Swallowed Object

Call the doctor if your child has swallowed a foreign object.

• Buttons, button batteries, pins, fishbones, balloons: All these items and more are swallowed by adults and children by accident or on purpose.

What should I do about a swallowed object?

• Parents of infants and toddlers are most likely to seek medical attention. Children in this age group are curious and often eat inedible materials such as dirt and coins, and also have trouble swallowing some common foods.
• Older children and adults may swallow objects to seek attention or may have trouble with the anatomy of their esophagus leading to a blockage after eating a normal meal.
  • A swallowed object that blocks the airway is a true medical emergency. If the person is not breathing, call 911 for this medical emergency immediately.
  • Most swallowed objects pass through the body and out in a bowel movement without any medical intervention.

• Infants and toddlers' curious and oral nature draws them to put objects into the mouth. Children in this age group also are unable to adequately chew common foods such as peanuts and hot dogs.
• Older children and adults may eat inedible items to seek attention or as a result of a psychiatric condition.
• A medical condition may cause the esophagus to narrow, which causes food to become stuck in the esophagus.

Most swallowed objects cause no symptoms at all, while some objects cause immediate choking and vomiting.

Depending on the texture of the item, such as a toy, there may be some local pain or bleeding in the back of the throat.

If something gets stuck, several symptoms may occur:

• Drooling
• Vomiting
• Painful swallowing
• Pain in the chest or throat
• Gagging

Unrecognized items ingested and stuck may lead to these symptoms:

• Refusal to feed in infants
• Weight loss and malnutrition
• Vomiting blood
• Blood in the stool
• Severe chest infection

When any nonfood item is swallowed, call a doctor. A description of the item should be given.

• If no symptoms are present and the doctor is comfortable with the situation of the patient, a routine visit to the office may suffice.
• If the person has any symptoms, or the object swallowed is concerning to the physician, the doctor will probably refer the patient to the emergency department.

If any symptoms continue and won't go away after swallowing an object or large piece of food, go to the local emergency department. If you have a similar object to the one swallowed, bring it along to help the doctor determine what type of object may be causing the blockage.

The doctor will take a complete history and will specifically want to know what was swallowed, when it was swallowed, and any symptoms the patient has. A physical examination will focus on the mouth, throat, and lungs. The doctor may perform one or more of the following tests:

• X-rays of the neck, chest, and abdomen may be performed to help locate any objects that will show up in this format, such as coins, batteries, metal toys, and bones.
• Enhanced X-rays with barium may be used to help locate stuck objects not seen on regular X-rays.
• The doctor may make a direct inspection of the area above the voice box with a special fiber optic light or indirect inspection with a dental mirror. These procedures require a cooperative patient.
• Direct visualization with a fiber optic scope (endoscopy) may be needed to see objects in the esophagus. This is procedure is usually performed in a short procedure unit or in the operating room.

If the object swallowed causes choking, basic first aid is essential. If someone is choking and can make noise or speak, do not attempt the abdominal thrusts. Give the person a chance to clear the object. Once it is apparent that the airway is clear, there is little that can be done at home. Reassurance will help an anxious child or adult.

• The physician may conclude that the object swallowed only caused minor trauma to the throat or esophagus and ask the patient to eat or drink something. If this can be done without difficulty or pain, he or she may be discharged with instructions including warning signs of any complications.
• If an object is seen in the back of the throat on visual inspection, the doctor may attempt to remove it. A local anesthetic can be sprayed to make removal more comfortable. The physician will simply grab the object with forceps and remove it.
• If the object is seen around the area of the voice box, immediate removal is required. This procedure is rarely done in the emergency department. Commonly, an ear, nose, and throat specialist (ENT) removes the object in the short procedure unit or in the operating room.
• Objects, including food, stuck in the esophagus must be removed. A gastroenterologist perform this using a fiber optic scope. No operation is needed. Occasionally, a foreign body in the upper esophagus can be removed by placing a catheter below the object. A balloon is then inflated, and the object is lifted out of the mouth.
• For objects, especially food, stuck in the esophagus, medicine therapy may be tried. Medications such as nitroglycerine given under the tongue and glucagon given by IV can relax the esophagus and allow passage of the food to the stomach. An IV catheter is required for this. The success rate is poor with this procedure.
• Swallowed objects that make it to the stomach usually pass in the stool without difficulty. Special consideration must be given to objects such as button batteries and sharp objects such as pins and bones. These usually pass without consequence, but occasionally they get stuck somewhere in the digestive tract.

Items stuck for a longer period of time lead to erosion of the esophagus. These usually make the patient very ill. Once erosion occurs, surgery is needed to remove the item and to repair any damage and prevent further erosion and infection.

Follow-up with a doctor or a specialist is recommended. Some objects retained inside the body need to be monitored with periodic X-rays to be sure they come out. A full evaluation of the esophagus is necessary after removal of an object from that area. This ensures that the anatomy of the esophagus is normal. Generally, a routine follow-up is all that is needed. Complications from swallowed objects are, the exception not the rule.

• Keep small objects, including coins, toy parts, and button batteries, out of the reach of small children.
• Cut food into appropriate sizes for both adults and children.
• If adults are having progressive difficulty swallowing solids, a liquid or puree diet will help with symptoms until medical attention can be obtained.

With early recognition and removal, most people recover well after swallowing something they should not, or if an object becomes stuck.

• Some people who get food lodged in their esophagus must then undergo further testing to ensure there is no correctable narrowing or cancer of the esophagus.
• Foreign bodies not removed must be monitored with periodic x-rays to ensure they have moved through and out of the body. This is especially true for button batteries and sharp objects. Coordination with the family doctor is imperative.