{
 "topic": "Foreign Body Ingestion",
 "slug": "foreign-body-ingestion",
 "category_id": 15070,
 "passage_count": 14,
 "source_chars": 11643,
 "enough_material": true,
 "references": [
  {
   "title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024",
   "author": null,
   "pages": [
    604,
    2285,
    2315,
    2316
   ]
  },
  {
   "title": "Pediatric Otolaryngology (American Academy of Pediatrics) ( etc.)",
   "author": null,
   "pages": [
    427
   ]
  },
  {
   "title": "Caring for the Hospitalized Child",
   "author": "Section on Hospital Medicine, American Academy of Pediatrics;Jeffrey C. Gershel;Daniel A. Rauch;",
   "pages": [
    540,
    545
   ]
  },
  {
   "title": "Diagnostic Imaging: Pediatrics",
   "author": "A. Carlson Merrow Jr. MD",
   "pages": [
    225
   ]
  },
  {
   "title": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "author": null,
   "pages": []
  },
  {
   "title": "Cover",
   "author": "Vitalsource Download",
   "pages": [
    5133,
    5526
   ]
  },
  {
   "title": "Pediatric Decision-Making Strategies",
   "author": "Pomeranz, Albert J.",
   "pages": [
    48
   ]
  }
 ],
 "passages": [
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 2315",
   "text": "Foreign body (FB) ingestions are common in children, with most ingestions occurring between 6 months and 3 years of age. Generally, FB ingestions in young children are unintentional and involve small household objects (coins, toys, jewelry, magnets, batteries, etc.). Although children may present with symptoms of abdominal pain or chest pain, stridor, drooling, respiratory distress, fever, dysphagia, or inability to tolerate oral intake after FB ingestions, up to 50% of children may be asymptomatic at the time of presentation. A thorough history and clinical examination is required, including evaluation for respiratory distress, oropharyngeal injury, and signs of perforation such as subcutaneous emphysema or peritoneal signs. When determining the appropriate management of a child after FB ingestion, clinicians must consider patient age and anatomy; object type, location, and size; timing of ingestion; presence or absence of symptoms; nil per os (NPO) status; and logistical factors (availability of necessary"
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 2316",
   "text": "Foreign body (FB) ingestions are common in children, with most ingestions occurring between 6 months and 3 years of age. Generally, FB ingestions in young children are unintentional and involve small household objects (coins, toys, jewelry, magnets, batteries, etc.). Although children may present with symptoms of abdominal pain or chest pain, stridor, drooling, respiratory distress, fever, dysphagia, or inability to tolerate oral intake after FB ingestions, up to 50% of children may be asymptomatic at the time of presentation. A thorough history and clinical examination is required, including evaluation for respiratory distress, oropharyngeal injury, and signs of perforation such as subcutaneous emphysema or peritoneal signs. When determining the appropriate management of a child after FB ingestion, clinicians must consider patient age and anatomy; object type, location, and size; timing of ingestion; presence or absence of symptoms; nil per os (NPO) status; and logistical factors (availability of necessary"
  },
  {
   "source": "Pediatric Otolaryngology (American Academy of Pediatrics) ( etc.), p. 427",
   "text": "_**Kristina W. Rosbe, MD**_ **Introduction Epidemiology and Prevention Signs and Symptoms** **Imaging Treatment Complications** **401** **Chapter 19: Aerodigestive Tract Foreign Bodies** ## \u25a0 **Introduction** Foreign body ingestion and aspiration are an important cause of morbidity and mortality in the pediatric population. Foreign bodies remain a diagnostic challenge because their presentation can vary from lifethreatening airway compromise to subtle respiratory symptoms that often are mis diagnosed. A high level of clinical suspicion can prevent delays in diagnosis and complications related to these delays. ## \u25a0 **Epidemiology.and.Prevention**"
  },
  {
   "source": "Caring for the Hospitalized Child, p. 540",
   "text": "![](/tmp/pdf-images/pdf-0537-00.png) **511** ## **Ingestions** **Chapter 67: Gastrointestinal Foreign Body 513** _**Hai Jun H. Rhim, MD, MPH, MHPE, FAAP, and Katherine Tang, MD, FAAP**_ **Chapter 68: Toxic Exposures 519** _**Blake A. Froberg, MD, FAAP, FACMT**_ ![](/tmp/pdf-images/pdf-0539-00.png) **513** ~~**CHAPTER 67**~~ ## **Gastrointestinal Foreign Body** ## **Introduction** About 75% of gastrointestinal (GI) foreign body ingestions occur in children younger than 5 years. Other high-risk patient populations include children with developmental delays, psychological disorders, GI anatomical anomalies, or motility disorders."
