#193: How Did That Get There? Foreign Bodies in Pediatric Patients

September 30, 2026 | By Jennifer Chisolm

Audio

Kids put everything everywhere. In this episode, we talk with pediatric emergency medicine physician Gabriel Devlin, MD, about the evaluation and management of pediatric foreign body ingestions and insertions from airway foreign bodies and button batteries to magnets, nasal beads, and bugs in the ear.

Pearls

1. On AP/PA chest X-rays, a coin or round object appearing face-on (as a large circle) is located in the esophagus, while an object viewed edge-on (as a thin slit) in the airway is typically in the trachea.
2.  Button batteries lodged in the esophagus create an electrical current with saliva, generating sodium hydroxide that causes rapid liquefactive necrosis and potential perforation. They must be removed via endoscopy as soon as possible. 
3. While a single ingested magnet can often be watched, multiple magnets are high-risk because they can attract each other across intestinal walls, causing pressure necrosis, perforations, and fistulas. 
4. Always drown live insects in the ear canal using viscous lidocaine or mineral oil before attempting extraction to prevent the bug from struggling and rupturing the tympanic membrane. 

Foreign Bodies Episode Show Notes 

Airway Foreign Bodies

Initial Approach & Clinical Presentation

When evaluating a suspected foreign body, clinicians should gather history around three key elements:

• Witnessed ingestion or insertion (though absent in about half of cases).
• A choking event.
• Focal physical exam findings (e.g., unilateral wheezing, crackles, drooling, or localized pain).

Tiers of Severity

• Complete Obstruction / Unconscious: Assess ABCs, emergent transport to the OR for rigid bronchoscopy/laryngoscopy once stable.
• Severe Respiratory Distress / Unstable: Expedite direct evaluation and OR transfer; avoid sending an unstable child to radiology.
• Stable / Localized Symptoms: Allows for a structured diagnostic workup (imaging, specialist consultation).

Management Before Scope: Keep the child as calm and quiet as possible. Agitation worsens hypoxia and can dislodge the object into complete obstruction. Minimize interventions and await anesthesia/pulmonology in a dim, comforting environment(J. Emerg. Medicine, 2023).

On AP/PA chest X-rays, a coin or round object appearing face-on (as a large circle) is located in the esophagus, while an object viewed edge-on (as a thin slit) in the airway is typically in the trachea(Pediatric Anesthesia, 2009).

Gastrointestinal Foreign Bodies

Button Batteries

When exposed to mucosal moisture, button batteries conduct an electrical current that generates caustic sodium hydroxide (lye), leading to rapid liquefactive necrosis and perforation(Pediatrics, 2010). Ideally, they must be removed within two hours. On radiographs, they display a characteristic double-ring sign (an inner ring visible within the outer circle) on the AP view and a distinct step-off on the lateral view. For children over one year of age who are without respiratory distress or allergies, honey can be administered pre-arrival (10 mL every 10 minutes) if the ingestion occurred within the last 12 hours. Once inpatient, sucralfate can be used to temporize while awaiting gastroenterology consultation, but water irrigation must never be performed on a button battery (J Pediatr Gastroenterol Nutr, 2015).

Magnets

Multiple magnets attract across intestinal walls, causing pressure necrosis, ulcers, and bowel perforation. Single magnets may be observed, but multiple require urgent removal.

Super-Absorbent Polymer Beads

Rapidly swell in moisture and cause high-grade mechanical bowel obstruction.

Sharp Objects

High risk of perforation; require removal.

Watchful Waiting for Low-Risk Objects

Criteria: Asymptomatic patients with small, blunt, non-dangerous objects (e.g., small coins, blunt toys) located past the esophagus.

Protocol: Can monitor for up to 4 weeks. Advise parents to sift stools to confirm passage and avoid unnecessary radiation. Obtain serial X-rays weekly to track progress, and provide strict return precautions for vomiting, fever, or abdominal distension(StatPearls, 2025).

Nasal Foreign Bodies

• Most commonly lodge on the right side due to the patient population’s right-handedness at two bottlenecks: beneath the inferior turbinate or anterior to the middle turbinate (Scand. J. Research, 2017).
• Nasal foreign bodies are rarely emergencies. Spontaneous aspiration from the nose is virtually undocumented; aspiration usually only occurs during clumsy removal attempts(per our guest’s opinion).
• Oxymetazoline and lidocaine spray to reduce edema and pain.
• Self-blow (for kids > 3) or the “Mother’s Kiss” technique (~60% success rate) where a parent blows into the child’s mouth while occluding the unaffected nostrilcan be used. (CMAJ, 2012).
• Use a headlamp to free both hands. Alligator forceps work for graspable items, right-angle hooks roll round beads forward, and suction with an umbrella-tip catheter captures smooth spheres. Avoid water irrigation (pushes objects deeper) and Foley catheters. Never attempt removal more than twice; if unsuccessful, refer urgently to ENT(per our guest’s opinion).

Ear Foreign Bodies

• Positive pressure does not work well in the ear canal. Irrigation is safe and effective for non-organic objects (never irrigate button batteries or organic items, which swell).
• Never grab a live insect with forceps, as it will scratch or rupture the tympanic membrane. Drown/paralyze it first using viscous lidocaine or mineral oil, then extract or irrigate(StatPearls, 2025).
• Procedural sedation is frequently required due to extreme sensitivity and narrow margins for error(per our guest’s opinion).

Links

George Carlin’s comedy show on ridiculousness and dangers of euphemistic/soft language – https://www.youtube.com/watch?v=o25I2fzFGoY

Goal

Listeners will be able to manage pediatric foreign body ingestions and insertions while quickly recognizing high-risk hazards such as button batteries and multiple magnets to provide prompt, emergent interventions and prevent complications.

Learning Objectives

After listening to this episode, listeners will…  

1. Differentiate a coin from a button battery on plain radiographs by identifying the double-ring sign on the AP view and the step-off on the lateral view.
2. Differentiate esophageal vs tracheal foreign bodies on plain radiographs.
3. Outline the emergent management steps and pre-hospital interventions (such as honey administration) for a suspected esophageal button battery ingestion.
4. Recognize the clinical risks associated with multiple ingested magnets and distinguish them from single, low-risk foreign bodies.
5. Learn common clinical techniques such as the “Mother’s Kiss” and appropriate instrumentation to safely remove foreign bodies.

Disclosures

Dr. Devlin reports no relevant financial disclosures. The Cribsiders report no relevant financial disclosures. 

Citation

Yildirim MB, Chisholm J, Devlin G, Chiu C, Masur S.  “#193: How Did That Get There? Foreign Bodies in Pediatric Patients”. The Cribsiders Podcast. https:/www.thecribsiders.com/ September 30, 2026.