A prospective study of foreign-body ingestion in 311 children

Int J Pediatr Otorhinolaryngol. 2001 Apr 6;58(1):37-45. doi: 10.1016/s0165-5876(00)00464-x.

Abstract

Objective: To determine the preferable management protocol of foreign body ingestion in pediatric patients.

Methods: All pediatric patients aged less than 12 years who presented with suspected foreign body ingestion in a hospital setting over a period of 3 years were prospectively studied. The usefulness of symptoms and various diagnostic procedures to identify the impacted foreign bodies were analyzed.

Results: Of 311 children aged 4 months to 12 years, 115 foreign bodies were encountered. The presentations in children aged younger than 5 years were markedly different from the older children, who behaved more like adults. All sharp foreign bodies (107 cases or 93%), mostly fish bones (90.4%), were found in the oropharynx under direct vision using either tongue depressor (57%), Macintosh laryngoscope (6%), indirect laryngeal mirror (2%) or transnasal flexible endoscopy (28%). Coins (eight cases or 7%) were the only foreign body impacted at or below the level of cricopharyngeus. A plain cervical X-ray has a low sensitivity (15.9%) and a high specificity (99.5%) in identifying the foreign bodies.

Conclusions: As the majority of the foreign bodies were sharp bones and situated in the oropharynx, a management protocol involving examination with a tongue depressor, transnasal laryngoscope, selective lateral soft tissue neck X-ray, chest X-ray and watchful observation is usually adequate. Removal of these foreign bodies can be accomplished using a tongue depressor and Macintosh laryngoscope. Patients with a suspected coin ingestion have to be evaluated by X-ray, and a rigid pharyngo-oesophagoscopy should be the mainstay of treatment.

MeSH terms

  • Age Distribution
  • Child
  • Child, Preschool
  • Female
  • Foreign Bodies / diagnosis*
  • Foreign Bodies / epidemiology*
  • Foreign Bodies / therapy
  • Hong Kong / epidemiology
  • Humans
  • Incidence
  • Infant
  • Laryngoscopy
  • Larynx
  • Male
  • Pharynx*
  • Predictive Value of Tests
  • Prospective Studies
  • Risk Factors
  • Sensitivity and Specificity
  • Sex Distribution