Risks of foreign body ingestion in children
DOI:
https://doi.org/10.13112/pc.1127Keywords:
Bezoars; Child; Endoscopy; Foreign Bodies; MagnetsAbstract
Foreign body ingestion is one of the most common pediatric gastroenterological emergencies. Most cases resolve spontaneously and without consequences; however, some foreign bodies may cause serious complications, including obstruction, perforation, chemical injuries to the gastrointestinal tract, infections, and, in rare cases, death. The associated risks depend on the child’s age, the type of object, and its location within the gastrointestinal tract. The greatest risk of severe injury and complications is posed by button batteries, which can cause severe oesophageal chemical injury within just two hours of ingestion, as well as multiple magnets, which can lead to bowel necrosis and fistula formation. Sharp objects carry a risk of perforation, while long and large objects often remain lodged in the stomach or duodenum. In the presence of symptoms such as pain, vomiting, dysphagia, hypersalivation, or dyspnea, appropriate diagnostic and therapeutic management is required. Risk assessment and therapeutic decision-making are based on the type, size, and location of the foreign body, the child's clinical presentation, their age, and the time elapsed since ingestion. Given the potential for serious outcomes, a strong preventive component is also necessary, including parental education, product safety regulation, and public health campaigns. Timely recognition and intervention, along with preventive measures, are essential to reducing morbidity and mortality associated with foreign body ingestion in childhood. This review article aims to highlight the importance of prompt and accurate diagnosis, as well as an appropriate therapeutic approach, for foreign body ingestion to prevent and reduce adverse outcomes in this clinical entity.
References
1. Demiroren K. Management of Gastrointestinal Foreign Bodies with Brief Review of the Guidelines. Pediatr Gastroenterol Hepatol Nutr. 2023;26:1–14.
2. Kramer RE, Lerner DG, Lin T, Manfredi M, Shah M, Stephen TC, et al. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr. 2015;60:562–74.
3. Mubarak A, Benninga MA, Broekaert I, Dolinsek J, Homan M, Mas E, et al. Diagnosis, Management, and Prevention of Button Battery Ingestion in Childhood: A European Society for Paediatric Gastroenterology Hepatology and Nutrition Position Paper. J Pediatr Gastroenterol Nutr. 2021;73:129–36.
4. Vuković J, Perica M, Paležac L, Dujšin M, Grizelj R, Omerza L, Filipović Grčić B, Brkić T, Pulanić R. Ingestija stranog tijela u djece - šestogodišnje iskustvo. Paediatr Croat. 2012;273–7.
5. Karišik M. Foreign body aspiration and ingestion in children. Acta Clin Croat. 2023;62:105–12.
6. Speidel AJ, Wölfle L, Mayer B, Posovszky C. Increase in foreign body and harmful substance ingestion and associated complications in children: a retrospective study of 1199 cases from 2005 to 2017. BMC Pediatr. 2020;20:560.
7. Lalith S, Gopalakrishnan KL, Ilangovan G, Jayajothi A. Rapunzel Syndrome. J Clin Diagn Res. JCDR 2017;11:TD01–2.
8. Quitadamo P, Anselmi F, Caldore M, Caruso F, Bucci C, Del Monaco C, et al. Foreign body ingestion in children: Beware of disk batteries and multiple magnets. Acta Paediatr. 2021;110:2862–4.
9. Knežević M, Kolja Poljak N, Knežević D, Poljak N. Promjena trenda u pristupu liječenju stranih tijela jednjaka u Kliničkom bolničkom centru Split. Medica Jadertina. 2023;173–80.
10. Waltzman ML. Management of esophageal coins. Curr Opin Pediatr 2006;18:571–4.
11. Gurevich Y, Sahn B, Weinstein T. Foreign body ingestion in pediatric patients. Curr Opin Pediatr. 2018;30:677–82.
12. Eyring JB, Hemeyer BM, Walker S, Allen WP, Liang S, Stewart C, et al. Button Battery Ingestion: Exploring Socioeconomic Risk Factors. Otolaryngol Neck Surg. 2025;173:96–105.
13. Festa NT, Thakkar H, Hewitt R, Dhaiban M, Muthialu N, Cross K, et al. Foreign body ingestion during the COVID-19 pandemic: a retrospective single centre review. BMJ Paediatr Open. 2021;5:e001042.
