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Saturday, May 17, 2014

My child swallowed....

It happens all the time. Kids put things in their mouth that isn't supposed to be eaten. Parents often call about what to do when their toddlers or children swallow things. Most of the time things will just pass -- though I'm not a fan of watching the stools for the swallowed object because it just worries parents if they miss it.
photo source: Shutterstock

The biggest risk group is children between the ages of 6 months and 6 years, but anyone can be at risk. I have seen an older school aged child swallow a magnet after putting 2 small strong magnets on either side of their tongue to look like a tongue piercing. Adults have been known to swallow things such as needles (many sewers put the needle in their mouth if you think about it).

If you are around kids it is a good idea to know child CPR and refresh your skills every couple years. Classes are often held at local Red Cross stations, hospitals, or fire departments. You can also find classes by searching "CPR" and your zip code. For great information on signs and symptoms of choking and general treatment of choking, visit this KidsHealth Choking link.

If your child seems to put more non-food items in his mouth than other kids, he is at risk of pica. Pica is when a person compulsively puts non-foods in his mouth. For more see the KidsHealth Pica link.

Always keep the poison control number (1-800-222-1222) stored in all your phones! You will see below that I refer to them often. If you call your doctor about a potentially toxic substance, chances are we will refer to poison control. They have the best database of substance risks and their treatments. Don't delay treatment by calling the doctor!
For more information: http://www.aapcc.org
Here's a list of common things and what to do.
  • Balloons: Balloons are statistically some of the most inhaled or ingested foreign bodies. One reason is they are so popular with kids, and often are found at parties or other large crowds, where toddlers and young children are often less directly supervised. They can suffocate a child quickly if they are inhaled. Call 911 if there is any difficulty breathing, drooling, or other signs of distress. If swallowed, they will pass on their own.
  • Batteries: If you think your child has swallowed a battery, whether or not he appears distressed, immediately take him to an emergency room. If there is distress, call 911. Batteries can cause voltage burns or leak, causing acidic burns as soon as four hours after being swallowed. X-rays will confirm if the battery is in the chest or abdomen. They usually need to be removed to prevent serious injury. Be sure to keep all of your batteries, especially the small button batteries, safely stored away from children.
  • Bugs: Most of us has swallowed a bug some time in our life. You might not even know if a small one hides in your soda can and you take a big gulp. A little extra protein, right? Unless your child chokes, or if it has a stinger (bee, wasp) there is nothing to worry about. If he's choking, follow choking instructions (link at top). If you suspect a bee or wasp was swallowed, especially if your child seems to be reacting to a sting in the mouth, or there's sudden difficulty breathing, drooling, or choking, call 911. Serious reactions to stings in the mouth can occur.
  • Buttons: Buttons, much like coins, are generally harmless unless they get stuck. See the information on coins. Unlike coins, they are not easily seen on X-ray, which can make identification of a stuck coin a little trickier, but if you suspect an issue, talk to your doctor.
  • Cleaning products, laundry detergent, and other chemicals: These are highly dangerous and you should call poison control with any suspicion of ingestion or 911 if there are signs of distress. These should always be stored away from children to prevent the possibility of swallowing in the first place. Even the "green" products are usually not safe with ingestion.
  • Coins: Coins are some of the most frequently swallowed objects. These usually pass through the body without any problems. Unfortunately many parents never see it come out the other end. Since it is so common you would think there would be a consensus as to how to manage it. There isn't. Of course if there is any distress, drooling, breathing difficulty or coughing, your child should be seen immediately, ideally in an ER so that an immediate surgical consult can be made if necessary. If it was inhaled into the windpipe instead of swallowed into the esophagus or stuck high in the esophagus causing compression on the wind pipe, it may need to be removed. As for kids who swallow coins and have no symptoms, it isn't as clear cut. Some doctors get X-rays for all children who swallow a coin to be sure it isn't stuck in the esophagus (about a third of those stuck eventually end up passing, but most need to be removed). Others only X-ray if there are symptoms. Some remove the ones in the esophagus immediately, others will wait up to 48 hours if there is no distress. Generally once it reaches the stomach it will pass.
