A practical approach to high-risk foreign body ingestion in children

Children commonly present with a history of witnessed or unwitnessed ingested foreign body (FB). Most are low risk objects, with the child or young person remaining asymptomatic enabling management without imaging or intervention. However, there are a several high-risk objects and clinical scenarios where it is important to have high clinical suspicion as they can cause serious injury if they remain in the gastrointestinal tract. Such injuries include oesophageal obstruction, perforation, fistulae into surrounding structures e.g. trachea, blood vessels, and bowel obstruction or perforation and can lead to long term complications or death. Button battery ingestion is particularly dangerous as necrosis, erosion and perforation can occur within hours and even after the battery has been removed, serious complications can still develop days, weeks, or months later. Currently there is not enough research to agree a standard approach following the ingestion of all FBs. This article aims to allow clinicians to follow a standardised approach and enact safe management of ingested FBs in children, whilst avoiding unnecessary investigation or ionising radiation. It includes guidance on which patients can go home safely without investigation or follow-up, which patients require investigations and which patients require emergent or urgent intervention by specialty teams.