Surge in foreign body ingestions concerning yet preventable

Children frequently ingest foreign objects — particularly during the ages of 6 months to 3 years. Although about 80% to 90% of foreign bodies pass through the gastrointestinal tract spontaneously without difficulties, some may cause serious complications and require endoscopic or surgical removal depending on the type, size and shape of the object; its location in the gastrointestinal tract; and time since ingestion, according to a review published in Clinical Endoscopy.

Research suggests that foreign body ingestions pose an increasing threat to child wellness, and they can also place a significant burden on EDs in the United States.

Uptick in foreign body ingestions

A recent retrospective analysis of a national database published in Pediatrics illustrated that this trend has dramatically escalated in the U.S., with the number of ED visits for swallowing foreign objects, such as coins, toys, jewelry and batteries, among young children nearly doubling between 1995 and 2015.

Danielle Orsagh-Yentis

Currently, the cause of the increase in foreign body ingestions is highly speculative, Danielle Orsagh-Yentis, MD, lead author of the study and a pediatric gastrointestinal motility fellow at Nationwide Children’s Hospital, told Infectious Diseases in Children.

Orsagh-Yentis suspects the reason is multifactorial, but she suggested that one plausible cause is the increased prevalence and accessibility of newer types of objects, such as button batteries, on the market.

“Kids explore the world with their mouths, so anything that is in their realm of reach is something that they could potentially ingest,” she said.

Thuy Lam Ngo

Thuy Lam Ngo, DO, MEd, assistant professor of pediatrics at Johns Hopkins University School of Medicine, hypothesizes that people are more dependent on devices and electronics, making button batteries and toys with small pieces more common — and obtainable to children — in households.

Additionally, it is possible that because the study was based on a national database, more cases were captured than have been previously recorded because coding capabilities and documentation may have improved over time, Orsagh-Yentis said.

“Nevertheless, this is a dramatic rise over time, so it is something that we as providers need to take note of,” she said. “It’s an alarming trend to say the least.”

Strain on EDs

The spike in foreign body ingestions among young children has put a strain on EDs in the country, according to Ngo, but how much of a burden depends on the type of foreign object that has been ingested and its location in the child’s body, she said.

Lithium or button batteries are the “biggest threat,” according to Ngo. These types of batteries can cause erosion of the esophagus and thus require an emergency operation. Bigger objects, such as coins, can get stuck in the esophagus and may also need to be removed in the operating room.

“So it ends up causing a lot of strain in terms of resources not just in the ED, but in the hospital as well,” she said.

Children presenting to the ED with a foreign body ingestion will most likely receive X-rays, which also contribute to the burden, Orsagh-Yentis said.

“If we can limit some of these ingestions, that would certainly be ideal for the kids’ sake and also from a system standpoint,” she said.

Management of foreign body ingestions

When a child presents to the ED under suspicion of having swallowed a foreign body, the general practice has remained the same over the years — evaluate the child for any symptoms, perform imaging and remove the object endoscopically or surgically if necessary, according to Orsagh-Yentis.

Although there have not been many treatment advances in this area of emergency medicine, Ngo said the sharing of knowledge has streamlined the management of pediatric patients who have swallowed foreign objects.

For example, it was previously believed that button batteries needed to be removed immediately regardless of where they were located in the body, but it is now understood that children who have ingested a button battery and do not display symptoms, including difficulty or inability to swallow, can be discharged if it is located in the stomach at the time of care, she said. Similarly, children who swallow coins and similar objects can go home if they do not have any symptoms and the object is in the stomach, she said.

In these cases, it is important for providers to talk to the family about symptoms that may require immediate return to medical care, she said.

Another area in which there has been improved understanding is the treatment of children who swallow high-powered magnets.

“If you swallow one, it’s not a big deal, but if you swallow two, the magnets can pass through the esophagus, pass through the stomach and they can adhere to each other in the intestines, cause intestinal perforation and subsequent complications related to that,” Ngo warned.

Importance of educating parents

Although the uptick in foreign ingestions is concerning for providers, these accidents are largely preventable.

“It is incumbent on us as physicians to talk about the dangers inherent in ingesting these types of objects and to educate the families we see on a regular basis,” Orsagh-Yentis said. “We need to work on discussing what may happen when a child ingests one of these objects.”

The AAP recommends that pediatricians discuss preventive medicine tactics with parents, such as safe storage and choking hazards, as part of a well-child check, according to Ngo.

“Having that discussion with parents in terms of home safety would be the most beneficial preventive care that we could do as pediatricians,” Ngo said.

These discussions should take place whenever a child is being treated regardless of the reason for treatment, but especially when a foreign body has been swallowed or inserted in the nose or ears, according to Ngo.

“The more we talk to families about it, the more they are aware of the objects that need to be placed out of reach of their small child,” she said.

Orsagh-Yentis said safe storage includes keeping potentially ingestible and hazardous objects locked in a cabinet and/or at an unreachable height that is out of the sight of children.

She noted that certain objects cannot always be locked away or kept on an elevated surface. In these instances, vigilance is extremely important, she said.

“Caregivers need to be watching children carefully, seeing what’s available, what’s around them and what could potentially be ingested and trying to eliminate those items as much as possible from children’s access,” she said. – by Alaina Tedesco

Disclosures: Ngo and Orsagh-Yentis report no relevant financial disclosures.

