FOREIGN BODY INGESTION IN CHILDREN - AN EMERGENCY CONDITION REQUIRING IMMEDIATE EVALUATION

Boyana Grozeva

doi:10.35120/medisij0501043g

Authors

Boyana Grozeva University “Prof. d-r Asen Zlatarov”, Burgas, Republic of Bulgaria Author

DOI:

https://doi.org/10.35120/medisij0501043g

Keywords:

children, foreign body, ingestion, button battery

Abstract

Accidental foreign body ingestion is common in pediatric practice. Young children, especially those under five years, tend to put different kinds of small objects from their environment into their mouths. Sometimes due to the still immature reflexes, they are unintentionally swallowed. Most often these are coins, followed by magnets, button batteries, toys or jewelry, but also many others. Luckily, in most cases, these foreign bodies pass through the gastrointestinal tract without causing any symptoms or injuries. Some of them don’t even get noticed or registered. However, it is estimated that in 10 to 20 percent of the cases there is a need for medical intervention.

A critical condition is lodgment in the esophagus because it requires extraction as soon as possible. Most often it occurs in its upper third. At this location the object is able to cause serious clinical discomfort, requiring rapid approach. Even dyspnea by compressing the trachea is possible. Injuries of the tissues, particularly after delayed diagnosis and treatment, might be a further dangerous consequence. Especially lodged button batteries cause critical damage of the esophageal wall in a very short time due to an electrolysis reaction on the site of the negative pole. This generates an alkali burn that might lead to life-threatening complications as perforation, fistulas to the trachea or to major blood vessels. Lethal outcomes are reported. Studies have demonstrated the development of significant injuries even only two hours of impaction. This emphasizes the importance of initiation of the extraction immediately.

Thus, in spite of the overall good prognosis clinicians have to be extremely alert when confronted with a child after foreign body ingestion. Immediate and profoundly evaluation is necessary in order to detect or exclude lodgment in esophagus- a condition requiring quick intervention. Especially when button batteries are involved time is crucial in order to prevent devastating complications.

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References

Akinkugbe, O., James, A. L., Ostrow, O., Everett, T., Wolter, N. E., & McKinnon, N. K. (2022). Vascular complications in children following button battery ingestions: A systematic review. Pediatrics, 150(3), e2022057477.

Arana, A., Hauser, B., Hachimi-Idrissi, S., & Vandenplas, Y. (2001). Management of ingested foreign bodies in childhood and review of the literature. European journal of pediatrics, 160(8), 468-472.

Duan, Q., Zhang, F., Wang, G., Wang, H., Li, H., Zhao, J., et al. (2020). Vocal cord paralysis following lithium button battery ingestion in children. European journal of pediatrics.

Eich, C., Lenz, M., Becke, K., et al. (2016). S2k-Leitlinie: Interdisziplinäre Versorgung von Kindern nach Fremdkörperaspiration und Fremdkörperingestion. Anästhesiologie & Intensivmedizin, 57, 296-306.

National Capital Poison Center Button Battery Ingestion Triage and Treatment Guideline. (2018). Button battery ingestion guideline. Retrieved from https://www.poison.org/battery/guideline

Gurevich, Y., Sahn, B., & Weinstein, T. (2018). Foreign body ingestion in pediatric patients. Current opinion in pediatrics, 30(5), 677-682.

Hoagland, M. A., Ing, R. J., Jatana, K. R., Jacobs, I. N., & Chatterjee, D. (2020). Anesthetic implications of the new guidelines for button battery ingestion in children. Anesthesia and analgesia, 130(3), 665-672.

Jatana, K. R., Litovitz, T., Reilly, J. S., Koltai, P. J., Rider, G., & Jacobs, I. N. (2013). Pediatric button battery injuries: 2013 task force update. International journal of pediatric otorhinolaryngology, 77(9), 1392-1399.

Kay, M., & Wyllie, R. (2005). Pediatric foreign bodies and their management. Current gastroenterology reports, 7(3), 212-218.

Kramer, R. E., Lerner, D. G., Lin, T., Manfredi, M., Shah, M., Stephen, T. C., et al. (2015). Management of ingested foreign bodies in children: A clinical report of the NASPGHAN Endoscopy Committee. Journal of pediatric gastroenterology and nutrition, 60(4), 562-574.

Krom, H., Visser, M., Hulst, J. M., Wolters, V. M., Van den Neucker, A. M., de Meij, T., et al. (2018). Serious complications after button battery ingestion in children. European journal of pediatrics, 177(7), 1063-1070.

