What Does Foreign Body Swallowing Mean in Children?

Foreign body swallowing is the presence of an indigestible or digestible object in the gastrointestinal system (esophagus, stomach, small and large intestines, rectum, anus, from mouth to anus) in a way that causes clinical problems due to pathological reasons.

 

Figure: Gastrointestinal system

In Which Age Group Is Foreign Object Ingestion More Common in Children and Why?

30-60% of foreign object ingestion is seen under the age of 2, and 90% in preschool. The average age of occurrence is around 3 years. In 95% of patients, it is swallowed accidentally, and in the rest, it is swallowed by siblings putting it in their mouths.

This is the period when babies start to catch and put things they catch in their mouths, chew and swallow. It is also the period when children start to chew and swallow large pieces of food. Again, objects that are suitable for entering the airways, especially toys, start to be around children at this age. For this reason, it is more common in this age group.

A foreign object entering the gastrointestinal system is more common in boys than in girls. This is attributed to the fact that boys are more active than girls.

Which Objects Most Often Enter the Gastrointestinal System?

We can generally divide aspirated objects into two. Radiopaque, that is, objects seen directly on X-rays, and non-opaque, objects not directly seen on direct radiographs. Which of these objects are aspirated more is related to the social lifestyles of societies. Opaque objects are swallowed most frequently in Türkiye. These are; metal coins, pins, safety pins, marbles, beads, hairpins, nails, magnets, watch batteries and bone fragments. Non-opaque objects are; food items, unchewed pieces of meat, olives, plum pieces.

 

Figures: X-ray images of different foreign bodies in different anatomical locations of the digestive system.

Are There Foreign Bodies That Present Specialty When Swallowed?

Yes, there are. These are watch batteries, swallowing 2 or more magnets, and some toys with chemical content. Batteries have chemical content and when swallowed, they can react with stomach acid and cause chemical burns, Magnets attract each other and can cause necrosis (rottenness of the intestine) and perforation by squeezing the intestine between them, Other toys with chemical content increase in number and volume when combined with water and can cause blockage, so attention should be paid to these.

 

Picture: X-ray image of two magnets in the gastrointestinal system

What are the Clinical Complaints in Children with Foreign Objects in the Gastrointestinal System?

The clinical issue is whether the swallowed foreign object gets stuck or not, the anatomical region where it gets stuck and the chemical properties of the objects. These objects are most commonly stuck in the esophagus, so complaints are usually related to this region. Difficulty swallowing, saliva coming out of the mouth, a feeling of getting stuck, and if delayed, aspiration into the respiratory tract are clinical complaints related to these.

There may be no clinical complaints as long as the objects do not get stuck and cause obstruction, and we can only detect these by the child stating that they swallowed.

If the objects get stuck and stay for a long time, they can perforate. If they perforate in the legs, the patient may be brought with complaints of abdominal pain and acute abdomen.

In Which Anatomical Regions Can Foreign Objects Get Stuck?

Physiologically narrow regions in the gastrointestinal system; the upper, middle and lower end of the esophagus, duodenum, cecum and rectum. There may also be pathological strictures that have occurred due to surgery or other reasons, these are stenosis due to esophageal surgeries and corrosive substance burns.

 

Picture: Food items located in the narrowing of the esophagus

How is Foreign Body Ingestion Diagnosed in Children?

The diagnosis is made by history and physical examination and confirmed by imaging methods. Some of these patients do not have clinical complaints, but since the children state that they swallowed, they are taken to the doctor by their families. The clinical findings that can be seen are explained above.

Imaging in Diagnosis

• The main imaging methods used in the diagnosis of foreign body aspirations;
• Lung X-ray, standing direct abdominal X-ray, contrast X-rays and computerized tomography
• However, X-rays can be taken in the lateral, oblique and decubitus positions to better define the localization and size of the object.
• Studies have shown that most swallowed foreign bodies are radiopaque. Therefore, they are seen on direct X-rays. However, if they are not seen, additional tests can be performed.

How is Gastrointestinal Foreign Body Treated in Children?

The treatment plan is planned according to the type of object swallowed (blunt, sharp and chemical properties), size and location. Most of these objects do not cause clinical problems and come out of the anus on their own, so no action is taken and they are monitored. Objects that pass through the duodenum (duodenum) usually come out on their own within 2-7 days. There is no need for the patient to follow a special diet during follow-up. Only the child's stool is monitored to see if he/she passes it, and if not, an x-ray is taken every 2-3 days to check if it moves.

Can an Enema be Given to a Child Who Swallows a Foreign Object? Is Diet Helpful?

There is no need for a diet, but foods that will cause constipation can be avoided. Enemas are also not necessary except in special cases.

Which Foreign Bodies in the Gastrointestinal System in Children Are Intervened?

The criteria for intervention for foreign bodies in the gastrointestinal system in children are as follows;

• Foreign bodies stuck in the esophagus
• Large objects in the stomach and duodenum
• Especially in young children and objects larger than 3-4 cm
• Objects that do not move into the stomach and duodenum for more than 2 weeks
• Foreign bodies that cause complications.
• Watch batteries in the stomach and duodenum
• Children who swallow more than one magnet and magnetic toys

How are Foreign Bodies in the Gastrointestinal System in Children Removed?

The procedure to be selected is selected according to the area where the object is stuck, the characteristics of the object and its size. Regardless of the procedure, it is performed under anesthesia and in the operating room. These procedures; Magill clamp, Rigid and Flexible esophagoscopy, endoscopy, balloon extraction, bouginage and application of some pharmacological agents.

What Can We Do to Protect Ourselves from Foreign Object Ingestion?

The most effective treatment is prevention!

Children between the ages of six months and three years often put objects in their mouths, increasing the risk.

• Children should be monitored during play and should not be allowed to run with various objects or food in their mouths.
• Other precautions that can be taken include not having objects that can be put in their mouths and enter their airways in places that children in the first 3 years of age can reach, and keeping toys containing small parts away from children in this age group.
• In order to prevent foreign object ingestion, programs should be organized, especially for the education of parents.
• When foreign object ingestion is detected or suspected, 112 should be called without delay.
• Not to attach objects such as amulets or gold tags with safety pins, which is a common habit in our country.

*** The information provided here and the content of the website have been arranged for the purpose of informing visitors, especially families. No information should be considered as advice by visitors and should not lead to any decision or action. The patient should definitely be examined by a pediatric surgeon, and a decision should be made by consulting him/her and consulting his/her personal knowledge.