Tiny Ingestions, Big Worries: Navigating High-Risk Pediatric Foreign Body Ingestions in Urgent Care

As an urgent care clinician, I’ve handled my fair share of foreign body ingestions. But nothing quite prepares you for when the patient is your own child. One late night, just as I had finally settled in with Netflix, my seven-year-old son appeared at the top of the stairs—wide awake when he should have been fast asleep. If you’ve read my previous blog about Mycoplasma Pneumonia, you won’t be surprised to hear it was the same child. Out of my three boys, he’s the one who seems determined to always keep me on my toes. This time, with tears in his eyes, he said, “I accidentally swallowed a magnet bead.” 

At that moment, mom instincts kicked in, and my PA brain switched on—I knew I had to get him to our local pediatric urgent care before they closed.

If you're familiar with Murphy's Law, you could guess the timing couldn't have been worse. My husband was away for military training, so I called a neighbor to stay with my other kids while I rushed my son to urgent care. My first questions were, “How many did you swallow?” and “Are you sure it was just one?”

Thankfully, everything turned out okay—X-rays confirmed he had swallowed just one magnet bead. With careful monitoring, it passed without complications. That night gave me a renewed appreciation for the role we play as urgent care clinicians—not just treating medical issues, but supporting worried parents while helping patients dodge a costly ER visit. 

Let’s take a closer look at some of the vital information you need to know for managing high-risk foreign body ingestions in kids.

Keys to Managing Swallowed Foreign Body

1. Start With a Thorough History

When a child arrives with suspected ingestion, gathering a clear history is essential:

• What was ingested? Was it a magnet, button battery, or something else?
• How many? Multiple magnets, water beads, or batteries can cause serious harm!
• When? Timing is crucial, especially with button batteries. Just one button battery can cause tissue damage quickly.
• Symptoms? Look for signs like drooling, difficulty breathing, or vomiting, which may require the patient to be immediately transferred to the ER.

2. Physical Exam

Begin with the ABCs of medicine (airway, breathing, circulation). Assess the child’s general appearance, neck, heart, lungs, and abdomen for signs of distress or the location of the foreign body.

3. Asymptomatic v. Symptomatic

• Asymptomatic: Don’t be reassured by the lack of symptoms, especially with high-risk objects like magnets and button batteries, which can cause serious harm even without immediate symptoms.
• Symptomatic: Watch for signs of airway compromise (e.g., drooling, wheezing), abdominal pain, vomiting, or signs of obstruction.

4. Imaging: Your Best Friend

If the child is stable, X-rays can be helpful. Get both AP and lateral views from the nose to the rectum. The lateral view can be particularly helpful for detecting stacked magnets or other foreign bodies that might look harmless in an AP view.

High-Risk Foreign Bodies to Watch Out For:

• Button Batteries: These can burn tissue within hours. If a button battery ingestion is confirmed or suspected in a child aged ≥12 months, immediately administer oral honey (10 mL every 10 minutes) to protect mucosa—but don’t delay transport to the ER. If your office doesn’t have honey on hand, consider stocking it now.
• Magnets: Multiple magnets can attract through intestinal walls, causing severe complications like bowel perforation. 
• Water Beads: These expand rapidly in the digestive system, causing obstruction. They are radiolucent and won’t appear on standard X-rays, making them tricky to diagnose. 
  
  

When to transfer to the ER

Transfer immediate for:

• Button batteries or water beads
• Multiple magnets
• Sharp objects (fish bones, toothpicks)
• Large objects (>5 cm long or >2 cm wide)
• Signs of airway compromise or GI obstruction

If you're unsure, don’t hesitate to call Poison Control (1-800-222-1222), or for button battery cases, the National Button Battery Hotline (800-498-8666) can be a valuable resource. However, always prioritize arranging the patient’s transport to the ER without delay.

Final Thoughts

That night with my son reminded me of how quickly situations can escalate from calm to critical. It also reaffirmed why we do what we do: to guide families through unsettling moments with expertise and empathy.

So, whether it’s a button battery, a magnet, or something else entirely, take every ingestion seriously. Time is of the essence with high-risk foreign bodies. Stay informed, act quickly, and never underestimate the difference you can make—for the patient and the parent standing anxiously by their side.

Want to learn more? Tune in to the UC RAP episode, "You Swallowed What? Pediatric Foreign Bodies", where Brett Murray, MD, and I dive into key insights and pearls on managing high-risk pediatric foreign body ingestions.