  },
  {
   "source": "Diagnostic Imaging: Pediatrics, p. 225",
   "text": "7. Bamber AR et al: Fatal aspiration of foreign bodies in infants and children. Fetal Pediatr Pathol. 33(1):42-8, 2014 8. Mallick MS: Tracheobronchial foreign body aspiration in children: A continuing diagnostic challenge. Afr J Paediatr Surg. 11(3):225-8, 2014 9. Jung SY et al: Three-dimensional CT with virtual bronchoscopy: a useful modality for bronchial foreign bodies in pediatric patients. Eur Arch Otorhinolaryngol. Epub ahead of print, 2011 10. Pass\u00e0li D et al: Foreign body inhalation in children: an update. Acta Otorhinolaryngol Ital. 30(1):27-32, 2010 - \u25cbChronic FB leads to granuloma formation/granulation tissue ## **CLINICAL ISSUES** ## **Presentation** - Most common signs/symptoms - \u25cbFBA may present acutely or in delayed fashion; event often unwitnessed or not remembered until later - Same day (25%): Wheezing, cough, \u00b1 fever - Day 2-7 (45%): Indolent cough, medically refractory wheezing, dyspnea - Delayed by > 1 week (30%): Same as above ## **Demographics**"
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "Gastrointestinal Foreign Body Esophageal Foreign Body: Diagnosis Children with esophageal foreign bodies often have a history of swallowing the object (either witnessed by parents or reported by the child). Symptoms associated with esophageal impaction include dysphagia, refusal to eat, foreign-body sensation, localizing pain, drooling, gagging and vomiting. In the absence of an ingestion history, the diagnosis may be challenging because these same symptoms occur with common childhood ailments such as acute gastroenteritis, pharyngitis, or gingivostomatitis. Any patient with swallowing difficulty requires a thorough examination of the mouth, oropharynx, neck, chest, and abdomen. Radiographic evaluation may be needed in some cases (see Chapter 56 Pain: Dysphagia ). The approach to a child with an ingested foreign body is outlined in Figure 32.4 ."
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "Young children are at increased risk for foreign-body aspiration or ingestion due to their inquisitive nature and tendency to explore objects with their mouths. According to the American Association of Poison Control Centers\u2019 National Poison Data System, 67,771 foreign-body exposures were reported in children 5 years of age and younger in the United States in 2016. Emergency room encounters for foreign-body ingestions in children less than 6 years of age are on the rise, increasing 91.5% from 1995 to 2015. Once an object or food is in a child\u2019s mouth, it can be ingested, or it can lodge in the pharynx or respiratory tract. Often, a \u201cchoking episode\u201d will clear the foreign body; however, serious sequelae of an aspirated object can range from an acute life-threatening event to a slowly evolving pneumonia. The severity of an ingested foreign body is determined by the nature of the object (e.g., blunt, long, sharp, battery, magnetic) and its location in the gastrointestinal (GI) tract. Generally, most ingested"
  },
  {
   "source": "Cover, p. 5526",
   "text": "## Reed A. Dimmitt ## **FOREIGN BODY INGESTION** ## **INTRODUCTION** The American Association of Poison Control Centers reported in 2014 that 50% of all ingestions were in children under 6 years of age. Coins are the most frequently ingested object in young children. The incidence of food impactions, while less frequent, is increasing in part due to the increase incidence of other esophageal disorders, such as eosinophilic esophagitis. Other foreign body ingestions (FBIs) include button batteries; magnets; and sharp, long, or absorptive (objects containing superabsorbent compounds) objects. While most FBIs will pass spontaneously through the gastrointestinal tract, another 10% to 20% will require endoscopic removal. Fortunately, less than 1% will require surgical intervention. Any history of possible FBI requires immediate attention with the need for and timing of removal being dependent on the nature of the FBI as well as the patient\u2019s symptoms. ## **PATHOGENESIS AND EPIDEMIOLOGY**"
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 604",
   "text": "## **Airway Obstruction Due to Foreign Body** Children under 5 years of age are particularly susceptible to foreign body aspiration and choking. Liquids are the most common cause of choking in infants, whereas small objects and food (e.g., grapes, nuts, hot dogs, candy) are the most common source of foreign bodies in the airways of toddlers and older children. A history consistent with foreign body aspiration is considered diagnostic. Any child in the proper setting with the sudden onset of choking, stridor, or wheezing should be considered to have a foreign body aspiration until proven otherwise. ![](/tmp/pdf-images/pdf-0604-14.png) Fig. 79.6 Abdominal thrusts with the conscious victim standing or sitting. Unfortunately, this classic history is not always present in all cases of foreign body aspiration."
