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emedicine.medscape.com

Pediatric Foreign Body Ingestion

Updated: Oct 04, 2018
Author: Gregory P Conners, MD, MPH, MBA, FAAP, FACEP; Chief Editor: Dale W Steele, MD, MS

Overview

Practice Essentials
As children explore and interact with the world, they will inevitably put foreign bodies into their mouths and swallow some of
them.

Most swallowed foreign bodies pass harmlessly through the gastrointestinal (GI) tract. Foreign bodies that damage the GI tract,
become lodged, or have associated toxicity must be identified and removed. Children with preexisting GI abnormalities (eg,
tracheoesophageal fistula, stenosing lesions, previous GI surgery) are at an increased risk for complications.

Although adults most often present to the ED because of health problems related to ingestion of radiolucent foreign bodies
(typically food), children usually swallow radiopaque objects, such as coins, pins, screws, button batteries, or toy parts. Although
children commonly aspirate food items, it is less common for small children to present because of foreign body complications
due to food ingestion. Swallowed objects are shown in the images below.

A swallowed coin lodged at the thoracic inlet. Image courtesy of Gregory Conners, MD, MPH.

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A swallowed radiolucent object (plastic guitar pick) is made visible in the upper esophagus after ingestion of barium. Image
courtesy of Raymond K. Tan, MD, and Gregory Conners, MD, MPH.

Pathophysiology
Esophagus

Most complications of pediatric foreign body ingestion are due to esophageal impaction, usually at one of three typical locations.
[1] The most common site of esophageal impaction is at the thoracic inlet. Defined as the area between the clavicles on chest
radiograph, this is the site of anatomical change from the skeletal muscle to the smooth muscle of the esophagus. The
cricopharyngeus sling at C6 is also at this level and may "catch" a foreign body. About 70% of blunt foreign bodies that lodge in
the esophagus do so at this location. Another 15% become lodged at the mid esophagus, in the region where the aortic arch and
carina overlap the esophagus on chest radiograph. The remaining 15% become lodged at the lower esophageal sphincter (LES)
at the gastroesophageal junction.

Children with preexisting esophageal abnormalities (eg, repair of a tracheoesophageal fistula) are likely to have foreign body
impaction at the site of the abnormality. If a child with no known esophageal pathology has a blunt foreign body lodged at a
location other than the 3 typical locations described above, the possibility of a previously unknown esophageal abnormality
should be considered. The presence of eosinophilic esophagitis has been recognized as contributing to adult esophageal foreign
body impaction and may be its presenting feature; although less common in children, eosinophilic esophagitis has also been
associated with pediatric esophageal food impaction.[2]

Pointed objects, such as thumbtacks, may become impaled and, therefore, lodged anywhere in the esophagus. Small objects,
such as pills and smaller button batteries, may adhere to the slightly moist esophageal mucosa at any point.

Stomach/lower gastrointestinal tract

Once a swallowed foreign body reaches the stomach of a child with a normal GI tract, it is much less likely to lead to
complications. Foreign bodies occasionally become lodged at the ileocecal valve.[3] Coins made largely from zinc, most notable
United States cents, have been reported to interact with stomach acid leading to stomach ulceration.[4] Foreign-body — induced
appendicitis has been reported.[5] Other exceptions include pointed or toxic foreign bodies or objects too long (ie, >6 cm) or too
wide (ie, >2 cm) to pass through the pyloric sphincter.

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Another important exception is the child who has swallowed more than one magnet; reports exist of swallowed toy magnets
attracting and adhering tightly to each other through the GI tract, leading to small bowel obstruction or necrosis of intervening
tissues, sometimes with severe sequelae.[6, 7, 8] Magnets may also attract other ferrous swallowed foreign bodies, causing
similar problems.[9]

Children with known GI tract abnormalities are more likely to encounter complications. Previous surgery may cause
abnormalities of peristalsis, increasing the likelihood of foreign body impaction. For example, children who have had surgery to
correct pyloric stenosis are more likely to retain a foreign body in the stomach.

Previously unsuspected lower GI tract abnormalities may present as a complication of foreign body ingestion. For example, a
small foreign body may become lodged in a Meckel diverticulum.

