Swallowing a coin is common in childhood, especially among toddlers (six months to three years) who explore their world orally. Most swallowed coins pass through the digestive tract without causing harm. Between 80% and 90% of foreign objects that clear the esophagus will pass spontaneously and exit the body in the stool. The correct response depends on where the coin is lodged and what symptoms the child is exhibiting.
Immediate Assessment of Airway and Esophagus Blockage
The most immediate concern after a child swallows a coin is ensuring the object did not lodge in the airway or the esophagus. A coin in the windpipe (trachea) causes acute respiratory distress, which is an emergency. Signs of obstruction include persistent coughing, wheezing, stridor, or an inability to speak or cry. If any of these symptoms appear, parents must seek emergency medical help immediately.
Even if the child is breathing normally, a coin may be lodged in the esophagus. Obstruction prevents food and liquids from passing, causing symptoms like excessive drooling, gagging, vomiting, or refusal to eat or drink. The child may also complain of pain in the throat or chest area. A coin lodged in the esophagus requires immediate removal, typically within 24 hours, to prevent serious tissue damage.
Confirm the object swallowed was a coin and not a button battery, which can appear similar on an X-ray. Button batteries are a medical emergency because they can cause a severe electrical burn to the esophageal lining in as little as two hours, requiring immediate intervention regardless of symptoms. If uncertain about the object, assume it is a battery and treat the situation as an emergency.
Criteria for Non-Emergency Doctor Visits
If the child is breathing comfortably, shows no signs of drooling, and is able to swallow liquids without distress, the coin has likely passed into the stomach. A medical evaluation is required to confirm the coin’s location and rule out risks. A physician will order an X-ray, as coins are radio-opaque and visible, confirming the object is not stuck in the esophagus.
Certain factors increase the risk of the coin becoming impacted later in the digestive tract, requiring consultation. Coins larger than 23.5 millimeters, such as a U.S. quarter, may struggle to pass through the pylorus, the exit valve of the stomach, especially in children under five years old. Children under one year of age also have smaller gastrointestinal tracts, which makes consultation mandatory even if they appear asymptomatic.
The coin’s composition can also pose a risk if it remains lodged for an extended period. Pennies minted after 1982 contain zinc, which stomach acid can leach over time, potentially leading to zinc toxicity if the coin does not pass. If you are unsure of the coin’s size or type, or if your child has a pre-existing gastrointestinal condition, a doctor’s visit is necessary for assessment and a follow-up plan.
Home Management and Monitoring the Passage
Once a medical professional confirms the coin is safely in the stomach and clears the child for home management, monitoring its natural passage is the focus. Maintain the child’s normal diet and activity level; regular movement and food intake encourage the coin to travel through the intestines. Adding high-fiber foods like whole-grain cereals and fruits may help bulk up the stool and assist in the coin’s excretion.
Diligently monitor the child’s stool until the coin is found. The coin typically passes within four to six days, though it can take up to a few weeks. Avoid using laxatives or attempting to induce vomiting, as these interventions can be ineffective or cause complications.
While waiting for the coin to pass, remain vigilant for secondary symptoms indicating a complication, such as intestinal obstruction. These worrisome signs include new or worsening abdominal pain, persistent vomiting, blood in the stool, or the onset of a fever. If the coin has not passed after four weeks or if any of these new symptoms develop, a return to the doctor is necessary for a follow-up X-ray or potential removal procedure.