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AAP Conference Preview: Be on the lookout for subtle signs of foreign body ingestion :

October 7, 2016

Editor’s note: For more on educational sessions and events at the 2016 AAP National Conference & Exhibition in San Francisco, read the preview issue of AAP News Today. To register for the conference, visit

Now you see it, now you don’t.

That may be a telltale sign that a child has swallowed something he shouldn’t have.

“Not uncommon is a parent telling us that they saw the child playing with (fill in object) and then it disappeared,” said David Rothstein, M.D., M.S., FAAP, a pediatric surgeon at Women and Children's Hospital of Buffalo and a member of the AAP Section on Surgery.

Dr. Rothstein and Anna Meyer, M.D., FAAP, will review the various ways children who have swallowed a foreign body may present to the emergency department (ED) or pediatrician’s office during a session titled “Ingestions and Foreign Bodies of the Airway and Gastrointestinal Tract (S1124)” from 2-3:30 p.m. Oct. 22 at the AAP National Conference & Exhibition in San Francisco. They also will discuss how to determine if imaging studies or urgent referral is needed.

Despite education and legislation to prevent children from ingesting foreign bodies, it still happens.

“Nothing is foolproof,” said Dr. Rothstein, associate professor of surgery, University at Buffalo Jacobs School of Medicine and Biomedical Science.

Often, the signs that a child has ingested a foreign body are subtle, such as pain on swallowing, drooling, wheezing or a sensation of irritation in the back of the throat.

“Sometimes, a parent will bring in a child with, say, a chronic cough that may be suggestive of a foreign body inhalation,” he said.

Key historic and physical exam findings that should prompt further investigation will be covered by Dr. Rothstein and Dr. Meyer, an otolaryngologist and head and neck surgeon at UCSF Benioff Children's Hospital in San Francisco and a member of the AAP Section on Otolaryngology-Head and Neck Surgery.

Among the common items swallowed are coins and game pieces. Caustic ingestion is rare in the U.S. but still exists in resource-poor regions, Dr. Rothstein said. Ingestions by teens also are rare, unless they have a developmental disability.  

The presenters also will look at trends in foreign body ingestions, including some of the successes and failures of legislation.

“Battery ingestion is still a killer, despite legislation and improvements in packaging, warnings, etc.,” Dr. Rothstein said.

It is important to get kids to the ED as soon as possible and avoid delays, he said. For complex cases, ears-nose-throat, gastrointestinal and surgical specialists should work together.

“Having all available resources is best,” Dr. Rothstein concluded.

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