Typically 1-5 years old (or adults with intellectual impairment)
Most are low risk and do not need imaging or intervention
FB lodged in the oesophagus will present with drooling or dysphagia
Intestinal obstruction will present with abdominal pain, vomiting, dysphagia or anorexia
Beware any inhalation symptoms rather than ingestion
Fish bones in oropharynx - may need ENT
Please note any prior medical or surgical history that may hinder transit of the FB
Anatomy
Impact
Oesophagus:
Cricopharyngeus (C6) [narrowest part of GIT]
Aortic arch (T4) and
OG sphincter (T11)
Pylorus of stomach
Duodenum
Ileocaecal valve (rarely flexures)
High risk
Button batteries in the oesophagus must be removed within 2 hours of ingestion. This is a time critical situation
FB size >6cm long, >2.5cm wide
Magnet ± metal ingestion are potentially dangerous and (like button batteries in the oesophagus) require removal
Management
Avoid x-rays in well children who have ingested a "non-high-risk" object and are eating normally now
High risk objects (right) or any signs of obstruction sould have an AP and lateral neck/chest and abdominal films (single film in younger children)
Sharp objects beyond the oesophagus are generally benign
If the child has ingested a low risk FB <6cm long or 2.5cm wide, is clinically well and is eating normally, they can be discharged without imaging or formal follow up
Ensure those discharged are "safety netted" with appropriate advice (please return if breathing problems, abdominal pain, not eating, vomiting or fever)
Links
Content by Dr Íomhar O' Sullivan . Last review Dr Rory O'Brien Dr ÍOS 11/07/23.