Impacted foreign bodies

A foreign body lodged in the GI tract may have little or no effect; cause local inflammation leading to pain, bleeding, scarring,
and obstruction; or erode through the GI tract. Migration from the esophagus most often leads to mediastinitis but may involve
the lower respiratory tract or aorta and create an aortoenteric fistula. Migration through the lower GI tract may cause peritonitis.

Epidemiology
Frequency

United States

Although exact figures are unavailable, foreign body ingestion is clearly common among children. More than 125,000 ingestions
of foreign bodies by people aged 19 years and younger were reported to American Poison Control Centers in 2007.[10] In a
cross-sectional survey of parents of more than 1500 children, 4% of the children had swallowed a coin (the most commonly
swallowed foreign body in many studies).[11]

A study that analyzed emergency department (ED) visits involving magnet ingestion in children from 2002 to 2011 found that
there has been an alarming increase in ED visits for magnet ingestion in children. A national estimate of 16,386 children
presented to EDs in the United States during the 10-year study period with possible magnet ingestion. ED visits due to possible
magnet ingestion increased 8.5-fold from 2002 to 2011 with a 75% average annual increase per year. The majority of patients
reported to have ingested magnets were younger than 5 years (54.7%).[12]

International

Pediatric foreign body ingestion is a worldwide problem. Impaction of swallowed fish bones is more commonly observed in
countries where fish is a major dietary staple, including Asian countries.[13] A massive database describing pediatric foreign
body injury in European and other countries, the "Susy Safe project," recently published information regarding nearly 17,000
cases in children aged 14 years and younger; about 18% of these involved foreign body ingestion.[14]

Mortality/Morbidity

See the list below:

Most foreign bodies pass harmlessly through the GI tract and are eliminated in the stool.

Systemic reactions, such as from nickel allergy, are unusual but have been reported, typically in massive ingestions or
occupational exposures.

Retained foreign bodies may cause GI mucosal erosion, abrasion, local scarring, or perforation.

Esophageal foreign body migration may lead to peritonitis, mediastinitis, pneumothorax, pneumomediastinum,
pneumonia, or other respiratory disease.

Migration into the aorta may produce an aortoenteric fistula, a horrific complication with a high mortality rate.

Esophageal button batteries may cause substantial mucosal injury in as few as 2 hours.[15]

Swallowed magnets in the intestines may strongly attract other swallowed magnets or metallic objects through
mucosal tissues, leading to ulceration, pressure necrosis, fistula creation, or perforation.[6, 7, 8] A swallowed
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combination of magnets and button batteries may be especially dangerous.[9]

Complications of removal procedures may lead to iatrogenic morbidity or mortality from the procedure or from
accompanying sedation/anesthesia.

Traumatic epiglottitis has been reported in conjunction with foreign body ingestion, due to epiglottis injury from a finger
sweep or from the swallowed object itself, even after the object has been removed or expelled.[16]

Sex

See the list below:

The male-to-female ratio in young children is 1:1.

In older children and adolescents, males are more commonly affected than females.

Age

Children of all ages ingest foreign bodies. However, incidence is greatest in children aged 6 months to 4 years. This reflects the
tendency of small children to use their mouths in the exploration of their world. Younger children may be "fed" foreign bodies by
older children or be intentionally given foreign bodies by abusive adults. In the teenaged years, concomitant psychiatric
problems, mental disturbances, and risk-taking behaviors may lead to foreign body ingestion.

Presentation

History
See the list below:

Children commonly come to medical attention after a caregiver witnesses the ingestion of a foreign body or after a child
reports an ingestion to a caregiver.

Alternatively, the child may present because of signs or symptoms of a complication of ingestion.

Occasionally, the caregiver discovers a foreign body that has passed in the stool and brings the child in for evaluation.

Children with significant complications of foreign body ingestion may be initially asymptomatic.

Children may have vague symptoms that do not immediately suggest foreign body ingestion.

When caring for children, always keep the possibility of foreign body ingestion in mind.

