This document discusses foreign body ingestion and aspiration in pediatrics. It notes that coins are the most common foreign body ingested, occurring in children 6 months to 3 years old, with 93-99% passing spontaneously but buttons batteries and magnets can cause severe injuries. Symptoms may include drooling, difficulty swallowing, or appearing unwell. Diagnostic evaluation includes radiographs, CT scans, and endoscopy. Common lodging sites for ingested objects are the esophagus. Coin shapes are identifiable on x-rays. Button batteries show a double circular pattern. Aspiration most often involves nuts in children under 3 and lodges in the right mainstem bronchus. Physical exam may show coughing,

1. Foreign body in
pediatrics

2. High light
 Foreign Body Ingestion
 Most common is coin ingestion ( 31-46%)
 Foreign body ingestion age from 6 month to 3 years
 93-99% of blunt foreign bodies would pass spontaneously through the GI tract and only
1% of cases required surgery.
 10-20% of patients undergo endoscopy, with 1% undergoing surgical management
 The physician, therefore, must always consider the possibility of a foreign body ingestion
in a child with “sore throat,” dysphagia, increased secretions, and drooling, especially if
the child is ill-appearing

3.  unique mechanisms of injury with button batteries (lithium battery) and
magnets, involving :
 pressure necrosis
 hydrolysis, and liquefaction necrosis,
 chemical burn
 carry greater morbidity and mortality and should prompt consideration of immediate
removal.
 The majority of objects pass within 4 to 6 days, but some may take up to 4 weeks.
 larger >2 cm in diameter or longer > 5 cm (or a length greater than 3 cm in infants)
sharp or toxic bodies and more than one magnet -- > GI consultation and endoscopic
removal
 due to the higher potential for obstruction at the pylorus, duodenal sweep, or ileocecal valve.

4. Case
 A 15-month-old presents to the emergency department for difficulty
feeding and irritability.
 The child was noted to be unwell appearing, drooling, and sitting up and
leaning forward.
 The mother reported a symptom duration of about 12 hours and said the
child had been well prior to that time.

5. How to approach (History of event):
 Did you witness the child ingesting a foreign body? or child report to you
that?
 Do you know what the foreign body is? (size, shape, identity)
 Do you know when the child ingested the foreign body?
 Have you found the foreign body in the stool already?
 Has the child previously swallowed any objects before?
 Does the child have any other medical illnesses or have had previous
surgery?
 ?

6. How to approach
 Ask and look for
 asymptomatic at the time of presentation ( developed chronic F.B > 7 days)
 Symptomatic -- > vomiting and regurgitation.
 Other symptoms include dysphagia, odynophagia, drooling, respiratory symptoms, pain in
the throat, neck, or chest, or foreign body sensation
 abdominal distention and Pain ,Hematochezia and Unexplained fever
 chronic foreign body (76% of patients )presented with respiratory symptoms,
including respiratory distress, asthma-like symptoms, and cough
 diagnostic evaluation,
 radiographs, x-ray and CT.
 Endoscopy
 is the diagnostic and therapeutic modality of choice in patients who have ingested a
dangerous object such as a button battery or sharp item,

7. Common site in esophagus
 proximal esophagus at the level of the
cricopharyngeus muscle (in line with
the clavicles on X-ray, thoracic
inlet)(77%)
 the mid-esophagus at the level of the
aortic arch (at the carina on X-ray),
 the lower esophageal sphincter (2-4
vertebral levels above the gastric
bubble on X-ray),

8. Coin or bottom battery
 X-ray Lateral and AP
 Battery show :
 two –steps/ subtle step-off in lateral view
 double circular pattern in AP view
 coins will appear as a singular rectangular opacity on the lateral view
 coins with the edge alone showing are lodged in the trachea ( but not allows)
Trachea or esophagus

15. Aspiration
 Age < 3 years mostly
 Vegetable matter in 70-80%
 Peanuts & other nuts (35%)
 80-90% Right mainstem
 history of choking is present in 75% to 90% of cases, Gagging and sudden
onsite of Wheezing ,Hoarseness, Dysphonia
 Can mimic asthma, croup, pneumonia
 Asymptomatic interval 20-50% not detected for one week-- > Inflammation
and Complications
 Emphysema Obstructive atelectasis Hemoptysis Pneumonia Lung abscess Fever

16.  physical exam :
 Coughing
 Stridor  UAW
 biphasic stridor Intrathoracic trachea
 Prolonged expiratory wheeze  Bronchi Unequal breath sounds
 Diagnostic triad - <50% Unilateral wheeze
 Ipsilaterally diminished breath sounds

17. Management
 Stable or unstable
 Unstable ABC --- > stabilize patient
 Stable :
 Symptomatic or not (high index of suspicion )
 Imaging
 Radiography PA & lateral views of chest & neck
 Inspiration & expiration
 Lateral decubitus views
 Airway fluoroscopy
 CT ( sensitivity 100% , NPV 100%)
25% have normal radiography

19.  Perform bronchoscopy
 if another one of the following is positive:
 – History
 – PE
 – Radiography
 Bronchoscopic evaluation is warranted on the basis of a positive history alone
 The role of beta-2 agonist remains unclear
 Alleviation of discomfort
 Expelling foreign body could be life threatening
 Not a replacement for bronchoscopy