Pediatric Foreign Body Ingestion


Practice Essentials

As children explore and interact with the world, they will inevitably put foreign bodies into their mouths and swallow some of them.

Most swallowed foreign bodies pass harmlessly through the gastrointestinal (GI) tract. Foreign bodies that damage the GI tract, become lodged, or have associated toxicity must be identified and removed. Children with preexisting GI abnormalities (eg, tracheoesophageal fistula, stenosing lesions, previous GI surgery) are at an increased risk for complications.

Although adults most often present to the ED because of health problems related to ingestion of radiolucent foreign bodies (typically food), children usually swallow radiopaque objects, such as coins, pins, screws, button batteries, or toy parts. Although children commonly aspirate food items, it is less common for small children to present because of foreign body complications due to food ingestion. Swallowed objects are shown in the images below.

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A swallowed coin lodged at the thoracic inlet. Image courtesy of Gregory Conners, MD, MPH.

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A swallowed radiolucent object (plastic guitar pick) is made visible in the upper esophagus after ingestion of barium. Image courtesy of Raymond K. Ta....



Most complications of pediatric foreign body ingestion are due to esophageal impaction, usually at one of three typical locations.[1] The most common site of esophageal impaction is at the thoracic inlet. Defined as the area between the clavicles on chest radiograph, this is the site of anatomical change from the skeletal muscle to the smooth muscle of the esophagus. The cricopharyngeus sling at C6 is also at this level and may "catch" a foreign body. About 70% of blunt foreign bodies that lodge in the esophagus do so at this location. Another 15% become lodged at the mid esophagus, in the region where the aortic arch and carina overlap the esophagus on chest radiograph. The remaining 15% become lodged at the lower esophageal sphincter (LES) at the gastroesophageal junction.

Children with preexisting esophageal abnormalities (eg, repair of a tracheoesophageal fistula) are likely to have foreign body impaction at the site of the abnormality. If a child with no known esophageal pathology has a blunt foreign body lodged at a location other than the 3 typical locations described above, the possibility of a previously unknown esophageal abnormality should be considered. The presence of eosinophilic esophagitis has been recognized as contributing to adult esophageal foreign body impaction and may be its presenting feature; although less common in children, eosinophilic esophagitis has also been associated with pediatric esophageal food impaction.[2]

Pointed objects, such as thumbtacks, may become impaled and, therefore, lodged anywhere in the esophagus. Small objects, such as pills and smaller button batteries, may adhere to the slightly moist esophageal mucosa at any point.

Stomach/lower gastrointestinal tract

Once a swallowed foreign body reaches the stomach of a child with a normal GI tract, it is much less likely to lead to complications. Foreign bodies occasionally become lodged at the ileocecal valve.[3] Coins made largely from zinc, most notable United States cents, have been reported to interact with stomach acid leading to stomach ulceration.[4] Foreign-body — induced appendicitis has been reported.[5] Other exceptions include pointed or toxic foreign bodies or objects too long (ie, >6 cm) or too wide (ie, >2 cm) to pass through the pyloric sphincter.

Another important exception is the child who has swallowed more than one magnet; reports exist of swallowed toy magnets attracting and adhering tightly to each other through the GI tract, leading to small bowel obstruction or necrosis of intervening tissues, sometimes with severe sequelae.[6, 7, 8] Magnets may also attract other ferrous swallowed foreign bodies, causing similar problems.[9]

Children with known GI tract abnormalities are more likely to encounter complications. Previous surgery may cause abnormalities of peristalsis, increasing the likelihood of foreign body impaction. For example, children who have had surgery to correct pyloric stenosis are more likely to retain a foreign body in the stomach.

Previously unsuspected lower GI tract abnormalities may present as a complication of foreign body ingestion. For example, a small foreign body may become lodged in a Meckel diverticulum.

Impacted foreign bodies

A foreign body lodged in the GI tract may have little or no effect; cause local inflammation leading to pain, bleeding, scarring, and obstruction; or erode through the GI tract. Migration from the esophagus most often leads to mediastinitis but may involve the lower respiratory tract or aorta and create an aortoenteric fistula. Migration through the lower GI tract may cause peritonitis.