Esophageal foreign body symptoms

Dysphagia

Food refusal, weight loss

Drooling, gagging

Emesis/hematemesis

Foreign body sensation

Chest pain, sore throat

Stridor, cough

Unexplained fever

Altered mental status

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Stomach/lower GI tract foreign bodies

Abdominal distention/pain, vomiting

Hematochezia

Unexplained fever

Physical
See the list below:

Specific physical examination findings are unusual.

Physical findings may suggest complications of foreign body migration, such as peritoneal irritation or rales.

Abrasions, streaks of blood, or edema in the hypopharynx may be evidence of proximal swallowing-related trauma.
Inspection of the oropharynx may occasionally reveal an impacted foreign body.[17]

Drooling or pooling of secretions suggests an esophageal foreign body but may be due to an esophageal abrasion as a
result of a swallowed foreign body.

Causes
See the list below:

Most cases occur as children discover and place small objects in their mouths.

Foreign body ingestion, especially if a repeated problem, may suggest a chaotic home environment and neglect.

Children with known GI tract abnormalities or previous complications of foreign body ingestion are more likely to have
complications.

Older children may be seeking attention or be manifesting psychological abnormalities.

Ingestion of unusual foreign bodies may suggest an underlying abnormality. For example, an association exists between
toothbrush ingestions and bulimia in teenaged girls.[18]

DDx

Differential Diagnoses
Appendicitis

Aspiration Pneumonitis and Pneumonia

Disk Battery Ingestion

Emergent Treatment of Gastroenteritis

Esophagitis

Intussusception

Large-Bowel Obstruction
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Munchausen Syndrome

Pediatric Appendicitis

Pediatric Gastroenteritis in Emergency Medicine

Pediatric Pyloric Stenosis

Pediatric Reactive Airway Disease

Pediatrics, Gastrointestinal Bleeding

Peptic Ulcer Disease

Pharyngitis

Pneumothorax

Small-Bowel Obstruction

Trachea Foreign Bodies

Workup

Workup

Laboratory Studies
See the list below:

Children with foreign body ingestion typically do not require laboratory testing.

Laboratory studies may be indicated for workup of specific complications, such as potential infection.

Imaging Studies
See the list below:

Chest/abdominal radiography

Most ingested foreign bodies are radiopaque (in contrast to inhaled foreign bodies which usually are radiolucent).

If the swallowed object may be radiopaque, a single frontal radiograph that includes the neck, chest, and entire
abdomen is usually sufficient to locate the object. Subsequent, focused radiographs may then be used to more
fully evaluate the patient, as noted below.

If the object is below the diaphragm, further radiographs are generally unnecessary (in the absence of previous GI
disorders, such as repaired pyloric stenosis).

If the object is in the esophagus, frontal and lateral chest radiographs are necessary to precisely locate and better
identify the object and to be sure that the foreign body is not, in fact, two adherent objects.

Button (disk) batteries typically have distinctive appearances on radiographs. A lateral view reveal a distinctive 2-
step border, as opposed to the smooth borders of most coins (although this may also be the result of 2 adherent
coins of different size[19] ). Frontal views may suggest a corresponding ring just inside the outermost ring of the
battery. A magnified digital radiographic image of an object may reveal identifying characteristics allowing
identification of the swallowed object, such as the distinctive design of a well-known coin.[20]

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Coins and similarly shaped objects in the chest may be localized to either the esophagus or the airway by their
position on a frontal radiograph. With rare exceptions,[21] coins in the esophagus appear in the coronal orientation
(ie, coin seen as a disk on frontal view), while coins in the trachea appear in the sagittal orientation (ie, coin seen
from the side on frontal view).

If the ingested object is radiolucent, the object's location may be inferred from effects (eg, airway compression)
seen on plain radiographs. However, such findings are not reliable.

Radiolucent objects in the esophagus may be better visualized by repeating the study after having the child drink a
small amount of dilute contrast (esophagram). This should not be done if endoscopy is planned. Special care must
be taken if the esophagus could possibly be obstructed or perforated.

When a foreign body is strongly suspected on clinical grounds, visualization by endoscopy, which has the added
advantage of allowing removal of the object, may be the most efficient method of management.