14. Wu W, Lv Z, Xu W, Liu J, Sheng Q. An analysis of foreign body ingestion treatment below the pylorus in children. Medicine (Baltimore). 2017;96:e8095.
15. Gregori D, Scarinzi C, Morra B, Salerni L, Berchialla P, Snidero S, et al. Ingested foreign bodies causing complications and requiring hospitalization in European children: results from the ESFBI study. Pediatr Int. 2010;52:26–32.
16. Brumbaugh DE, Colson SB, Sandoval JA, Karrer FM, Bealer JF, Litovitz T, et al. Management of button battery-induced hemorrhage in children. J Pediatr Gastroenterol Nutr. 2011;52:585–9.
17. Paediatric Surgery Trainee Research Network, Neville JJ, Harwood R, Bethell GS, Rhodes H, Arthur F, et al. Magnet and button battery ingestion in children: multicentre observational study of management and outcomes. BJS Open. 2022;6:zrac056.
18. Khalaf RT, Ruan W, Orkin S, Wilsey M, Fishman DS, Mallon D, et al. Gastric injury secondary to button battery ingestions: a retrospective multicenter review. Gastrointest Endosc. 2020;92:276–83.
19. Litovitz T, Whitaker N, Clark L, White NC, Marsolek M. Emerging Battery-Ingestion Hazard: Clinical Implications. Pediatrics. 2010;125:1168–77.
20. Safavi AR, Brook CD, Sakai O, Setty BN, Zumwalt A, Gonzalez M, et al. Urgency of Esophageal Foreign Body Removal: Differentiation Between Coins and Button Cell Batteries. Otolaryngol Head Neck Surg. 2022;166:80–5.
21. Anfang RR, Jatana KR, Linn RL, Rhoades K, Fry J, Jacobs IN. pH-neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury. Laryngoscope. 2019;129:49–57.
22. Akilov KA, Asadullaev DR, Yuldashev RZ, Shokhaydarov SI. Cylindrical and button battery ingestion in children: a single-center experience. Pediatr Surg Int. 2021;37:1461–6.
23. Middelberg LK, Leonard JC, Shi J, Aranda A, Brown JC, Cochran CL, et al. High-Powered Magnet Exposures in Children: A Multi-Center Cohort Study. Pediatrics. 2022;149:e2021054543.
24. Otjen JP, Rohrmann CA, Iyer RS. Imaging pediatric magnet ingestion with surgical-pathological correlation. Pediatr Radiol. 2013;43:851–9.
25. Mandhan P, Alsalihi M, Mammoo S, Ali MJ. Troubling Toys: Rare-Earth Magnet Ingestion in Children Causing Bowel Perforations. Case Rep Pediatr. 2014;2014:1–4.
26. Amil‐Dias J. Diagnosis and management of eosinophilic esophagitis in children: An update from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr 2024;79:394-437.
27. Smith CR, Miranda A, Rudolph CD, Sood MR. Removal of impacted food in children with eosinophilic esophagitis using Saeed banding device. J Pediatr Gastroenterol Nutr. 2007;44:521–3.
28. Reeves PT, Trappey AF, Smalley R, Pieroni K, DeVito J. A protocol to guide diagnosis and management of water bea.d ingestions. J Pediatr Gastroenterol Nutr. 2025;1–3. doi:10.1002/jpn3.70140.
29. Eng K, Kay M. Gastrointestinal Bezoars: History and Current Treatment Paradigms. Gastroenterol Hepatol. 2012;8:776–8.
30. ESPGHAN. ESPGHAN Button Buttery Awareness Day; 2025. [Internet]. [citirano 10. lipanj 2025.]. Dostupno na: https://www.espghan.org/knowledge-center/education/ESPGHAN-BBI-Awareness-Day-2023
31. Duracell. Duracell specialty 2032 Lithium coin battery 3V; 2025. [Internet]. [citirano 10. lipanj 2025.]. Dostupno na: https://www.duracell.co.uk/product/lithium-coin-2032-batteries/
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Copyright (c) 2026 Iva Matičević, Ivan Jakopčić, Matea Kovačić Perica, Branka Runtić Jurić, Ivana Todorić, Mirna Natalija Aničić, Lana Omerza, Duška Tješić-Drinković, Irena Senečić-Čala
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