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Swallowed objects in children

Dr.Prathibha Sukumar, Consultant Paediatric Surgeon, Sut Hospital Pattom

Children accidentally swallowing objects is a very common occurrence

Why does it happen?

Very young babies explore their surroundings with all their senses including sense of taste and “mouthing” that is putting objects in their mouth. Accidentally very small objects can enter their mouth and get swallowed.

Older children put objects in their mouth put of curiosity or as part of games. The unusual tingling sensation felt on licking a button battery makes them do this repeatedly. Due to the small size and smooth surface,  the battery can then slide down the throat.

Which are the dangerous objects?

Obviously sharp objects like sewing needles, open safety pins, nails, pins, screws, fish bones, etc. can cause severe injuries to the mouth, food pipe and stomach lining.

However, the most dangerous object is the button battery or button cell. Due to its smooth surface and small size, it can pass into food pipes easily. Owing to its method of discharging current, electrical burns occur on all the lining surfaces it touches. It can get stuck in the food pipe and cause the formation of a hole through all its layers. It can even burn through into the windpipe which lies just next to the food pipe causing injuries there also.

Other objects like coins, buttons, beads, stones, marbles, large seeds, etc.. can cause retching due to size. Magnets and metallic objects and large stones may also cause injuries.

How to identify?

Older children may come and tell about the accidental swallowing. But due to fear they may try to hide it. Parents should always be suspicious and periodically check the toys for any parts which may be missing.  The child may start choking while playing or may have drooling of saliva. They will be unable to swallow, may retch or vomit. X-rays can pick up metallic objects. Plastic, and rubber objects will not be seen through.

What first aid to give?

If a child is choking, place the child facedown and pat firmly just below the shoulder blades. Objects might get pushed out. If an object which is not sharp is seen outside mouth, try to pull it out gently. If it is a sharp object, do not try to remove. If child is not having difficulty in breathing, keep the child calm while taking child for treatment.

What not to do?

Do not put finger in mouth to try to remove object if object is not seen as it may push it deeper. Do not try to remove sharp objects or objects which seem to be stuck. Do not give child any liquids or solid food to drink or eat. They may choke.

What is the Treatment?

Sharp objects and dangerous ones like button batteries may need to be removed surgically or by endoscopy. Other swallowed objects are managed based on what the object is and its location. Some can be followed up until they get passed out of the intestine naturally.

Some may need surgical removal. Always remember “Prevention is better than cure!”