Coins are the most common foreign object swallowed by young children, who often explore their environment by placing small, accessible items into their mouths. The majority of ingested coins—between 80% and 90%—pass naturally through the digestive tract without complication. However, because a coin can potentially obstruct the airway or become lodged in the esophagus, a prompt and calm assessment of the child’s condition is necessary. The immediate goal is to determine the coin’s location and the urgency of medical intervention.
Immediate Triage and Emergency Action
The first step after witnessing or suspecting a coin ingestion is to assess the child’s breathing and overall distress level. If the child is coughing, sputtering, drooling excessively, struggling to breathe, or unable to speak or cry normally, the coin may be blocking the airway. This situation is an immediate, life-threatening emergency, and parents must call emergency services.
If the child is breathing comfortably, speaking, or crying without difficulty, the coin has most likely entered the esophagus and is heading toward the gastrointestinal tract. Even if the child appears fine, professional medical advice is always necessary to confirm the coin’s location. Parents should contact their pediatrician, a medical helpline, or the nearest emergency department for guidance. It is important to note the type of coin, as pennies minted after 1982 contain zinc, which can cause irritation if lodged for an extended time, and must be ruled out from a button battery, which is a true emergency.
Signs the Coin is Stuck
A coin may become lodged in the esophagus, the narrow tube connecting the throat to the stomach, which requires prompt medical attention. Parents should watch for specific signs of obstruction, even if the child was initially asymptomatic after the ingestion. One primary sign is dysphagia, or difficulty swallowing, which may manifest as refusal to eat or drink.
Excessive drooling is another significant indicator that the coin is lodged, as the child cannot swallow their secretions past the obstruction. Other symptoms may include vomiting, gagging, or a sensation of pain in the chest or neck area. If any of these symptoms develop, the child must be taken to the emergency room without delay. An esophageal obstruction can lead to tissue damage if the coin is not removed within a matter of hours.
Monitoring for Safe Passage
If a medical professional has confirmed that the coin has passed into the stomach and the child remains without symptoms, at-home observation may be recommended. The coin is then expected to pass naturally through the rest of the digestive system. Parents should maintain the child’s normal diet and ensure adequate hydration, as a regular diet helps promote normal bowel movements.
The passage of a coin usually takes between three and seven days, though it can occasionally take up to several weeks to exit the body. During this period, the coin’s passage is confirmed by checking the child’s stools until the coin is found. If the coin has not passed within a few weeks, or if any new symptoms arise, parents should contact their healthcare provider for a follow-up assessment.
Medical Intervention and Retrieval
If a coin becomes symptomatic or does not progress as expected, medical intervention is required, beginning with an X-ray to confirm the exact location. A coin lodged in the esophagus is removed with urgency, as it can cause pressure and potential damage to the esophageal wall. Removal is typically performed using endoscopy, where a flexible tube is inserted through the mouth to grasp and retrieve the coin.
For a coin that is in the stomach but is either causing symptoms or has remained in the same spot for an extended period, such as four weeks, an endoscopic removal may also be performed. Esophageal coins are the most time-sensitive and require immediate attention. Surgical intervention is rarely needed, typically reserved for cases where the coin is stuck past the stomach in the intestines and causing an obstruction or other complications.