United States

Although exact figures are unavailable, foreign body ingestion is clearly common among children. More than 125,000 ingestions of foreign bodies by people aged 19 years and younger were reported to American Poison Control Centers in 2007.[10] In a cross-sectional survey of parents of more than 1500 children, 4% of the children had swallowed a coin (the most commonly swallowed foreign body in many studies).[11]

A study that analyzed emergency department (ED) visits involving magnet ingestion in children from 2002 to 2011 found that there has been an alarming increase in ED visits for magnet ingestion in children. A national estimate of 16,386 children presented to EDs in the United States during the 10-year study period with possible magnet ingestion. ED visits due to possible magnet ingestion increased 8.5-fold from 2002 to 2011 with a 75% average annual increase per year. The majority of patients reported to have ingested magnets were younger than 5 years (54.7%).[12]


Pediatric foreign body ingestion is a worldwide problem. Impaction of swallowed fish bones is more commonly observed in countries where fish is a major dietary staple, including Asian countries.[13] A massive database describing pediatric foreign body injury in European and other countries, the "Susy Safe project," recently published information regarding nearly 17,000 cases in children aged 14 years and younger; about 18% of these involved foreign body ingestion.[14]


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Children of all ages ingest foreign bodies. However, incidence is greatest in children aged 6 months to 4 years. This reflects the tendency of small children to use their mouths in the exploration of their world. Younger children may be "fed" foreign bodies by older children or be intentionally given foreign bodies by abusive adults. In the teenaged years, concomitant psychiatric problems, mental disturbances, and risk-taking behaviors may lead to foreign body ingestion.


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Laboratory Studies

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Imaging Studies

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Other Tests

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Prehospital Care

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Emergency Department Care

The usual goal of ED management is to localize the position of the ingested foreign body. Patients with drooling, marked emesis, or altered mental status (likely from excess vagal stimulation) may require supportive measures to protect the airway.

Most patients should undergo radiographic imaging as described above. Metal detectors may be used to locate metallic foreign bodies. Even radiopaque foreign bodies may be difficult to localize. Referral for endoscopy should be considered.

Remember that children with no symptoms may have impacted foreign bodies and that children with foreign body sensation or pain may not. Radiographs of about 15% of children presenting to the ED after witnessed coin ingestions do not show a coin. Although some will have vomited or otherwise removed the ingested object before their evaluation, this suggests that not all children with even witnessed foreign body ingestions have truly ingested something.


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Surgical Care

A study presented the outcome of surgical treatment of esophageal perforations due to foreign body impaction in children along with a management algorithm. The study concluded that esophageal perforation following foreign body impaction is rare and requires prompt treatment. Surgical treatment tailored to the needs of individual patients is associated with a successful outcome and decreased morbidity.[32]

Medication Summary

Although drugs such as glucagon, benzodiazepines, and nifedipine have been successfully used to relax the lower esophageal sphincter in adult patients with esophageal foreign bodies, these measures are generally unsuccessful in children.

Laxatives are occasionally prescribed to hasten the passage of intestinal foreign bodies. While they likely lead to speedier passage, this is not necessarily associated with improved health of the patient, and so laxative use is not generally recommended. Specific circumstances may exist in which laxatives may be helpful, however.

The use of meat tenderizer (papain) to attempt to digest meat impacted in the esophagus is no longer recommended. Such usage may severely injure the esophagus.

Inducing vomiting may lead to aspiration, and so should be avoided.

Further Outpatient Care

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Further Inpatient Care

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Patient Education

For excellent patient education resources, visit eMedicineHealth's Digestive Disorders Center. Also, see eMedicineHealth's patient education article Battery Ingestion.