CT scan or MRI is rarely indicated but may enhance the detection of foreign bodies or complications (eg, perforations) in
special cases.

Other Tests
See the list below:

Metal detectors

The use of handheld metal detectors to identify the location of ingested metallic objects (especially coins) has
proven sensitive and specific.[22] In the case of aluminum (eg, flip top of a soda can), a metal detector may be
more sensitive since aluminum is often radiolucent.[23] The operator should have experience with this modality
before using it for patient care.

Patients with coins localized to the abdomen may be safely observed. However, patients with coins localized in the
esophagus probably should have confirmatory plain radiographs.

Procedures
See the list below:

Endoscopy

Endoscopy (esophagoscopy) may be diagnostic and therapeutic.

Children who require extensive radiologic investigation may be best served by referral to a pediatric
gastroenterologist or surgeon for endoscopy, which is safe and highly effective.

Treatment

Prehospital Care
See the list below:

Most children who have swallowed a foreign body do not require specialized care. For the large majority, providing
comfort care while transporting to an emergency department is all that is required.

Patients with drooling may require suction.

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Children benefit by being allowed to remain with their parents and being allowed to assume a position of comfort.

Although a theoretical risk of spontaneously vomiting and then aspiration of a foreign body exists, this is unusual.
Children should not routinely be intubated to protect their airways.

Similarly, do not attempt to dislodge a foreign body from a spontaneously breathing patient by giving abdominal thrusts or
syrup of ipecac.

If available, discussions regarding management of unusual foreign bodies with the local poison control center may be
helpful.

Emergency Department Care

The usual goal of ED management is to localize the position of the ingested foreign body. Patients with drooling, marked emesis,
or altered mental status (likely from excess vagal stimulation) may require supportive measures to protect the airway.

Most patients should undergo radiographic imaging as described above. Metal detectors may be used to locate metallic foreign
bodies. Even radiopaque foreign bodies may be difficult to localize. Referral for endoscopy should be considered.

Remember that children with no symptoms may have impacted foreign bodies and that children with foreign body sensation or
pain may not. Radiographs of about 15% of children presenting to the ED after witnessed coin ingestions do not show a coin.
Although some will have vomited or otherwise removed the ingested object before their evaluation, this suggests that not all
children with even witnessed foreign body ingestions have truly ingested something.

Esophageal foreign bodies

Objects found within the esophagus should generally be considered impacted. Because impacted esophageal
foreign bodies may lead to significant morbidity (and even mortality), removal of impacted esophageal foreign
bodies is mandatory. An important exception is blunt esophageal foreign bodies (except button [disk] batteries)
that are well tolerated and are known to have been in place for less than 24 hours (see Spontaneous passage
below).

Endoscopy (esophagoscopy) is by far the most commonly used means of removal and is usually the procedure of
choice. Most children with esophageal foreign bodies are stable. Endoscopy usually can be delayed until the
child's stomach is emptied and a surgical team is assembled. However, pointed objects, such as an embedded
esophageal thumbtack, should be removed as rapidly as possible to avoid further injury to the esophageal mucosa
and mediastinitis. Impacted button (disk) batteries are notorious for rapidly causing local necrosis and should be
emergently removed. Children with esophageal food impaction, an unusual finding in childhood, may benefit from
endoscopic evaluation, perhaps with biopsies, of the esophageal mucosa.[2]

Because endoscopy is relatively invasive and expensive, other methods of esophageal foreign body removal have
been investigated[24] and are probably more cost-effective when used appropriately. Both have been performed
most commonly on children with esophageal coins. Because any esophageal foreign body may pass
spontaneously, chest radiography should be performed immediately prior to any removal procedure.

Foley catheter method: Blunt foreign bodies may be removed by use of a Foley catheter. Typically, the
patient is restrained in a head-down position on a fluoroscopy table, and an uninflated catheter is passed
until distal to the object. The catheter is then inflated and gently withdrawn, drawing the foreign body with it.
One some occasions, the object is dislodged and passed into the stomach. Progress is typically monitored
fluoroscopically. This procedure is performed without radiographic monitoring at some centers with
extensive experience. Only experienced personnel should perform this procedure, and it should be
reserved for previously healthy children whose ingestion of a blunt object was witnessed less than 24 hours
prior to the procedure.

