That's Not A Piggy Bank!

This week's guest columnist is Dr. Christopher Clark, a Family Practice resident at the University Hospital and Clinics here in Lafayette. The saying "Find a penny, pick it up; all day long you'll have good luck" doesn't always apply, especially for one 5 year-old girl in the Pediatric Emergency Department. She was playing with some coins, inspecting them closely, even putting them in her mouth to taste them.  Then one hard swallow, and she felt something wrong, besides being "short changed."  Uh-oh! Kids put foreign objects (as we call them) in any place they can- ears, noses, and mouths. Infants and toddlers particularly like to explore with their mouths, being the most sensitive part of their bodies. And sometimes, they swallow stuff.  Luckily, about 80% of foreign objects pass through the gastrointestinal system without difficulty.  The one place they get can stuck is the esophagus, that tube that brings food from your mouth to your stomach.  When this happens, kids have to go to surgery to have the object removed. Parents usually know when something gets stuck.  School-age kids can report the feeling of the coin lodged in the esophagus.  Parents usually witness the ingestion in infants, but occasionally toddlers aren't in the room when they swallow something. Even then, a sudden onset of coughing, gagging, and crying alerts parents to what's happened.  However, twice in the past year in our ER, we've seen babies with weeks of coughing and vomiting, and order a chest x-ray to look for pneumonia.  Surprise, what's that coin doing in there!? Coins are the most commonly swallowed objects in children.  However, anything they can get down, they will- pen caps, wedding rings, Legos.  Again, most of these pass without difficulty.  In a few days they'll come out the other end.  However, some things that get stuck are an emergency.  The most common of these is disc or button batteries.  If these stop in the esophagus, mucus moistens them, setting up a current between the + and - sides, and they get hot. If left long enough, they'll burn through the esophagus, letting contamination into the neck and chest cavities, in turn causing life- threatening infection. The same goes for sharp objects like needles and pins. When I was 11 years-old, I remember playing with 12 game tokens from the arcade at a local pizza joint.  My 4 year-old sister watched as I counted them over and over.  Something distracted me and as my sister walked away, I now counted 11.  "Mom, someone took my coin!" I shouted.  She answered, "You just counted wrong!"  Then my sister began coughing and drooling. Like we said above, we don't always see when a kid ingests a foreign object.  Often though, we get clues like coughing and gagging after something goes missing.  In the Emergency Department, we first do an x-ray.  Most things that get stuck in the esophagus are metallic, like coins or batteries, easily seen by x-ray.. However, x-rays don't always show softer materials like plastic toys or fish bones. If we suspect those, CT scans are necessary. Also as we discussed above, most objects pass the esophagus.  They'll come out the other end in a few days.  Whether you want to confirm it's passed by "inspection," that's up to you. If you don't see it in your child's effluence, a repeat x-ray can confirm it's gone. However, if the thing's stuck in the esophagus, it needs to be removed.  The child is taken to the OR and a scope is passed down the throat. The object is visualized,  grasped with calipers, and pulled out.  Swallowed objects that need to come out right away- batteries and magnets.  These can cause internal injuries, and even if the child looks okay, need immediate evaluation in the ER. The best treatment of swallowed objects, of course, is prevention. Infants and toddlers should always be seated when eating.  When they eat while walking, they can stumble and choke on incompletely chewed food.  Houses should also be toddler-proofed for choking hazards.  This means crawling around the entire floor plan on hands and knees, seeing everything at their eye level.  Go anywhere they can go- under beds, into closets, behind doors. You need to do this periodically, not just once, since everyone occasionally drops stuff.  Finally, take a CPR class.  Practicing the Heimlich maneuver with a CPR mannequin makes it a lot easier to do if your child starts choking.