Overview of the management of suspected foreign body ingestion in children

CT: computed tomography.
* Refer to UpToDate content on the management of upper airway obstruction.
¶ In a child with negative conventional radiographs (no foreign body identified), a CT is not necessary if the child is asymptomatic and if suspected object is small (<2 cm) and blunt.
Δ In adults or older children, a long object is defined as one that is ≥5 cm; such objects should be removed from the stomach because they may not pass the duodenal sweep. There is no guidance for defining long objects in younger children. We generally remove an object from the stomach of a child <5 years if the object is longer than 2.5 cm.
◊ High-powered magnets are also known as "rare earth" or neodymium magnets. Management depends on the number of magnets present. Refer to UpToDate content and algorithms about magnet ingestion.
§ Guidelines vary for management of battery ingestion. Refer also to UpToDate topic on disc ("button") or cylindrical battery ingestion.
¥ Symptoms suggesting complications include vomiting, abdominal pain, fever, hematemesis, or melena.
‡ If an object remains in the stomach for more than 4 weeks, it should be removed because this means that the object is unlikely to pass beyond the pylorus. If the object is radiolucent and in the stomach, it is reasonable to remove the object initially if endoscopic expertise is readily available, especially if the object is larger than 2 cm, in which case it may not easily pass the pylorus. If observation is chosen, the parents should monitor stools until they determine that the object has passed and should notify the clinician if any symptoms develop.
† For objects beyond the duodenal bulb that are radiopaque, monitor with serial radiographs (weekly for blunt objects, daily for sharp or long objects). Surgery is reserved for patients who develop complications (eg, obstruction, perforation) and for nonprogression of a foreign body (a blunt object that remains in the same location distal to the duodenum for more than 1 week or a sharp foreign body that does not advance radiographically for 3 consecutive days).
**If no object is identified, further evaluation depends on the patient's symptoms, type of object thought to be ingested, and likelihood that the ingestion occurred. If there is concern for aspiration of the object or for ingestion of an object that could lead to complications (large, long, or sharp), the evaluation might include diagnostic endoscopy or bronchoscopy, further imaging (eg, CT if not already done), and/or close observation.