The study purpose was to determine the ability of hand-held metal detectors (HHMDs) to identify the presence of ingested metallic foreign bodies (MFBs). Twenty-three children presenting to the emergency department with a complaint of MFBs ingested were enrolled. Sixteen of 23 patients had radiographically proven foreign bodies. The MFBs comprised coins (n = 11), a button battery (n = 1), a medallion (n = 1), a token (n = 1), a needle (n = 1), and a marble (leaded glass) (n = 1). The HHMD correctly detected 15 of 16 radiographically positive MFBs (93%) and correctly excluded a potential MFB in six of six radiographically negative cases. The only foreign body not detected was an ingested needle. One radiograph was equivocal. Radiographic localization of the ingested objects was as follows: esophagus, n = 4; stomach, n = 9; and intestines, n = 3. The HHMD correctly localized all detected MFBs. The HHMD had a sensitivity of 94%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 86%. HHMDs are effective screening devices for possible ingested MFBs. Positive studies localized to the stomach and lower gastrointestinal tract do not require confirmatory radiographic studies.