Infants and toddlers often swallow foreign objects while exploring the world by placing items in their mouths. While many small, smooth objects pass through the digestive tract without incident, ingesting a coin requires immediate medical assessment. The primary concerns are confirming the object is a coin and determining if it has caused an obstruction in the upper digestive or respiratory tracts. Understanding the risks and necessary steps is important for ensuring the child’s safety and guiding subsequent monitoring.
Assessing the Immediate Danger
The first step in any foreign object ingestion is to confirm the identity of the item, as this determines the urgency. A standard coin presents a risk of obstruction, but a button battery, similar in size and shape, poses an immediate chemical burn hazard. If the object is a flat, silver, disc-shaped button battery, it constitutes a medical emergency requiring an immediate trip to the emergency room. A button battery lodged in the esophagus generates an electrical current when exposed to saliva, causing severe tissue damage in as little as two hours through an alkaline chemical reaction.
If it is definitively a coin, the location is the next factor determining risk. A coin lodged in the esophagus (the tube leading to the stomach) is an urgent concern because it can cause tissue erosion and potentially compress the trachea, leading to breathing difficulty. A coin that has passed into the stomach is generally less urgent, as 80% to 90% of objects reaching this point will pass naturally. Any sign of respiratory distress, such as wheezing or difficulty breathing, means emergency medical services must be contacted immediately, as the coin may have entered the airway or severely compromised the esophagus.
Signs That the Coin Is Stuck
If the coin is lodged, it is most likely stuck in the esophagus, the narrowest part of the upper gastrointestinal tract. Symptoms of obstruction can manifest quickly after ingestion. A child may experience excessive drooling because they are unable to swallow secretions past the coin.
The child might also refuse to eat or drink, or vomit immediately after attempting to swallow. Other signs include neck, throat, or chest pain, depending on the coin’s location. Persistent coughing, gagging, or noisy breathing suggest the coin is causing irritation or partial obstruction of the airway due to its proximity to the trachea.
The Expected Path and Home Monitoring
If an X-ray confirms the coin is safely in the stomach and the child is asymptomatic, a doctor usually recommends home monitoring. Once past the esophagus and the pylorus valve, the coin typically traverses the intestines without issue. The coin usually passes in the stool within three to seven days, though this process can sometimes take up to four weeks.
Parents must monitor the child’s bowel movements by checking diapers or toilet use until the coin is recovered. The child should maintain a normal diet and stay hydrated, as this supports healthy bowel function. Dietary changes or laxatives are not necessary or recommended unless specifically advised by a medical professional. If the coin has not passed within a few weeks, or if the child develops new symptoms, medical re-evaluation is necessary.
Medical Procedures for Removal
If a coin is lodged in the esophagus or remains in the stomach for an extended period, medical intervention is required to prevent complications. The first step is an X-ray to precisely determine the coin’s location and orientation. Coins in the esophagus generally require removal within 24 hours to prevent tissue damage, as prolonged contact can lead to serious complications.
The most common removal procedure is endoscopy, where a specialized flexible tube with a camera and grasping tools is passed through the mouth into the esophagus or stomach. This procedure is performed under sedation or general anesthesia and allows the physician to directly visualize and safely retrieve the foreign object. For coins lodged high in the esophagus, a physician may use a non-endoscopic technique, such as a Foley catheter or a blunt instrument, to dislodge the coin and allow it to be removed or pass into the stomach. Surgical intervention is rare, usually reserved for coins that have perforated the intestinal wall or become impacted far down in the small intestine.