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Quick reference medical handouts used by Pediatric offices


Swallowed coins


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see also: You Swallowed What?

 

As children explore the world, it is inevitable that they will put foreign bodies into their mouths and swallow some of them and coins are the most commonly swallowed objects.  Swallowed coins, if they make it to the stomach, are almost always passed through the GI tract and excreted. However, there are a few narrow points where a coin can get stuck, and present a problem. The large majority of children who ingest foreign bodies are between six months and four years of age. This reflects small children's use of their mouths to explore the world. However, children of all ages ingest foreign bodies.    

 
Symptoms of esophageal foreign bodies
  • difficulty swallowing

  • food refusal amd weight loss

  • drooling

  • vomiting / vomiting blood

  • feeling of foreign body in throat

  • chest pain

  • sore throat

  • stridor and cough

  • unexplained fever

The three most likely locations for a coin to get stuck are at the thoracic inlet (in the esophagus right behind the upper notch in the sternum), at the cardiac level in the esophagus (a slight narrowing due to pressure on the esophagus from the heart), and at the lower esophageal sphincter (the ““valve”” at the top of the stomach that helps keep stomach contents from refluxing upwards).

 

Surprisingly, a coin can become trapped in these locations and be asymptomatic for weeks. A child can continue to swallow and eat. Usually, if symptoms are present, they are in the form of a lingering cough, as the esophagus presses on the soft rear-portion of the trachea and irritates the cough receptors. The longer the coin is trapped the higher the risk. The greatest risk it that in time, due to inflammation and irritation of the esophageal tissues, the esophagus can rupture, leaking infectious material into the mediastinum, the space where the heart and great vessels are located. I nfection of the mediastinum, mediastinitis, is associated with a very high fatality rate. It is therefore prudent in the case of suspected coin swallowing to obtain a chest, and possibly abdominal, x-ray to confirm that the coin is not trapped. If the coin has passed into the stomach then observing the child for passing the coin is usually the course of action. Rarely coins do become trapped in the intestines, requiring surgical intervention. Swallowed button batteries present a particularly hazardous risk as the contents of these batteries can result in rapid erosion of the esophageal wall, causing mediastinitis. Extreme care should be taken to keep such batteries away from small children.

 

Change that makes its way into the stomach is best left to continue its journey through the digestive tract, which takes two to five days. But if the coin is lodged in the esophagus, the organ that connects the mouth to the stomach, it needs to be retrieved. Trapped coins can obstruct the passage of food or even perforate the wall of the esophagus. In most medical centers, swallowed coins are removed with the aid of an endoscope, a thin tube equipped with forceps, a light, and a tiny camera lens.

 

Is there any way to prevent coin ingestion? Short of spending all of your change, the best way to keep a little money-grubber from eating his future allowance is to supervise him closely. But since constant vigilance is impossible, it is important to keep coins safely out of reach —— on an inaccessible surface, say, or in a childproof drawer. Another option: Designate a secure piggy bank for those pennies. After all, it’s never too early to start saving for college

posted 07-11-07

 

As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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