Children frequently ingest foreign objects — particularly during the ages of 6 months to 3 years. Although about 80% to 90% of foreign bodies pass through the gastrointestinal tract spontaneously without difficulties, some may cause serious complications and require endoscopic or surgical removal depending on the type, size and shape of the object; its location in the gastrointestinal tract; and time since ingestion, according to a review published in Clinical Endoscopy.

Research suggests that foreign body ingestions pose an increasing threat to child wellness, and they can also place a significant burden on EDs in the United States.

Uptick in foreign body ingestions

A recent retrospective analysis of a national database published in Pediatrics illustrated that this trend has dramatically escalated in the U.S., with the number of ED visits for swallowing foreign objects, such as coins, toys, jewelry and batteries, among young children nearly doubling between 1995 and 2015.

Danielle Orsagh-Yentis

Currently, the cause of the increase in foreign body ingestions is highly speculative, Danielle Orsagh-Yentis, MD, lead author of the study and a pediatric gastrointestinal motility fellow at Nationwide Children’s Hospital, told Infectious Diseases in Children.

Orsagh-Yentis suspects the reason is multifactorial, but she suggested that one plausible cause is the increased prevalence and accessibility of newer types of objects, such as button batteries, on the market.

“Kids explore the world with their mouths, so anything that is in their realm of reach is something that they could potentially ingest,” she said.

Thuy Lam Ngo

Thuy Lam Ngo, DO, MEd, assistant professor of pediatrics at Johns Hopkins University School of Medicine, hypothesizes that people are more dependent on devices and electronics, making button batteries and toys with small pieces more common — and obtainable to children — in households.

Additionally, it is possible that because the study was based on a national database, more cases were captured than have been previously recorded because coding capabilities and documentation may have improved over time, Orsagh-Yentis said.

“Nevertheless, this is a dramatic rise over time, so it is something that we as providers need to take note of,” she said. “It’s an alarming trend to say the least.”

Strain on EDs

The spike in foreign body ingestions among young children has put a strain on EDs in the country, according to Ngo, but how much of a burden depends on the type of foreign object that has been ingested and its location in the child’s body, she said.

PAGE BREAK

Lithium or button batteries are the “biggest threat,” according to Ngo. These types of batteries can cause erosion of the esophagus and thus require an emergency operation. Bigger objects, such as coins, can get stuck in the esophagus and may also need to be removed in the operating room.

“So it ends up causing a lot of strain in terms of resources not just in the ED, but in the hospital as well,” she said.

Children presenting to the ED with a foreign body ingestion will most likely receive X-rays, which also contribute to the burden, Orsagh-Yentis said.

“If we can limit some of these ingestions, that would certainly be ideal for the kids’ sake and also from a system standpoint,” she said.

Management of foreign body ingestions

When a child presents to the ED under suspicion of having swallowed a foreign body, the general practice has remained the same over the years — evaluate the child for any symptoms, perform imaging and remove the object endoscopically or surgically if necessary, according to Orsagh-Yentis.

Although there have not been many treatment advances in this area of emergency medicine, Ngo said the sharing of knowledge has streamlined the management of pediatric patients who have swallowed foreign objects.

PAGE BREAK

For example, it was previously believed that button batteries needed to be removed immediately regardless of where they were located in the body, but it is now understood that children who have ingested a button battery and do not display symptoms, including difficulty or inability to swallow, can be discharged if it is located in the stomach at the time of care, she said. Similarly, children who swallow coins and similar objects can go home if they do not have any symptoms and the object is in the stomach, she said.

In these cases, it is important for providers to talk to the family about symptoms that may require immediate return to medical care, she said.

Another area in which there has been improved understanding is the treatment of children who swallow high-powered magnets.

“If you swallow one, it’s not a big deal, but if you swallow two, the magnets can pass through the esophagus, pass through the stomach and they can adhere to each other in the intestines, cause intestinal perforation and subsequent complications related to that,” Ngo warned.

Importance of educating parents

Although the uptick in foreign ingestions is concerning for providers, these accidents are largely preventable.

“It is incumbent on us as physicians to talk about the dangers inherent in ingesting these types of objects and to educate the families we see on a regular basis,” Orsagh-Yentis said. “We need to work on discussing what may happen when a child ingests one of these objects.”

The AAP recommends that pediatricians discuss preventive medicine tactics with parents, such as safe storage and choking hazards, as part of a well-child check, according to Ngo.

“Having that discussion with parents in terms of home safety would be the most beneficial preventive care that we could do as pediatricians,” Ngo said.

PAGE BREAK

These discussions should take place whenever a child is being treated regardless of the reason for treatment, but especially when a foreign body has been swallowed or inserted in the nose or ears, according to Ngo.

“The more we talk to families about it, the more they are aware of the objects that need to be placed out of reach of their small child,” she said.

Orsagh-Yentis said safe storage includes keeping potentially ingestible and hazardous objects locked in a cabinet and/or at an unreachable height that is out of the sight of children.

She noted that certain objects cannot always be locked away or kept on an elevated surface. In these instances, vigilance is extremely important, she said.

“Caregivers need to be watching children carefully, seeing what’s available, what’s around them and what could potentially be ingested and trying to eliminate those items as much as possible from children’s access,” she said. – by Alaina Tedesco

Disclosures: Ngo and Orsagh-Yentis report no relevant financial disclosures.