Bougienage method: Blunt esophageal foreign bodies may be advanced into the stomach with a bougie.
While the child is sitting upright, the lubricated instrument is gently passed down the esophagus, dislodging
the object. The object is then expected to pass through the rest of the GI tract; thus, this procedure should
not be performed on children with known lower GI tract abnormalities. A brief observation period and a
repeat radiograph should follow any removal procedure to rule out retained foreign bodies and other
complications (eg, pneumomediastinum). Because any esophageal foreign body may pass spontaneously,
chest radiography should be performed immediately prior to any removal procedure. Again, only

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experienced personnel should perform this procedure, and it should be reserved for healthy children whose
ingestion of a blunt object was witnessed less than 24 hours prior to the procedure.

The Foley catheter and bougienage methods have been shown to be more cost-effective than endoscopy,
for properly selected patients. [25, 26, 27, 28, 29]
Emergency department rapid sequence intubation, followed by removal of esophageal coins with Magill
forceps and/or a Foley catheter, may be effective in children. [30]

Spontaneous passage: Blunt foreign bodies located at the LES often spontaneously pass within several hours of
ingestion. This has been best studied in coin ingestions. Previously healthy children may be given food and drink
and have repeat radiographs 24 hours following ingestion. Often, the coin passes through the LES, and a removal
procedure can be avoided.[1, 31] This may be most successful in asymptomatic children.

Complications: Children with significant complications such as airway involvement, peritonitis, or hematemesis (possibly
heralding exsanguination from an aortoenteric fistula), should be referred to an appropriate surgeon without delay.

Stomach/lower GI tract

Most swallowed foreign bodies harmlessly pass through the GI tract once they have reached the stomach. Treatment of
children with known abnormalities of the GI tract or previous problems with foreign bodies should be discussed with a
specialist, preferably one familiar with the child.

Unusual foreign bodies: Very sharp or pointed objects may perforate the GI tract (sewing needles are notorious).
Therefore, such objects should be endoscopically removed from the stomach. If such an object has passed into the
intestines, early consultation with a surgeon is recommended. Objects that are too long (eg, >6 cm) or too wide (eg, >2
cm) to pass through the pyloric sphincter should be removed from the stomach.

Button (disk) batteries in the stomach or intestines do not need to be removed immediately, as they generally pass
through the lower GI tract without difficulty. Button batteries retained in the stomach or at a fixed spot in the intestines
should be removed. One strategy is to instruct families to observe the stool for the battery and to return for a repeat
radiograph if it is not passed in 2-3 days. If a battery is still in the stomach at that time, it should be endoscopically
removed. If it is in the intestines, its progress should be intermittently monitored via radiographs, to be sure it is
progressing.

Body packers (ie, patients who have ingested wrapped packages of drugs to avoid detection during transport) are at risk
of death if the packets rupture. Such patients should be hospitalized and whole-bowel irrigation considered. Consultation
with a poison control center is suggested.

Consultations
See the list below:

The treatment of children with known GI tract disorders should be discussed with a physician familiar with the child
whenever possible.

Experienced personnel, such as a pediatric surgeon, otolaryngologist, or gastroenterologist, should perform endoscopy.

Psychiatric consultation is indicated for those with a suspected or confirmed associated psychiatric problem.

Surgical Care
A study presented the outcome of surgical treatment of esophageal perforations due to foreign body impaction in children along
with a management algorithm. The study concluded that esophageal perforation following foreign body impaction is rare and
requires prompt treatment. Surgical treatment tailored to the needs of individual patients is associated with a successful outcome
and decreased morbidity.[32]

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Medication

Medication Summary
Although drugs such as glucagon, benzodiazepines, and nifedipine have been successfully used to relax the lower esophageal
sphincter in adult patients with esophageal foreign bodies, these measures are generally unsuccessful in children.

