Children who have swallowed a foreign body

Children sometimes swallow foreign bodies and are taken by their parents to their general practitioner. While good management of the problem can prevent severe complications, it is important to be alert to over-diagnosis and overtreatment. A focused history and general physical examination, with attention being paid to vital functions, form the cornerstone of management, with radiography as potential supplementary investigation. Urgent referral to secondary care is essential if there are red flags, such as patients with ABC instability, patients showing signs of inflammation (fever) or obstruction (stomach ache, salivation, and vomiting), and patients with signs of haemorrhage (haematemesis and melaena). Referral is also necessary if the child has swallowed a battery, one or more magnets, or a long (> 5cm) or sharp object. General practitioners should always be alert to the possibility of poisoning. Watchful waiting is recommended for patients not at risk of a complicated course and without the abovementioned red flags. Coins, marbles, and other small blunt objects are often spontaneously evacuated within 4-6 days without further complications. Doctors and parents should be alert for symptoms occurring in the first 3 days.