Ingestion of foreign bodies and caustic substances in children

Question 1

Red flag features with ingestion of foreign bodies in children

Answer 1

• Caustic substance
• Batteries
• Magnets
• Sharp objects
• Large objects (>6cm long or >2.5cm wide)
• Super absorbent polymers (risk of obstruction)
• Lead containing substances
• Medications, plants or illicit drugs

Question 2

Examination of a child with an ingested foreign body

Answer 2

Airway
- Coughing, choking, respiratory distress or stridor
- Examine the oral cavity: ulcerations, lacerations, bleeding points, swelling

GI
- Drooling, dysphagia
- Abdominal tenderness
- Odynophagia

Systemic
- Sepsis
- Signs of systemic poisoning

Question 3

Mechanism of injury following caustic substance ingestion

Answer 3

• pH <2 or >11
• Strong bases tend to be tasteless, they adhere to local mucosa and cause severe ulceration
• Acids are irritant and will cause choking and gagging, they cause a necrotic coagulopathy
• Both can cause laryngeal oedema and airway compromise

Question 4

Management of child with caustic substance ingestion injury

Answer 4

• Early intubation is gold standard, likely to be difficult, will need ENT support
• IV steroids
• OGD to assess GI damage
• Antibiotics if perforation
• May need tracheostomy

Question 5

Mechanism of injury following button battery ingestion

Answer 5

• The negative pole of the battery generates hydroxide ions leading to localised caustic injury
• Generally occurs when the battery gets lodged in the oesophagus leading to the accumulation of the alkali substance
• Pressure necrosis can also occur

Question 6

Management of child following button battery ingestion

Answer 6

• Ascertain type and size of battery if possible
• CXR and AXR
• Removal within 2 hrs if battery is lodged in the oesophagus, patient is symptomatic with battery in stomach, ingestion of battery and magnet, known GI abnormality such as Meckel’s

Question 7

Mechanism of injury following magnet ingestion

Answer 7

• High risk if neodymium magnets, or co-ingested with another metallic object, large magnets or multiple
• Can lead to obstruction and pressure necrosis in the small bowel
• Bowel perforation