Young children and toddlers are at the highest risk for swallowing and/or aspirating foreign bodies because of their normal behavior of exploring the world with their mouths. In some instances a history to support a diagnosis of swallowed/ aspirated foreign body may be available... either through direct observation or that of a child playing with small things or eating suspect foods (e.g. nuts, hot dogs, popcorn). In such cases, a parent will observe a child placing an object in the mouth, or in the case of an aspiration, beginning to cough, choke, or gag. However, most children are not directly observed, and a high index of suspicion is required. Prevention through safe practices is important as 80% of aspirations occur in children less than 3 years old. There are an estimated 500 deaths annually in the U.S. due to asphyxiation.

Aspiration may be of a liquid substance, but this is unusual in the neurologically intact child. The more common emergent aspiration is that of food. Oftentimes, small foodstuffs such as nuts or seeds are swallowed inappropriately by a developing toddler. Small toy parts or objects are also culprits. The foreign object lodges on the right side almost twice as often as the left. Symptoms of respiratory difficulty may vary from absent to acute, emergent asphyxia.

Swallowed foreign bodies are also more common in children. Very common objects include coins, small batteries, and food.

As most objects are radiopaque, a chest film often locates the suspected part. If a suspected object is radiolucent, a thin barium swallow may be performed to help locate it. Frequently these may lodge in the esophagus at either the level of the thoracic inlet, the area where the esophagus crosses the aorta, or the gastroesophageal junction.

Symptoms can be myriad, and may range from refusal to eat solids, drooling, vomiting (should not be induced), dysphagia (generally, an older child can localize a foreign body trapped above the thoracic inlet but not if trapped below), cough exacerbated by feeds, or no symptoms may be present at all. Fewer than 20 percent will have any abnormalities on physical examination so that the diagnosis depends on radiography.

If the object has been located in the esophagus and is causing no difficulties, it may be observed for 24 hours. Sedation may aid in its passage.

If it has not passed into the stomach within 24 hours, it should be removed endoscopically as mucosa may grow over the object and impede its removal over time. The exception to this rule is the known ingestion of a button disc battery. These should be removed as soon as possible even if asymptomatic as tissue damage has been known to occur as quickly as 4 hours post-ingestion.

Pieces of meat or other foods may be aided with meat tenderizer after 12 hours although this is controversial as they may damage the esophagus themselves. Disk batteries greater than 15 mm and lodged in the stomach should be considered for removal. Otherwise, a trial of passage should be given for 24 hours.

Other objects considered for removal in the asymptomatic patient include sharp objects or those that are long and narrow, as these may be better removed electively rather than risk the chance of intestinal perforation. If not removed, progress of these objects should be noted with serial films every 3-5 days and stool straining.