Oesophageal button battery and the choking toddler

(i) Battery vs coin and time target. On AP radiograph a battery shows the double-ring / halo sign; on lateral a step-off. A coin is a uniform disc without step-off. An oesophageal button battery is removed by OGD within 2 hours because electrolytic liquefaction necrosis progresses within hours toward full-thickness injury and aortoesophageal fistula risk.^[1][3]

(ii) Bridge and definitive care. Nil by mouth for solids if obstructed; urgent endoscopy team. Tissue-protective honey/sucralfate bridge may be considered within 12 hours of ingestion where the child can swallow safely (dose, formulation and age eligibility per local protocol). These do not replace emergent removal. After removal admit and watch for delayed fistula (sentinel bleed).^[2][3][5]

(iii) Choking and aspiration. Infant under 1 year: up to five back blows then five chest thrusts (no abdominal thrusts); child over 1 year: back blows alternating with abdominal thrusts — per current first-aid guidelines and local protocol (review: paediatric choking evidence low-quality and divergent). Never blind finger sweep. If stable with suspected aspirated FB: oxygen, calm, NBM, call paediatric anaesthesia/ENT for rigid bronchoscopy (diagnostic and therapeutic gold standard); normal CXR does not exclude radiolucent FB.^[4][6]