Young children often swallow small objects such as coins, toys, button batteries and magnets. Most pass on their own, but button batteries in the esophagus and multiple magnets can cause serious injury within hours and need urgent removal.
Key symptoms
- Often no symptoms after the event was witnessed
- Drooling, refusing to eat or trouble swallowing
- Vomiting, gagging or chest pain
- Coughing, wheezing or noisy breathing if the object is in the airway
What you find on exam
- Airway, breathing and work of breathing first
- Look for drooling and neck or chest tenderness
- Abdominal exam for tenderness or distension
- Listen for wheezing or decreased breath sounds
Tests
- X-rays from neck to abdomen, front and side views, to find and locate metal objects
- Double ring or halo sign suggests a button battery rather than a coin
- CT or endoscopy if a non-visible object is suspected and symptoms persist
Treatment basics
- Button battery in the esophagus: emergency endoscopic removal
- Give honey on the way in for a recent battery swallow in children over 1 year
- Any esophageal object and multiple magnets need urgent endoscopy
- Smooth objects past the stomach in a well child can be watched as they pass
Red flags
- Swallowed button battery or more than one magnet
- Drooling, unable to swallow or breathing trouble
- Vomiting blood, fever or belly pain after ingestion
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.