see also: [[inhaled foreign body]], [[Button Batteries]] see: [RCH - Foreign Body Ingestion](https://www.rch.org.au/clinicalguide/guideline_index/Foreign_body_ingestion/) > [!danger] red flags > - **button batteries** lodged in the oesophagus need immediate removal, however once they enter the stomach, they are less concerning > - Note: parents may be advised to offer honey to children >12 months of age with suspected button battery ingestion; continue at regular intervals until reaching hospital > - large objects (**>6 cm long and/or >2 cm wide**) may become entrapped at the pylorus > - superabsorbent polymers may also cause impaction > - **magnet** + a metal object or >1 magnet ingestion can cause serious and potentially life-threatening complications > - lead based objects (eg fish sinker) that fail to transit through the stomach may cause acute systemic lead absorption > - multi-component objects may break apart and progress separately in the gastrointestinal tract (eg toys with lights, motors and batteries) and may require removal > - Medication patches > - esophageal foreign bodies impacted for >24 hours > - coin at level of cricopharyngeus muscle > [!attention] indications for removal > - Signs of respiratory distress > - Evidence of esophageal obstruction (inability to swallow secretions) > - Lithium button batteries in the esophagus > - Sharp or long (>5 cm) objects in the esophagus or stomach > - Multiple magnets or single magnet plus another metallic object within esophagus or stomach > - Signs or symptoms of intestinal inflammation, obstruction or perforation > - Esophageal foreign bodies impacted for >24 hr or for an unknown amount of time ![[Pasted image 20240119230200.png]] # common areas of entrapment in oesophagus - cricopharyngeal sling / thoracic inlet / c6 / btwn clavicles - aortic arch - L main stem bronchus - distal oesophagus / T10 / lower oesophageal sphincter # Assessment - history of possible foreign body ingestion - button battery risks - any [[Stridor]] or drooling? - features of [[inhaled foreign body]]? - alternative dx eg epiglottitis or bacterial tracheitis - review co-morbidities including vaccination history and development history - In context of OSCE likely need to screen circumstances of ingestion eg maternal well-being, supervision, access to medications or other high risk FB, etc. - if a medication, need to consider whether it was [[Neonates#normal milestones first 2 years|developmentally appropriate]] that the medication bottle was opened # Management Specialist referral may depend on ingested object and local services — discuss with senior clinician. See advice here: - Objects impacted in the oropharynx require urgent ENT evaluation. - [[Button Batteries]] can erode mucosal surfaces (ie lodged in the oesophagus) <2 hours and need immediate removal - 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 - Fish bones 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 - Offering fizzy drinks to children with food bolus obstruction appears to be safe and may be effective ## Magnets - one magnet on X-ray may still be high risk as two may have been swallowed giving appearance of one | Urgent referral to relevant specialist | Early discussion with relevant specialist | Seek advice from relevant specialist | | --------------------------------------------------------------------------------------- | ----------------------------------------- | ------------------------------------ | | Multiple magnets/single magnet + metallic object anywhere in the gastrointestinal tract | Single magnet in oesophagus or stomach | Single magnet beyond the stomach | ## Button Batteries see [[Button Batteries]] ## Other objects table | Item | management | | ---------------------------------------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Superabsorbent polymers<br>(expandable foreign body) | - May pass easily through proximal gastrointestinal tract and pylorus, then expand large enough to cause *bowel obstruction* <br>- Early discussion with Poisons Information Centre who can advise on growth potential of object and need for endoscopic removal by gastroenterology | | oropharynx impaction | - require urgent ENT evaluation<br>- fish bones may lodge in tonsils and require removal | | Oesophageal food bolus | - need paeds gastro if doesn't spont resolve<br>- symptomatic children (drooling, neck or chest pain) need urgent endoscopy<br>- if they can manage secretions, discuss with paeds gastro and planned endoscopy in 12-24 hours<br>- *poor evidence for glucagon* and hyoscine butylbromide<br>- children with history of food bolus obstruction that has spontaneously cleared should be discussed with paeds gastro outpatients for further investigations | | Coins and blunt objects | - acutely symptomatic children require urgent endoscopy<br>- asymptomatic children with oesophageal object require endoscopic removal within 24 hours<br>- larger objects >6cm long require gastro or surgical opinion due to ↑ risk of obstruction<br>- any object with diameter >2cm (aussie 20c, 50c, and $1 coin) is *unlikely to pass through the pylorus of younger children* | | medication patch | - consider any toxidrome associated | # discharge criteria Child meets following criteria: 1. Looks well 2. Is pain free 3. Has no respiratory distress 4. Is able to eat and drink 5. Has a reliable history and a low risk FB has been ingested