The Other Side of The Coin

One day, a mother brought her young child into the clinic because of a sore throat. The child was a toddler and not very communicative, but the mother inferred that her child had a sore throat because she was not eating well. She had not been eating well for a couple days and there were no other symptoms. Her exam was completely normal, but her mother and I noticed that the young girl was drooling. She was too old to blame the drooling on teething, so it was suspicious. Part of the evaluation included a chest x-ray that revealed the culprit. She had swallowed a coin and it was stuck in her esophagus!

There are many things that children put in their mouths, besides the expected food and drink. I often see parents bringing their children to be evaluated because of a suspected object that has been swallowed. However, sometimes no ingestion event is witnessed and a child comes in with non-specific symptoms that may only suggest and not confirm a foreign body has been ingested. Coins are amongst the most common objects that are swallowed by young children.

The importance of this story is that the coin became lodged in the esophagus and did not pass into the stomach. Most ingested foreign objects will pass through the gastrointestinal tract without any issues. But, there are instances where they do get stuck and cause problems. An object that is stuck in the esophagus can cause a pressure injury to the lining of the esophagus and, possibly, tear a hole in the esophagus. These objects require prompt removal, especially if a child is symptomatic. One review stated that, “coins, magnets, sharp foreign bodies, or food impaction in the esophagus all mandate removal within 2 hours if the children’s secretions cannot be controlled. In asymptomatic children, they may be removed within 24 hours.”

The little girl in this story was sent to the emergency room. The coin was removed from the esophagus with a special endoscope in the operating room. There were no complications and she did well. A major takeaway from this story is that one always needs to keep a high index of suspicion for a swallowed foreign object, even if there is not a clear history of one being swallowed.

Has your child, or someone's child that you know, ever swallowed a foreign object? What was it?