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

MD/CRNP/RN Brief Rapid Assessment

If the ingestion is suspected to be intentional with the goal of self-harm (e.g. patient had suicidal ideation before swallowing object), then please also place the patient on the ED Behavioral Health pathway. Initiate consults to Social Work and Psychiatry.

History, Physical and Imaging

History Details of Ingestion
  • Suspected FB
    • Witnessed by caretaker
    • Choking episode
  • Time of ingestion
  • Size, configuration
    • Sharp end
    • Width > 2 cm, length > 5 cm (less likely to pass pylorus/duodenum)
    • Did family bring similar object with them
  • NPO time
  • Hx of GI anomaly, surgery or disease (especially esophageal)
  • Symptoms (related to age, location, size, duration of FB)
  • FB sensation
  • Refusing oral intake
  • Drooling, dysphagia, gagging
  • Choking, coughing with po intake
  • Respiratory symptoms
    • Stridor
    • Hoarseness
  • Chest pain
  • Abdominal pain, vomiting (signs of perforation, obstruction)
  • GI Bleeding
Physical Exam
  • VS, pulse ox, presence of fever
  • Drooling, oral lesions
  • Tripod position
  • Neck crepitus, stridor
  • Wheeze, unequal breath sounds
  • Check ears and nose, especially if FB not confirmed on X-ray
  • Signs suggesting acute abdomen
Imaging
  • AP single view (chest, neck, abdomen)
  • Lateral if:
    • Battery/magnet suspected
    • Esophageal location
    • FB location uncertain
Imaging Tips
  • Flat object location on AP
    • Esophagus: Orient in the coronal plane (i.e. coin is circular)
    • Trachea: Orient in the sagittal plane
  • Batteries
    • AP: Look for double ring on AP, suggests bilaminar structure
    • Lateral: Step-off between the anode and cathode
  • Magnets
    • Difficult to reliably distinguish single from multiple magnets
  • Non-radiopaque FB
    • Avoid GI contrast studies for suspected esophageal FBs
      • Discuss need with GI
      • May obscure visualization on endoscopy
      • Increases the risk of aspiration if there is an esophageal FB
    • Endoscopy favored
    • CT scan may be considered in special circumstances