Paeds · acute-care-resuscitation-and-toxicology
Oesophageal and gastrointestinal foreign-body ingestion
Also known as Foreign-body ingestion · Button battery ingestion · Coin ingestion · Magnet ingestion · Oesophageal food bolus impaction
A fellowship approach to the child who has swallowed a foreign body. The single decision that changes everything is whether a button battery or a complete oesophageal obstruction is lodged in the oesophagus, because both demand emergency endoscopic removal within two hours. Use a plain anteroposterior chest and abdominal radiograph with a lateral view to identify batteries and magnets, apply NASPGHAN and ESPGHAN urgency categories for every other object, observe blunt gastric objects that are below threshold size, and consult early for sharp, long, multiple-magnet and button-battery ingestions.
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Target exams
Red flags
- A button battery lodged in the oesophagus is a time-critical emergency requiring endoscopic removal within two hours, because alkaline necrosis can perforate within hours and cause aorto-oesophageal fistula days later
- Complete oesophageal obstruction with inability to swallow secretions, drooling and distress needs emergency endoscopy within two hours for aspiration risk
- Haematemesis, melaena or massive haemorrhage after a known or suspected battery ingestion signals aorto-oesophageal fistula until proven otherwise, even days after removal
- Two or more magnets, or a magnet with a metal object, anywhere in the gastrointestinal tract can inter-lock across bowel walls and cause pressure necrosis, fistula, volvulus and perforation
- Sharp objects lodged in the oesophagus or stomach, and objects longer than 6 cm or wider than 2.5 cm, require urgent endoscopic or surgical removal rather than observation
- Fever, severe abdominal pain, peritonism, persistent vomiting or signs of obstruction after any ingestion mean perforation or obstruction until imaging and surgical review say otherwise
Life stages
Care settings
Clinical exam formats
Board mappings
- Acute Care
- Current 2026 PREP curriculum — Learning Objective 2.4.4: Assess and manage infants, children and young people with potential cardiac, respiratory or neurological emergencies or acute sepsis
- Current 2026 PREP curriculum — Learning Objective 2.2.1: Recognise, prioritise and manage an acutely ill infant, child or young person
- Renewed curriculum for first-year trainees from 2027 — Learning goal 11: Acute care and procedures
- Renewed curriculum for first-year trainees from 2027 — Learning goal 6: Gastroenterology
- Clinical Applications
- Medical Sciences
- Long Cases
- Short Cases
- 4. Professional skills and knowledge: Patient management
- 7. Patient safety, including safe prescribing
- General Paediatrics: Manages common acute presentations in infants, children and young people
- Gastroenterology: Recognises and manages foreign body and caustic ingestion
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Clinical
- Communication
- General Pediatrics Content Outline — Domain 7: Emergency and Critical Care
- General Pediatrics Content Outline — Universal Task 3: Diagnosis
- General Pediatrics Content Outline — Universal Task 4: Management and Treatment
- Patient Care 4: Clinical Reasoning
- Patient Care 5: Patient Management
- Systems-Based Practice 1: Patient Safety
- Medical Expert
- Pediatrics: Core EPA #5 — Performing common procedures
Overview & Definition
A four-year-old is brought in after swallowing a coin. The clinical question is not whether to remove it, but where it sits, what it is, and how quickly it must come out. Foreign-body ingestion means any object swallowed into the gastrointestinal tract, and the practical classification is built around the objects that kill or main children when managed by a generic observe-and-wait rule. [1] [11]
Three object types override any observation strategy. A button battery lodged in the oesophagus generates hydroxide ions by electrolysis of tissue fluid, creating a local alkaline burn that can perforate within hours. Multiple magnets, or a magnet paired with a metal object, can trap bowel walls between them and cause pressure necrosis, fistula, volvulus and perforation. Sharp objects such as pins, needles and safety pins can perforate anywhere along the tract. Each of these has its own timing rule. [3] [6] [8]
The site of lodgement matters as much as the object. The oesophagus has three classic narrowing points where objects lodge: the cricopharyngeus at the thoracic inlet, the aortic arch and carina crossing, and the lower oesophageal sphincter. About two thirds of oesophageal coins lodge at the thoracic inlet. An object that has passed the pylorus usually transits spontaneously, with the exception of sharp, long or magnetic objects. [1] [11]
References12ShowHide
- [1]Kramer RE, Lerner DG, Lin T, et al. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee Journal of pediatric gastroenterology and nutrition, 2015.PMID 25611037
- [2]Oliva S, Romano C, De Angelis P, et al. Foreign body and caustic ingestions in children: A clinical practice guideline Digestive and liver disease, 2020.PMID 32782094
- [3]Mubarak A, Benninga MA, Broekaert I, et al. Diagnosis, Management, and Prevention of Button Battery Ingestion in Childhood: A European Society for Paediatric Gastroenterology Hepatology and Nutrition Position Paper Journal of pediatric gastroenterology and nutrition, 2021.PMID 33555169
- [4]Litovitz T, Whitaker N, Clark L Preventing battery ingestions: an analysis of 8648 cases Pediatrics, 2010.PMID 20498172
- [5]Tran C, Nunez C, Eslick GD, et al. Complications of button battery ingestion or insertion in children: a systematic review and pooled analysis of individual patient-level data World journal of pediatrics, 2024.PMID 39168931
- [6]Quitadamo P, Gragnaniello P, Isoldi S, et al. Magnetic foreign body ingestion in pediatric age Digestive and liver disease, 2024.PMID 37985250
- [7]Mantegazza C, Ferraro S, Biganzoli D, et al. Foreign body ingestion in children: Definition of a nomogram to predict surgical or endoscopic intervention Digestive and liver disease, 2024.PMID 37586909
- [8]Leinwand K, Brumbaugh DE, Kramer RE Button Battery Ingestion in Children: A Paradigm for Management of Severe Pediatric Foreign Body Ingestions Gastrointestinal endoscopy clinics of North America, 2016.PMID 26616899
- [9]Park SJ, Burns H Button battery injury: An update Australian journal of general practice, 2022.PMID 35773156
- [10]Whelan R, Shaffer A, Dohar JE Button battery versus stacked coin ingestion: A conundrum for radiographic diagnosis International journal of pediatric otorhinolaryngology, 2019.PMID 31404782
- [11]Gurevich Y, Sahn B, Weinstein T Foreign body ingestion in pediatric patients Current opinion in pediatrics, 2018.PMID 30036203
- [12]Eliason MJ, Ricca RL, Gallagher TQ Button battery ingestion in children Current opinion in otolaryngology and head and neck surgery, 2017.PMID 28858893