Realizing a toddler has swallowed a coin is frightening, but it is common for children between six months and four years old who explore by putting objects in their mouths. Medical professionals note that 80% to 90% of non-food items, including coins, pass through the digestive system without complication. The primary course of action involves a medical evaluation to determine the coin’s location and ensure the child is not experiencing an obstruction. The outlook for a swallowed penny is reassuring, provided the child remains asymptomatic and the coin is not lodged in the esophagus.
The Typical Journey: What Usually Happens
Once swallowed, the penny’s journey begins in the esophagus, the tube connecting the throat to the stomach. If it passes this initial barrier, it enters the stomach, where digestive acids act on its surface. The US penny, approximately 19 millimeters in diameter, is generally small enough to navigate the gastrointestinal tract in most children. Coins larger than 23.5 millimeters, such as a US quarter, are more likely to become stuck, making the penny less concerning for physical obstruction.
The penny’s composition is an important factor. Pennies minted after mid-1982 are 97.5% zinc with a thin copper plating, a change from the previous 95% copper composition. The acidic environment of the stomach can dissolve the copper coating, exposing the zinc core. If a post-1982 penny becomes lodged for an extended period, the release of zinc can cause irritation or damage to the digestive tract lining.
Once the penny moves from the stomach into the small and large intestines, the environment becomes less restrictive for passage. The smooth, round edges are generally not prone to catching or causing injury within the intestinal tract. For the vast majority of children, the coin will complete its journey and be excreted in the stool. This process typically takes 48 hours to five days, though it can occasionally take up to two weeks to pass.
Warning Signs Requiring Immediate Medical Attention
Although most pennies pass without issue, parents must remain vigilant for signs that the coin is lodged or causing internal harm. The most immediate and serious concern is a penny stuck in the esophagus, which is a medical emergency. Symptoms of esophageal obstruction include excessive drooling, difficulty or inability to swallow food or liquids, and a sensation of something being stuck in the throat or chest pain. The child may also gag, vomit immediately after swallowing, or refuse to eat.
A separate, life-threatening scenario occurs if the penny is aspirated into the windpipe, or trachea, instead of the esophagus. If the child is actively coughing, choking, or struggling to breathe immediately after the ingestion, this indicates a respiratory blockage requiring emergency intervention. After the penny has moved past the esophagus, symptoms of an intestinal obstruction may develop, which require prompt medical attention. These symptoms include persistent vomiting, severe abdominal pain, a fever, or blood in the stool or vomit.
Any symptoms suggesting the coin has not passed or is causing complications require an immediate visit to the emergency room. This is particularly true if a post-1982 zinc-based penny is lodged, as the potential for tissue damage increases over time. Medical imaging, usually an X-ray, is the only way to confirm the coin’s location and rule out an obstruction.
Monitoring and Follow-Up Care
If a medical professional confirms the penny has passed into the stomach and the child is asymptomatic, the typical recommendation is a “wait and watch” approach. The child can generally resume normal eating and drinking. Maintaining good hydration is helpful for ensuring normal bowel movements, and parents must check the child’s stools to confirm the penny has been passed.
Stool checks should be performed for every bowel movement until the coin is recovered, which may involve sifting through the stool. Dietary changes, such as increasing fiber intake, are sometimes suggested to encourage passage. Laxatives or attempts to induce vomiting are strongly advised against. Parents must remain alert for any delayed onset of warning signs as the child returns to their normal routine.
If the coin has not been recovered after ten to fourteen days, a follow-up consultation with the pediatrician is necessary. The doctor may order a repeat X-ray to check the penny’s current location. If the coin remains in the stomach for an extended period, often beyond four weeks, the doctor may refer the child to a specialist for possible non-surgical removal to prevent complications like zinc toxicity or obstruction.