and a low risk FB has been ingested.

    Appropriate discharge advice should be given.

    Further examination of the faeces is not recommended.

    Repeat X-rays are not necessary.

    The child/parents should be instructed to seek medical advice or return to ED if the following symptoms occur:

    • Breathing problems
    • Abdominal pain
    • Fever
    • Vomiting
    • Unable to tolerate food and drink

    Interventions

    • Objects seen or impacted in the oropharynx require urgent ENT evaluation.
    • Button batteries in contact with mucosal surfaces i.e. lodged in the oesophagus, need immediate removal. Once in the stomach they are benign.
    • Ingestion of multiple magnets +/- metal require early endoscopic removal. One magnet seen on X-ray may still be high risk, as two may have been swallowed which give the appearance of one.
    • It is rare for sharp objects to penetrate the mucosal wall of the gut, and these require no intervention if the child is otherwise well.
    • Fishbones may lodge in tonsils and require removal.
    • A FB lodged in the lower oesophagus, and where the child is able to swallow saliva successfully, may be observed for 24 hours to ensure that it transits. If it does not pass it will need to be removed.
    • Larger objects (>6 cm long and/or >2.5 cm in diameter) in the stomach require a Gastroenterology or Surgical opinion due to the increased risk of obstruction.
    Diagram-foreign-body-ingestion

    Consider consultation with local paediatric team when:

    • Child is symptomatic
    • Ingestion of a high risk object
    • Immediate removal needs to be facilitated (e.g. button battery)

    Consider transfer when:

    Children requiring care beyond the comfort level of that hospital 

    For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.

    Consider discharge when:

    Child appears well
    No risks or Red Flags are identified

    Parent information sheet

    Swallowed (ingested) foreign bodies

    Last updated August, 2017