Swallowed foreign objects

Question 1

A golden rule:

Answer 1

The natural passage of most objects entering the stomach can be expected, but very large coins need to be watched carefully.

X-ray all children (mouth to anus, esp. chest and abdomen) on presentation.

An abnormal GIT, especially the oesophagus, previous surgery, stenosing lesions are a concern.

Question 2

High risk foreign bodies include:

Answer 2

button

disc batteries

large objects > 6 cm long or > 2.5 cm wide

magnet + metal object

lead-based objects (if stuck → lead toxicity)

Question 3

Button/disc battery ingestion

Answer 3

If not in stomach, these (esp. lithium batteries)

• create an emergency if in oesophagus,
• because of perforation.

Must be removed ASAP.

This also applies to insertion in the ear canal and nares.

Question 4

Inhaled foreign bodies with choking

Answer 4

Most cough the FB out naturally

• encourage coughing.
• A finger sweep helps
• back blows
• Heimlich manoeuvre if >8 years age (take care with viscera).

A good guide is the rule of 5’s—

• 5 breaths
• 5 back blows
• 5 lateral chest thursts
• 5 abdominal thrusts (older child).