Laxatives are occasionally prescribed to hasten the passage of intestinal foreign bodies. While they likely lead to speedier
passage, this is not necessarily associated with improved health of the patient, and so laxative use is not generally
recommended. Specific circumstances may exist in which laxatives may be helpful, however.

The use of meat tenderizer (papain) to attempt to digest meat impacted in the esophagus is no longer recommended. Such
usage may severely injure the esophagus.

Inducing vomiting may lead to aspiration, and so should be avoided.

Follow-up

Further Outpatient Care

See the list below:

After an esophageal foreign body is removed, children with uncomplicated courses do not need to undergo further
evaluation.

A healthy child with repeated foreign body impaction or impaction at an unusual site should be evaluated for an
underlying esophageal disorder.

Most children with foreign bodies in the stomach or lower GI tract have no complications and may be safely discharged
from the emergency department. Caregivers of discharged children should be alerted to return if signs or symptoms of
the occasional complication (eg, abdominal pain or distention, hematochezia, unexplained fevers, constipation, vomiting)
develop.

Patients with known abnormalities of the GI tract, previous problems with foreign bodies, or unusual foreign bodies may
require special treatment.

In general, straining of the stool for the foreign body is unnecessary.

Except in special instances, serial radiographs to document progress are unnecessary. This would be most useful if the
results would be used to direct therapy, such as prolonged gastric retention of zinc coins, which may be indications for
gastroscopic removal. Button batteries remaining in the stomach for 4 or more days, especially if associated with
symptoms or if the battery is ≥15 mm in diameter in a child younger than 6, should be considered for removal.[15, 33]

The continued presence of a metallic foreign body may be documented by serial metal detector scans.

Further Inpatient Care

See the list below:

Children who require endoscopic foreign body removal are usually taken directly to the operating room or endoscopy
suite or are admitted preoperatively. These patients should be given nothing by mouth (NPO) and be given glucose-
containing intravenous fluids until the procedure.

Preprocedure radiographs to verify the location of the foreign body are recommended, as some foreign bodies may pass
into the stomach while awaiting endoscopy.

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General anesthesia often is used for endoscopic foreign body removal. However, sedation performed by experienced
personnel may be successful in selected cases.

Transfer
See the list below:

Most children do not require a removal procedure, and they may be treated at any facility capable of obtaining
radiographs of children.

Children who require foreign body removal procedures should be referred to a facility with experienced personnel.

Familiarity with pediatric airway emergencies is essential.

Deterrence/Prevention
See the list below:

Parents and other caregivers of children should be cautioned about leaving small objects where young children may find
them and place them into their mouths. This is especially common at times of unusual activity, such as parties, holidays,
when visitors are present in the home, or during travel.

Button batteries have become an increasingly common source of morbidity and even mortality as their use has increased
in recent years. Special care must be exercised around their use in toys and other objects to which children have access,
when they are discarded, and when stored around the home.[15, 34]

Complications
See the list below:

Esophageal foreign bodies

Mucosal abrasion

Esophageal stricture/obstruction

Retropharyngeal abscess

Failure to thrive

Esophageal perforation may lead to mediastinitis, pneumothorax, pneumomediastinum, aortoesophageal fistula

formation (and resulting hemorrhage), and tracheal compression.

Stomach/lower GI tract foreign bodies

Mucosal abrasion

Intestinal obstruction

Intestinal perforation may lead to peritonitis and sepsis.

Button (disk) batteries: Recent data suggest that ingestion of button batteries has become an increasingly important
cause of morbidity and mortality in children, likely because of button batteries' increased availability and the increased
production of electrical current in modern lithium batteries of ≥20 mm diameter.[44] Children 4 years or younger who have

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swallowed lithium batteries ≥20 mm diameter are at greatest risk of complication.[15] A study by Lee et al that included 5
cases of pediatric lithium battery ingestion, found that all cases had moderate to major complications to their esophagus
or gastric mucosa, even in children who did not exhibit symptoms post ingestion. Urgent removal within 24 hours is
recommended for even the asymptomatic child with a known lithium battery ingestion.[35]

Patient Education
For excellent patient education resources, visit eMedicineHealth's Digestive Disorders Center. Also, see eMedicineHealth's
patient education article Battery Ingestion.