Leinwand, K., Brumbaugh, D. E., & Kramer, R. E. (2016). Button battery ingestion in children: A paradigm for management of severe pediatric foreign body ingestions. Gastrointestinal endoscopy clinics of North America, 26(1), 99-118.

Lin, C. H., Chen, A. C., Tsai, J. D., Wei, S. H., Hsueh, K. C., & Lin, W. C. (2007). Endoscopic removal of foreign bodies in children. Kaohsiung journal of medical sciences, 23(9), 447-452.

Litovitz, T., Whitaker, N., & Clark, L. (2010). Preventing battery ingestions: An analysis of 8648 cases. Pediatrics, 125(6), 1178-1183.

Litovitz, T., Whitaker, N., Clark, L., White, N. C., & Marsolek, M. (2010). Emerging battery-ingestion hazard: Clinical implications. Pediatrics, 125(6), 1168-1177.

Little, D. C., Shah, S. R., St Peter, S. D., Calkins, C. M., Morrow, S. E., Murphy, J. P., et al. (2006). Esophageal foreign bodies in the pediatric population: Our first 500 cases. Journal of pediatric surgery, 41(5), 914-918.

Manfredi, M. A., Alvarez, R. P., Arai, K., Cheema, H. A., Darma, A., Elawad, M., et al. (2025). Global insights on the diagnosis, management, and prevention of pediatric ingestions: A report from the FISPGHAN expert panel. JPGN reports, 6(3), 274-287.

Mubarak, A., Benninga, M. A., Broekaert, I., Dolinsek, J., Homan, M., Mas, E., et al. (2021). Diagnosis, management, and prevention of button battery ingestion in childhood: A European Society for Paediatric Gastroenterology Hepatology and Nutrition position paper. Journal of pediatric gastroenterology and nutrition, 73(1), 129-136.

Pae, S. J., Habte, S. H., McCloskey, J. J., & Schwartz, A. J. (2012). Battery ingestion resulting in an aortoesophageal fistula. Anesthesiology, 117(6), 1354.

Panieri, E., & Bass, D. H. (1995). The management of ingested foreign bodies in children: A review of 663 cases. European journal of emergency medicine, 2(2), 83-87.

Philteos, J., James, A. L., Propst, E. J., Ostrow, O., McKinnon, N., Everett, T., & Wolter, N. E. (2022). Airway complications resulting from pediatric esophageal button battery impaction: A systematic review. JAMA otolaryngology–head & neck surgery, 148(7), 677-683.

Russell, R., Lucas, A., Johnson, J., Yannam, G., Griffin, R., Beierle, E., et al. (2014). Extraction of esophageal foreign bodies in children: Rigid versus flexible endoscopy. Pediatric surgery international, 30(4), 417-422.

Sethia, R., Gibbs, H., Jacobs, I. N., Reilly, J. S., Rhoades, K., & Jatana, K. R. (2021). Current management of button battery injuries. Laryngoscope investigative otolaryngology, 6(3), 549-563.

Shaffer, A. D., Jacobs, I. N., Derkay, C. S., Goldstein, N. A., Giordano, T., Ho, S., et al. (2020). Management and outcomes of button batteries in the aerodigestive tract: A multi-institutional study. Laryngoscope.

Sharpe, S. J., Rochette, L. M., & Smith, G. A. (2012). Pediatric battery-related emergency department visits in the United States, 1990-2009. Pediatrics, 129(6), 1111-1117.

Shivakumar, A. M., Naik, A. S., Prashanth, K. B., Yogesh, B. S., & Hongal, G. F. (2004). Foreign body in upper digestive tract. Indian journal of pediatrics, 71(8), 689-693.

Sutherland, J., & Bowen, L. (2023). Ingestion of foreign bodies and caustic substances in children. BJA education, 23(1), 2-7.

Tringali, A., Thomson, M., Dumonceau, J. M., Tavares, M., Tabbers, M. M., Furlano, R., et al. (2017). Pediatric gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guideline executive summary. Endoscopy, 49(1), 83-91.

Ventura, F., Candosin, S., Barranco, R., Bonsignore, A., Andrello, L., Tajana, L., & Osculati, A. (2017). A fatal case of coin battery ingestion in an 18-month-old child: Case report and literature review. American journal of forensic medicine and pathology, 38(1), 43-46.

Völker, J., Völker, C., Schendzielorz, P., Schraven, S. P., Radeloff, A., Mlynski, R., et al. (2017). Pathophysiology of esophageal impairment due to button battery ingestion. International journal of pediatric otorhinolaryngology, 100, 77-85.