Swallowing small objects is common in childhood, especially among infants and toddlers between six months and three years old who explore by putting items in their mouths. While most ingested objects pass through the digestive system without complication, an item can sometimes become lodged or cause damage. Understanding the specific signs that an object has been swallowed and knowing the appropriate response is important for a swift and safe outcome. Most foreign body ingestions happen accidentally at home, making parental awareness of symptoms and immediate actions valuable.
Key Indicators That Something Was Swallowed
The symptoms a child displays depend largely on where the object has become stuck.
If an object blocks the airway, the child is in immediate danger and may show signs of severe respiratory distress. Symptoms include sudden, forceful coughing, gagging, wheezing, noisy breathing (stridor), or the inability to cry or make any sound. If breathing is fully compromised, the child may begin to turn blue (cyanosis), indicating a lack of oxygen.
If the object is caught in the esophagus, symptoms often revolve around difficulty swallowing. Blockage can cause drooling, refusal to eat or drink, or vomiting immediately after attempting to swallow. The child may also experience pain in the chest or neck, or present with listlessness or a sudden onset of crying.
If the object is in the stomach or intestines, symptoms may be delayed or general, including abdominal pain, persistent vomiting, or blood in the stool or vomit. Many children, especially when the object is small and smooth, may not display any symptoms at all. If a missing object is suspected, immediate medical evaluation is required regardless of the child’s comfort.
Immediate Steps and First Aid Responses
The appropriate immediate response depends entirely on whether the child is actively choking or merely suspected of having swallowed something. If the child is conscious and breathing effectively—meaning they can cough forcefully, cry loudly, or speak—caregivers should not attempt to dislodge the object. Contact the pediatrician or a poison control center for guidance while preparing to travel to an emergency department. Caregivers must never attempt to induce vomiting, as this risks moving the object from the esophagus into the airway.
If the child is showing signs of choking and cannot cough, cry, or breathe, immediate first aid is necessary. For an infant under one year of age, the recommended technique involves a sequence of five back blows followed by five chest thrusts. The baby should be held face-down along the caregiver’s forearm with their head lower than their chest while delivering firm blows between the shoulder blades.
If the object is not expelled, the infant is turned face-up, and five quick chest thrusts are delivered with two fingers on the center of the breastbone. This cycle of five back blows and five chest thrusts should be repeated until the object is dislodged or the child becomes unresponsive. Caregivers should only attempt to remove an object from the mouth if it is clearly visible and easily reachable; avoid blind finger sweeps. If the child loses consciousness, call emergency services immediately, and cardiopulmonary resuscitation (CPR) should be started.
When Swallowed Objects Become a Medical Emergency
While most ingested objects pass spontaneously, certain items pose a unique and immediate threat, making their ingestion a medical emergency.
High-Risk Objects
Button batteries, found in many household electronics, can cause catastrophic internal chemical burns. If a lithium button battery lodges in the esophagus, saliva triggers an electric current that generates hydroxide, causing full-thickness burns in as little as two hours. The ingestion of multiple high-powered magnets is also extremely dangerous. These strong magnets can attract each other across loops of the intestinal wall, trapping the tissue between them. This attraction can cut off blood supply and lead to pressure necrosis, potentially causing perforations or fistulas in the bowel that require emergency surgery. Sharp objects, such as pins or tacks, require immediate evaluation due to the risk of perforating the gastrointestinal tract.
Severe Symptoms
Regardless of the object type, severe, persistent symptoms require an immediate trip to the Emergency Room or a call to 911. These triggers include continuous drooling, an inability to swallow liquids, severe chest or abdominal pain, or any sign of respiratory failure. The presence of blood in the vomit or stool, or the child becoming unconscious or turning blue, necessitates the immediate activation of emergency medical services.
Diagnostic Procedures and Removal Methods
Once the child reaches the hospital, the medical team locates the object and determines the safest course of action. Imaging studies are the first step, often beginning with an X-ray of the neck, chest, and abdomen. Most metallic objects (coins and batteries) are radiopaque and show up clearly. Objects made of plastic, wood, or certain types of glass may not be visible, requiring medical history to guide diagnosis.
If the object is below the esophagus, management depends on its type, size, and the child’s symptoms. For small, blunt, non-hazardous objects like a coin that has reached the stomach, doctors may recommend “watchful waiting.” These items usually pass naturally within a few days, and the caregiver monitors the child’s stool for passage.
For objects lodged in the esophagus or for high-risk items (batteries, magnets, or sharp objects), active removal is usually required. The most common method is endoscopy, where a flexible tube with a camera is passed down the throat to retrieve the foreign body. If an object is too large or has caused a bowel obstruction or perforation, surgery may be necessary.