Questions & Answers

Overview

What is pediatric foreign body ingestion?

What is the role of esophageal impaction in the pathophysiology of pediatric foreign body ingestion?

What is the role of GI tract in the pathophysiology of pediatric foreign body ingestion?

What is the prevalence of pediatric foreign body ingestion in the US?

What is the global prevalence of pediatric foreign body ingestion?

What is the mortality and morbidity associated with pediatric foreign body ingestion?

What is the sexual predilection of pediatric foreign body ingestion?

Which age groups are at highest risk for pediatric foreign body ingestion?

Presentation

Which clinical history findings suggest pediatric foreign body ingestion?

What are the esophageal symptoms of foreign body ingestion?

What are the GI tract symptoms of foreign body ingestion?

Which physical findings suggest pediatric foreign body ingestion?

What causes pediatric foreign body ingestion?

DDX

What are the differential diagnoses for Pediatric Foreign Body Ingestion?

Workup

What is the role of lab testing in the workup of pediatric foreign body ingestion?

What is the role of imaging studies in the workup of pediatric foreign body ingestion?

What is the role of metal detectors in the workup of pediatric foreign body ingestion?

What is the role of endoscopy in the diagnosis and management of pediatric foreign body ingestion?

Treatment

What is included in the prehospital care of pediatric foreign body ingestion?

What is the initial goal of emergency department (ED) management of pediatric foreign body ingestion?

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What is the emergency department (ED) management for esophageal foreign body ingestion?

What are the possible complications of pediatric foreign body ingestion?

What is the emergency department (ED) management for pediatric foreign body ingestions in the GI tract?

Which specialist consultations are beneficial for pediatric foreign body ingestion?

What is the role of surgery in the management of pediatric foreign body ingestion?

Medications

Which medications are used in the management of pediatric foreign body ingestion?

Which measures are contraindicated in the management of pediatric foreign body ingestion?

Follow-up

What is included in the long-term monitoring following a pediatric foreign body ingestion?

What is included in inpatient care for pediatric foreign body ingestion?

When is patient transfer indicated for the management of pediatric foreign body ingestion?

How is pediatric foreign body ingestion prevented?

What the possible complications of pediatric foreign body ingestion?

Where are patient education resources regarding pediatric foreign body ingestion found?

Contributor Information and Disclosures

Author

Gregory P Conners, MD, MPH, MBA, FAAP, FACEP Director, Division of Emergency Medicine, Children's Mercy Hospital;
Associate Chair of Pediatrics, Professor of Pediatrics and Emergency Medicine, University of Missouri-Kansas City School of
Medicine

Gregory P Conners, MD, MPH, MBA, FAAP, FACEP is a member of the following medical societies: Academic Pediatric
Association, American Academy of Pediatrics, American College of Emergency Physicians, American Pediatric Society, Society
for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-
Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center; Chairman,
Pediatric Institutional Review Board, Mercy St Vincent Medical Center, Toledo, Ohio

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine,
American Academy of Pediatrics, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Dale W Steele, MD, MS Professor of Emergency Medicine, Pediatrics, and Health Services, Policy, and Practice, Warren Alpert
Medical School of Brown University; Attending Physician, Department of Pediatric Emergency Medicine, Rhode Island Hospital

Dale W Steele, MD, MS is a member of the following medical societies: American Academy of Pediatrics, American Statistical
Association, Society for Medical Decision Making
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Disclosure: Nothing to disclose.

Additional Contributors

Jerry R Balentine, DO, FACEP, FACOEP Vice President, Medical Affairs and Global Health, New York Institute of Technology;
Professor of Emergency Medicine, New York Institute of Technology College of Osteopathic Medicine

Jerry R Balentine, DO, FACEP, FACOEP is a member of the following medical societies: American College of Emergency
Physicians, New York Academy of Medicine, American College of Osteopathic Emergency Physicians, American Association for
Physician Leadership, American Osteopathic Association

Disclosure: Nothing to disclose.

Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of
Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa,
Society of Critical Care Medicine, Wisconsin Medical Society

Disclosure: Nothing to disclose.

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