What is pediatric foreign body ingestion?What is the role of esophageal impaction in the pathophysiology of pediatric foreign body ingestion?What is the role of GI tract in the pathophysiology of pediatric foreign body ingestion?What is the prevalence of pediatric foreign body ingestion in the US?What is the global prevalence of pediatric foreign body ingestion?What is the mortality and morbidity associated with pediatric foreign body ingestion?What is the sexual predilection of pediatric foreign body ingestion?Which age groups are at highest risk for pediatric foreign body ingestion?Which clinical history findings suggest pediatric foreign body ingestion?What are the esophageal symptoms of foreign body ingestion?What are the GI tract symptoms of foreign body ingestion?Which physical findings suggest pediatric foreign body ingestion?What causes pediatric foreign body ingestion?What are the differential diagnoses for Pediatric Foreign Body Ingestion?What is the role of lab testing in the workup of pediatric foreign body ingestion?What is the role of imaging studies in the workup of pediatric foreign body ingestion?What is the role of metal detectors in the workup of pediatric foreign body ingestion?What is the role of endoscopy in the diagnosis and management of pediatric foreign body ingestion?What is included in the prehospital care of pediatric foreign body ingestion?What is the initial goal of emergency department (ED) management of pediatric foreign body ingestion?What is the emergency department (ED) management for esophageal foreign body ingestion?What are the possible complications of pediatric foreign body ingestion?What is the emergency department (ED) management for pediatric foreign body ingestions in the GI tract?Which specialist consultations are beneficial for pediatric foreign body ingestion?What is the role of surgery in the management of pediatric foreign body ingestion?Which medications are used in the management of pediatric foreign body ingestion?Which measures are contraindicated in the management of pediatric foreign body ingestion?What is included in the long-term monitoring following a pediatric foreign body ingestion?What is included in inpatient care for pediatric foreign body ingestion?When is patient transfer indicated for the management of pediatric foreign body ingestion?How is pediatric foreign body ingestion prevented?What the possible complications of pediatric foreign body ingestion?Where are patient education resources regarding pediatric foreign body ingestion found?


Gregory P Conners, MD, MPH, MBA, FAAP, FACEP, Director, Division of Emergency Medicine, Children's Mercy Hospital; Associate Chair of Pediatrics, Professor of Pediatrics and Emergency Medicine, University of Missouri-Kansas City School of Medicine

Disclosure: Nothing to disclose.

Specialty Editors

Mary L Windle, PharmD, Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH, Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center; Chairman, Pediatric Institutional Review Board, Mercy St Vincent Medical Center, Toledo, Ohio

Disclosure: Nothing to disclose.

Chief Editor

Dale W Steele, MD, MS, Professor of Emergency Medicine, Pediatrics, and Health Services, Policy, and Practice, Warren Alpert Medical School of Brown University; Attending Physician, Department of Pediatric Emergency Medicine, Rhode Island Hospital

Disclosure: Nothing to disclose.

Additional Contributors

Jerry R Balentine, DO, FACEP, FACOEP, Vice President, Medical Affairs and Global Health, New York Institute of Technology; Professor of Emergency Medicine, New York Institute of Technology College of Osteopathic Medicine

Disclosure: Nothing to disclose.

Timothy E Corden, MD, Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Disclosure: Nothing to disclose.


