Pathway for the Evaluation/Treatment of the Child with Foreign Body Ingestion

Coins/Blunt Objects Confirmed on X-Ray
Consider composition of FB, potential for toxicity,
Lead containing FB
Esophagus
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Consult
ENT: Proximal mid-esophagus
GI: Lower esophagus
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Symptoms
No Symptoms
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Respiratory distress
  • Severe pain
  • Multiple coins
  • Esophageal pathology*
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EMERGENT
ENDOSCOPIC REMOVAL
URGENT
ENDOSCOPIC REMOVAL
NPO, IVF
Alert OR 4-5444
Admit EDECU, ENT, or GI
NPO, IVF
Repeat xray prior to surgery
Stomach
Beyond Stomach
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Symptoms
No Symptoms
Symptoms
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Consult GI
Discharge
Consider
  • Alternate etiologies
  • Alternative FB
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Items within the stomach
  • Repeat X-ray
  • Case specific basis
  • Within 2-3 weeks:
    • Age < 2 yrs
    • Quarter
  • Within 1 week:
    • Cylindrical battery
  • Sooner if symptoms
Items beyond the stomach
  • Return if symptoms
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Consult
Surgical consult if thought to be FB related
*Additional Consults
Hx of esophageal surgery General Surgery
Suspected esophageal pathology GI
**Stomach
Width > 2 cm, length > 5 cm
(less likely to pass pylorus/duodenum)
Glucagon
In special circumstances, may be considered for FB at the lower esophageal sphincter, after consult with GI.
Glucagon IV dose: 0.025mg/kg/dose, max 0.5 mg
Coins usually appear larger on the X-ray due to magnification
Quarter 24 mm
Nickel 21 mm
Penny 19 mm
Dime 18 mm
Posted: July 2013
Authors: B. Sahn, MD, P. Mamula, MD, F. Henretig MD