Singapore Study Sheds Light on Follow-Up Procedures for Children Who Swallow Foreign Objects
SINGAPORE (CNA) – A recent study conducted in Singapore has provided paediatricians with valuable insights into the necessary follow-up procedures when a child swallows a foreign object.
Parents often rush to the nearest emergency department when they witness their child choking, struggling to breathe or cough, and turning blue in the face. However, in some cases, children who have swallowed foreign objects may experience pain in the throat, chest, or abdomen. They may also exhibit symptoms such as drooling, refusing to eat, or vomiting.
If the swallowed object successfully passes through the throat and enters the food pipe or oesophagus without causing any complications, parents are typically advised to take their child home and let the natural course of digestion take place.
In other words, they are encouraged to allow the child to pass the ingested item through their stool.
However, this situation can be concerning for parents as they wonder how long it will take for objects like coins, beads, button batteries, or magnets to exit their child’s body. Toddlers between the ages of one and two, who are in the exploratory stage of their development, are particularly prone to such incidents.
According to a recent study by Khoo Teck Puat – National University Children’s Medical Institute (KTP-NUCMI) at National University Hospital (NUH) based on medical records from 2015 to 2016, over 2,100 local children and adolescents, who were treated for swallowing foreign objects. They were all under the age of 18, and 70 per cent of them were below age six.
What are the commonly swallowed objects?
Ingested items are typically categorised into low- or high-risk objects. The former includes coins, marbles, beads and anything that is small, rounded and is least likely to cause complications when swallowed, according to Associate Professor Marion Aw, the head and senior consultant from Division of Paediatric Gastroenterology, Nutrition, Hepatology and Liver Transplantation at KTP-NUCMI.
On the other hand, high-risk objects can be multiple small magnets that can get stuck in the gastrointestinal tract, and sharp objects for obvious reasons. Prof Aw also listed button batteries as “high risk”. “Theoretically, the contents within the battery can leak out and cause injury to the lining of the stomach or intestines.”
The study found that coins were the most commonly ingested objects (41 per cent), followed by toys such as beads and marbles (27 per cent). High‑risk objects including multiple magnets, batteries or sharp objects made up 21 per cent of the cases.
Why track how long the swallowed objects take to exit the body?
Understanding how long it takes for swallowed objects to pass out of the body would help paediatricians decide how soon the follow-up should be, said Prof Aw, who is one of the researchers involved in the study.
Currently, paediatricians do not have this information as “the majority of the children did not keep the outpatient appointments given”, said Prof Aw, which led doctors to believe that the objects were all passed out prior to their appointments. As a result, “we would not have the exact timeframe that this happened”.
The study’s findings corroborated this: Only 350 patients (average age of four) followed through with their outpatient appointments.
So, what has the study found? According to Prof Aw, 50 per cent of the button batteries were passed out by day four and 100 per cent by day seven. “For coins, 50 per cent were passed out by day eight and 100 per cent by day 37,” she said.
“This means we can potentially advise parents that they can wait till day 30 to see if the coin has been passed out spontaneously, and we do not have to see the child unless the coin has not been passed out after five weeks. But for children who swallowed batteries, we may want to see them by day seven,” she said.
How long do objects take to be passed out anyway?
“The way swallowed objects pass is very similar to the passage of food,” said Prof Aw. But because these objects are not digested, “there are certain parts of the gastrointestinal tract” where “these objects are more likely to get stuck”.
These are usually the “transition points” such as where the oesophagus connects to the stomach, the stomach to the small intestine and the small intestine to the large intestine, she said.
If the object is not lodged in the throat but progresses down the oesophagus, it would enter and exit the stomach, and pass into the small intestine within four to six hours. “However, it is also possible that it may take more than one to two days for it to pass out of the stomach. For safer objects such as a coin, we can sometimes wait up to several weeks before active intervention,” said Prof Aw.
The next stretch of the object’s journey down south is through the small intestine into the large intestine (also known as colon), rectum and finally out of the body through the anus. The colon transit time varies from child to child, although some medical literature cites 36 hours as average, regardless of age and gender.
“I suspect for children who are chronically constipated, it would take a longer time to be passed out. However, we have not done a formal study to demonstrate this,” said Prof Aw.
What treatment do doctors use?
An X-ray would first be taken to assess the position of the swallowed object. If you’re wondering, laxatives aren’t typically used, said Prof Aw, unless the child has constipation and the swallowed item is deemed to be low risk in nature.
If the object is lodged in the oesophagus, endoscopy would be used to extract it. Once the object has gone past the oesophagus, it depends.
“For high-risk objects in the stomach, such as sharp objects and button batteries, we would go in and remove them.” As for the low-risk objects, “we would adopt a wait approach as most of them would pass out harmlessly”.
What if the object has already moved into the intestines? “The best option is to wait for it to be passed out spontaneously if the child is asymptomatic. If the child has complications, the next option is surgical intervention,” said Prof Aw.
Surgery is only used in children when risky objects are involved. “One of the riskiest objects are multiple magnets. They can stick to each other across the intestines and not be passed out of the body. They can also cause perforation in the intestine because of the pressure they exert,” said Prof Aw.
To save parents from the heartache and worry, prevention is better than cure. “It is extremely important not to let young children put small, inedible objects into their mouth – especially sharp objects, button batteries and magnets. For infants and toddlers, they can play with objects larger than their fist.”