  1. Conners GP, Chamberlain JM, Ochsenschlager DW. Symptoms and spontaneous passage of esophageal coins. Arch Pediatr Adolesc Med. 1995 Jan. 149(1):36-9. [View Abstract]
  2. Hurtado CW, Furuta GT, Kramer RE. Etiology of esophageal food impactions in children. J Pediatr Gastroenterol Nutr. 2011 Jan. 52(1):43-6. [View Abstract]
  3. Pavlidis TE, Marakis GN, Triantafyllou A, Psarras K, Kontoulis TM, Sakantamis AK. Management of ingested foreign bodies. How justifiable is a waiting policy?. Surg Laparosc Endosc Percutan Tech. 2008 Jun. 18(3):286-7. [View Abstract]
  4. O'Hara SM, Donnelly LF, Chuang E, Briner WH, Bisset GS 3rd. Gastric retention of zinc-based pennies: radiographic appearance and hazards. Radiology. 1999 Oct. 213(1):113-7. [View Abstract]
  5. Robinson AJ, Bingham J, Thompson RL. Magnet induced perforated appendicitis and ileo-caecal fistula formation. Ulster Med J. 2009 Jan. 78(1):4-6. [View Abstract]
  6. Vijaysadan V, Perez M, Kuo D. Revisiting swallowed troubles: intestinal complications caused by two magnets--a case report, review and proposed revision to the algorithm for the management of foreign body ingestion. J Am Board Fam Med. 2006 Sep-Oct. 19(5):511-6. [View Abstract]
  7. Fenton SJ, Torgenson M, Holsti M, Black RE. Magnetic attraction leading to a small bowel obstruction in a child. Pediatr Surg Int. 2007 Dec. 23(12):1245-7. [View Abstract]
  8. Pryor HI 2nd, Lange PA, Bader A, Gilbert J, Newman K. Multiple magnetic foreign body ingestion: a surgical problem. J Am Coll Surg. 2007 Jul. 205(1):182-6. [View Abstract]
  9. Shastri N, Leys C, Fowler M, Conners GP. Pediatric button battery and small magnet coingestion: two cases with different outcomes. Pediatr Emerg Care. 2011 Jul. 27(7):642-4. [View Abstract]
  10. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Heard SE. 2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report. Clin Toxicol (Phila). 2008 Dec. 46(10):927-1057. [View Abstract]
  11. Conners GP, Chamberlain JM, Weiner PR. Pediatric coin ingestion: a home-based survey. Am J Emerg Med. 1995 Nov. 13(6):638-40. [View Abstract]
  12. Abbas MI, Oliva-Hemker M, Choi J, Lustik M, Gilger MA, Noel RA, et al. Magnet ingestions in children presenting to US emergency departments, 2002-2011. J Pediatr Gastroenterol Nutr. 2013 Jul. 57(1):18-22. [View Abstract]
  13. Lim CW, Park MH, Do HJ, Yeom JS, Park JS, Park ES, et al. Factors Associated with Removal of Impactted Fishbone in Children, Suspected Ingestion. Pediatr Gastroenterol Hepatol Nutr. 2016 Sep. 19 (3):168-174. [View Abstract]
  14. Susy Safe Working Group. The Susy Safe project overview after the first four years of activity. Int J Pediatr Otorhinolaryngol. 2012 May 14. 76 Suppl 1:S3-11. [View Abstract]
  15. Litovitz T, Whitaker N, Clark L, White NC, Marsolek M. Emerging battery-ingestion hazard: clinical implications. Pediatrics. 2010 Jun. 125(6):1168-77. [View Abstract]
  16. Kavanagh KR, Batti JS. Traumatic epiglottitis after foreign body ingestion. Int J Pediatr Otorhinolaryngol. 2008 Jun. 72(6):901-3. [View Abstract]
  17. Brayer AF, Sciera M, Conners GP. Pediatric coin ingestion: an unusual presentation. Int J Pediatr Otorhinolaryngol. 2000 Oct 16. 55(3):211-3. [View Abstract]
  18. Riddlesberger MM Jr, Cohen HL, Glick PL. The swallowed toothbrush: a radiographic clue of bulimia. Pediatr Radiol. 1991. 21(4):262-4. [View Abstract]
  19. Silverberg M, Tillotson R. Case report: esophageal foreign body mistaken for impacted button battery. Pediatr Emerg Care. 2006 Apr. 22(4):262-5. [View Abstract]
  20. Jackson JT, Conners GP. Radiographic identification of an esophageal United States one cent coin. Visual Journal of Emergency Medicine. 2017. 9:31-32.
