What is the initial goal of emergency department (ED) management of pediatric foreign body ingestion?

Updated: Oct 04, 2018
  • Author: Gregory P Conners, MD, MPH, MBA, FAAP, FACEP; Chief Editor: Dale W Steele, MD, MS  more...
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Answer

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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