  • Crayons or play doh: I used to wonder why so many things were labeled "non-toxic" -- at least until I had a child of my own. They put everything in their mouth! These are generally safe (again, unless they choke), although it is possible that these things contain lead or other contaminants. If your child frequently puts them in the mouth, it is probably a good idea to not allow them near your child and talk to your doctor about pica (see link above for more information). 
  • Dirt or rocks: Unless your baby chokes or bites down on a rock and breaks a tooth, dirt and rocks are generally harmless. If your child seems to crave these and eats dirt compulsively, see the pica link above.
  • Energy drink: Energy drinks are a popular choice for many, but they contain caffeine and other stimulants that can make them dangerous for children. Call poison control for instructions.
  • Grass or plants: Unless the grass was recently chemically treated or if the plant is poisonous, there is little to worry about here. If you're unsure about a plant being poisonous, contact poison control. If there is choking, do CPR or call 911.
  • Gum: Contrary to popular belief, the occasional swallowed gum does not stay in your gut for years. It isn't digested like other foods, but unless it gets stuck along the way, it finds its way out just like all your other food. 
  • Hand sanitizer: Hand sanitizer in small amounts, such as putting fingers in the mouth after rubbing sanitizer on the hands, is generally safe. Larger amounts can be dangerous and you should call poison control if you suspect ingestion.
  • Magnets: A single magnet is not a worrisome as multiple magnets, but since it often is not known exactly what a child swallows, it is always recommended to take your child to be evaluated if there is a suspicion of swallowed magnets. They will need X-rays and if there are multiple magnets, they must be removed to prevent perforation of the gut.
  • Medicines, vitamins, supplements: If your child swallowed (or potentially swallowed) a medication or supplement, call the poison control number ASAP. Have the bottle with you so you can answer their questions.
  • Nicotine: Sadly ingested nicotine has been an increasing problem since e-cigarrettes have been on the market, but even regular cigarettes, cigars, and their ashes pose problems. Effects of nicotine poisoning include vomiting, sweating, lethargy and tremors in mild poisoning and confusion, paralysis, and seizures in severe poisoning. If you even think your child has eaten a nicotine product, call poison control (or 911 if significant symptoms).
  • Pet food: As disgusting as it smells to me, kids love to eat pet food. The biggest risk here is choking. If they choke, use your CPR skills. If you're not confident with CPR, call 911 and they will walk you through it.
  • Pop-top from a can: The flip top that opens a soft drink can is usually not a concern unless a child chokes on it. It generally will pass through the intestines if swallowed, but if there are signs that it was inhaled or is stuck in the intestine, a child should be seen. These do not show up on X-ray because they are made of aluminum. 
  • Poop: This one is gross, but happens more than any parent wants to know. Many babies stick their hand down their diaper and then the hand goes to his mouth. While this is really gross, it does not cause any danger to the child. If it is his own poop, he will not be exposed to any new germs. If your child finds someone else's poop, usually animal poop, there is a little more concern for infection but still pretty low risk. Symptoms of nausea, vomiting, diarrhea, and low grade fever usually happen within 30 minutes to 4 hours after the ingestion if they are affected. In this case, treat symptoms as you would any other stomach bug and call your doctor. For specific information of various types of poop (even raccoon!) check out the Illinois Poison Control blog on poop. 
  • Salt and baking soda: These common kitchen items do not raise fear in many people, but if either is taken in large amounts, they can cause serious problems. One tablespoon of salt in a toddler can cause seizures due to electrolyte imbalances. More can be deadly. One tablespoon of baking soda changes a body's pH and can cause serious injury. If your child swallows either of these, call poison control immediately. 
  • Sharp objects: Any pointed object such as toothpicks, wire, chicken bones, open safety pins and hair pins can pierce the gut. If you think or know your child has swallowed one of these, get the child to the emergency room immediately.