  21. Conners GP, Hadley JA. Esophageal coin with an unusual radiographic appearance. Pediatr Emerg Care. 2005 Oct. 21(10):667-9. [View Abstract]
  22. Conners GP. Diagnostic uses of metal detectors: a review. Int J Clin Pract. 2005 Aug. 59(8):946-9. [View Abstract]
  23. Conners GP. Finding aluminum foreign bodies. Pediatr Rev. 2000 May. 21(5):172. [View Abstract]
  24. Kramer RE, Lerner DG, Lin T, et al. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr. 2015 Apr. 60 (4):562-74. [View Abstract]
  25. Conners GP. Esophageal coin ingestion: going low tech. Ann Emerg Med. 2008 Apr. 51(4):373-4. [View Abstract]
  26. Dahshan AH, Kevin Donovan G. Bougienage versus endoscopy for esophageal coin removal in children. J Clin Gastroenterol. 2007 May-Jun. 41(5):454-6. [View Abstract]
  27. Arms JL, Mackenberg-Mohn MD, Bowen MV, Chamberlain MC, Skrypek TM, Madhok M. Safety and efficacy of a protocol using bougienage or endoscopy for the management of coins acutely lodged in the esophagus: a large case series. Ann Emerg Med. 2008 Apr. 51(4):367-72. [View Abstract]
  28. Conners GP. A literature-based comparison of three methods of pediatric esophageal coin removal. Pediatr Emerg Care. 1997 Apr. 13(2):154-7. [View Abstract]
  29. Gonzalez KW, Reddy SR, Mundakkal AA, St Peter SD. The financial impact of flipping the coin. J Pediatr Surg. 2016. 52:153-155. [View Abstract]
  30. Bhargava R, Brown L. Esophageal coin removal by emergency physicians: a continuous quality improvement project incorporating rapid sequence intubation. CJEM. 2011 Jan. 13(1):28-33. [View Abstract]
  31. Sharieff GQ, Brousseau TJ, Bradshaw JA, Shad JA. Acute esophageal coin ingestions: is immediate removal necessary?. Pediatr Radiol. 2003 Dec. 33(12):859-63. [View Abstract]
  32. Peters NJ, Mahajan JK, Bawa M, Chabbra A, Garg R, Rao KL. Esophageal perforations due to foreign body impaction in children. J Pediatr Surg. 2015 Feb 7. [View Abstract]
  33. NBIH Button Battery Ingestion Triage and Treatment Guideline. Poison Control: National Capital Poison Center. Available at September 2016; Accessed: December 18, 2017.
  34. Litovitz T, Whitaker N, Clark L. Preventing battery ingestions: an analysis of 8648 cases. Pediatrics. 2010 Jun. 125(6):1178-83. [View Abstract]
  35. Lee JH, Lee JH, Shim JO, Lee JH, Eun BL, Yoo KH. Foreign Body Ingestion in Children: Should Button Batteries in the Stomach Be Urgently Removed?. Pediatr Gastroenterol Hepatol Nutr. 2016 Mar. 19 (1):20-8. [View Abstract]
  36. Conners GP. Management of asymptomatic coin ingestion. Pediatrics. 2005 Sep. 116(3):752-3. [View Abstract]
  37. Conners GP, Chamberlain JM, Ochsenschlager DW. Conservative management of pediatric distal esophageal coins. J Emerg Med. 1996 Nov-Dec. 14(6):723-6. [View Abstract]
  38. Varga Á, Kovács T, Saxena AK. Analysis of Complications After Button Battery Ingestion in Children. Pediatr Emerg Care. 2018 Jun. 34 (6):443-446. [View Abstract]

A swallowed coin lodged at the thoracic inlet. Image courtesy of Gregory Conners, MD, MPH.

A swallowed radiolucent object (plastic guitar pick) is made visible in the upper esophagus after ingestion of barium. Image courtesy of Raymond K. Tan, MD, and Gregory Conners, MD, MPH.

A swallowed coin lodged at the thoracic inlet. Image courtesy of Gregory Conners, MD, MPH.

A swallowed radiolucent object (plastic guitar pick) is made visible in the upper esophagus after ingestion of barium. Image courtesy of Raymond K. Tan, MD, and Gregory Conners, MD, MPH.

Lateral radiograph demonstrating the distinctive two-step profile of a button (disk) battery in the esophagus.

Frontal view of same esophageal button (disk) battery; note distinctive double-circle appearance, useful to differentiate a button battery from a coin.