  },
  {
   "source": "Caring for the Hospitalized Child, p. 545",
   "text": "Huang X, Hu J, Xia Z, Lin X. Multiple magnetic foreign body ingestion in pediatric patients: a single-center retrospective review. _Pediatr Surg Int_ . 2021;37(5):639\u2013643 PMID: 33388957 doi: 10.1007/s00383-020-04814-w Lee JH. Foreign body ingestion in children. _Clin Endosc_ . 2018;51(2):129\u2013136 PMID: 29618175 doi: 10.5946/ce.2018.039 Leinwand K, Brumbaugh DE, Kramer RE. Button battery ingestion in children: a paradigm for management of severe pediatric foreign body ingestions. _Gastrointest Endosc Clin N Am_ . 2016;26(1):99\u2013118 PMID: 26616899 doi: 10.1016/j.giec.2015.08.003 **519** ~~**CHAPTER 68**~~ ## **Toxic Exposures** ## **Introduction**"
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 2285",
   "text": "The majority (80%) of accidental foreign- body ingestions occur in children, most of whom are 5 years of age or younger. Older children and adolescents with developmental delays and those with psychiatric disorders are also at increased risk. Most ingested foreign bodies are associated with a good outcome as they pass spontaneously through an anatomically normal digestive tract. The presentation of a foreign body lodged in the esophagus constitutes an emergency and is associated with significant morbidity and mortality because of the potential for perforation and sepsis. Although coins are by far the most commonly ingested foreign body, followed by small toy items, it is the ingestion of batteries and multiple magnets that could lead to life- threatening complications. Food impactions are less common in children than in adults and usually occur in children in association with eosinophilic esophagitis (diagnosed in 92% of those presenting with food impactions and dysphagia) _,_ repair of esophageal atresia,"
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "Clinical Considerations Clinical Recognition Foreign bodies trapped in the laryngeal inlet can cause significant acute upper airway obstruction. The child usually presents with severe coughing, hoarseness, and significant respiratory distress. The larger challenge for emergency clinicians is recognizing foreign body aspiration when the event was not witnessed directly, and the child is not acutely compromised. Presenting symptoms such as cough, stridor, and examination findings such as wheezing and decreased aeration are nonspecific and seen commonly in routine pediatric illnesses such as croup, bronchiolitis, and asthma. One should be suspicious of airway foreign body in any child with sudden onset of symptoms or when there is a history consistent with ingestion or aspiration. Triage"
  },
  {
   "source": "Pediatric Decision-Making Strategies, p. 48",
   "text": "Nelson Texbook of Pediatrics, 19e. Chapters 138, 189, 315, 376, 377, 379, 383 Nelsons Essentials, 6e. Chapters 107, 133, 136 32 Part II u Respiratory System 9[Pulmonary contusions can occur as a result of chest ] trauma. The onset of symptoms may be acute or delayed. Contusions may be visible on a chest x-ray; however, initial film findings are often negative. 10[Historically, gastroesophageal reflux disease (both symp-] tomatic and asymptomatic) has been implicated as an etiology of chronic cough. Actual data supporting the role of reflux in chronic cough remains conflicting, except in children with neurologic impairment and a risk of aspiration."
  },
  {
   "source": "Cover, p. 5133",
   "text": "## **NASAL FOREIGN BODIES** Children often place foreign bodies in their noses without parental knowledge, resulting in delayed diagnosis associated with characteristic foul odor and unilateral rhinorrhea. A nasal foreign body should be considered if a child has persistent unilateral rhinorrhea unresponsive to routine management. With appropriate preparation and equipment, many intranasal foreign bodies can be removed in an office setting; occasionally, difficult cases may require removal under general anesthesia."
  }
 ]
}