Small children are like human vacuum cleaners. Everything goes in their mouths - toys, coins, paper, plastic (along with some objects too disgusting to mention). I have often felt that if my own home vacuum was ever broken, I could just take any 1-2 year old toddler, hold him up by both legs, and scour my floors clean by walking him throughout the house.
It is an unusual week that I don't see a toddler brought in to the emergency room because of concerns over what they swallowed. Coins are the most common, following by metal or glass. Parents are frequently quite anxious, worried that the object will become trapped in the GI tract, or worse, tear things up while on the way out.
Which brings up the question - what objects are actually harmful? Let's test your knowledge. Answer the following two questions, and see if you qualify as a swallowed foreign body expert.
Which of the following objects is the least dangerous to your child if they happen to swallow them?
1. A piece of broken glass
2. An aluminum pop-top ring
3. A plastic Lego piece
4. A straight pin
Answer: This is a trick question, because none of these objects are very dangerous. (I can anticipate your reaction already. None of them? Not even broken glass or a straight pin? Are you crazy?? How can that be?)
Once an object gets into the stomach, it is passed through the astonishing length of the small and large intestine via an action called peristalsis. Peristalsis is a slow, rhythmic contraction, designed to move food and drink through the GI tract, allowing the re-absorption of water and nutrients, before expelling what's left over as waste. Non-food items, like broken glass, become enveloped by the food-stool mixture, as this journey proceeds. Furthermore, the inner wall of the intestine is smooth and coated with thick mucous, so that even if the object is sticking out or exposed, it rarely injures the bowel as it slimes its way along.
Could a pin, glass, or other sharp object, if jutting out from the stool, cut the anus as it leaves the body? It's possible, but very unlikely.
2. Which of the following objects, if swallowed, requires an urgent evaluation by a physician?
1. An unknown pill or medicine
2. A coin
3. A disk battery
4. A piece of a balloon
No tricks here. All four of these items are potentially harmful, and require an evaluation.
First, unknown medicines. Obviously, some medicines, particularly those found in grandma's handbag, could be a problem. Adult medicines come in adult dosages increasing the risk to your child. So when in doubt, have your little one checked out immediately if you suspect an ingestion of medicine. Take some reassurance in knowing that most pills taste terrible, and toddlers rarely chew up and swallow a single whole pill, preferring to spit it out in favor of more delectable floor items.
Coins are a straightforward matter. If the coin makes it into the stomach, it will make it into the toilet or diaper. However, occasionally, the coin gets lodged in the esophagus. If it stays stuck, it can erode through the wall of the esophagus, and create a true emergency. But take heart - this eroding process doesn't happen overnight. If an X-ray reveals that the coin is lodged in the esophagus, a GI specialist goes in with a fiber-optic scope and removes it in a fairly simple and safe procedure.
Disk batteries present a unique risk. If a disk battery gets stuck in the esophagus, it can leak out its caustic chemicals with potentially dangerous consequences. (Surprisingly enough, the bowel tolerates even leaky batteries just fine.) Any ingestion of a disk battery requires an immediate physician evaluation, just to be certain that it has made it into the stomach or intestine.
The blow-up end of rubber balloons, particularly the hard rubber ring, is an object that bears particular concern. These lodge easily deep in the throat, and threaten to completely block the airway if not removed quickly.
One final caution - rarely, a swallowed object goes down the wrong tube. It gets inhaled past the vocal cords and into the trachea, rather than swallowed. Or like the balloon piece, can get stuck in the deeper recesses of the throat. The results are usually quite obvious. Instead of breathing softly, the child will cough, choke, wheeze, or vomit. Whereas a child who has swallowed a coin or plastic toy is likely happy and acting normal, a child with the same object lodged in their trachea or bronchi will appear distressed and often with respiratory difficulty. If you suspect such a problem, head for the nearest ER.
Did you hear the one about the mother that brought her toddler into the doctor?
Doctor: What's wrong with Billy?
Mom: He swallowed a nickel yesterday, but I found a quarter in his poop today? What should I do?
Doctor: Keep feeding him nickels.
But in addition to feeding him nickels, make sure the coins make it quickly into the stomach. And if I may add a personal comment . . . for me . . . digging through my child's diaper for a nickel-turned-into-a-quarter was just not worth the twenty-cent profit.
