Last week my 28 month old grandson Coby swallowed a penny.
Lauren heard something in his mouth that didn’t sound normal.
“What’s in your mouth?”
“A coin!”
“What?! Open your mouth!”
“I swallowed it.”
“Did you really!?!?”
“Yes”
“What kind of coin was it?”
“The gold one.”
As I told him over the phone the next day, when you are smart enough to inform your mommy, “I swallowed the gold one,” you should also be savvy enough NOT to put things in your mouth that don’t belong.
When it happened, Lauren knew to refer to my old blog post, but as a nod to Coby I figured this is one worth updating and refreshing.
They put WHAT in their mouth?
Kids like to explore. Many times this involves sticking things where they don’t belong. Being fairly oral critters, most of the time the object they are handling gets placed in the mouth. When this happens there are two passages where something might go down.
If it goes into the esophagus, that is the beginning of the digestive tract. It hopefully will make its way down into the stomach, through the intestines and then get pooped out.
If something was swallowed, here are some things to consider:
Is it stuck?
How does the child look? Are they able to take a sip of water? Can they swallow just fine? Is their breathing relatively normal?
If something has gotten stuck in the esophagus they will look uncomfortable. There will be frequent coughing and throat clearing going on. You will know that something is amiss. This will necessitate a visit to the ER.
(In Coby’s case, he was able to easily drink water and eat an applesauce pouch, which was very reassuring)
Is it poisonous?
If you have any doubt about that, call the poison control center
1-800-222-1222 . For more info about dealing with poison, here is my blog post.
Is it potentially germ laden?
The answer is most likely yes, but that doesn’t mean you need to freak out.
When I was still working in the pediatrician’s office, I would get calls all the time about kids eating things that are pretty disgusting. More often than not, there were no actual consequences.
Young infants are the most vulnerable to germs, but the good news is that they don’t usually have the hand/mouth coordination to actually get anything into their mouth.
Once they have mastered that milestone, they are old enough that a normal healthy gut has good bacteria that can be somewhat protective.
If whatever it is that they ingested is going to cause trouble, symptoms will usually show up with tummy aches, vomiting and loose stools within a day or so. Persistent tummy upset will usually warrant an evaluation.
Is it a battery or magnet?
Any battery can be trouble, but button batteries can be a tremendous hazard because they can be easily swallowed and they seem to be everywhere these days.
Several years ago I got a call from a mom of 15 month old twins. There they were, sitting on the floor with mom’s pedometer right in between them. It was open and the battery was gone. Because of the uncertainty involved, we did have to send them to get x-rays. Indeed there it was, that little battery, sitting in the stomach of one of the kids.
In this case it passed safely, but if a battery gets stuck anywhere on the way it can cause a dangerous amount of damage.
As an important safety measure, pay attention to where any button batteries are in all of your little gadgets and make sure that your kids have no access to them. Keep a strict inventory and perhaps stick a piece of duct tape across any battery compartments.
Other objects that you need to be wary of are magnets. I am not talking about the little letters that you may have on your fridge. The ones that cause concern are the industrial strength magnets that you may find in some “grown up” toys like buckyballs or jewelry.
If more than one of those get swallowed it can wreak havoc on the intestines and be deadly. Keep them away from your kids!
Water/Agua beads
I am glad that these weren’t around when my kids were little. Coby is such a little goat, that Lauren has wisely not let them anywhere in her house.
These are little sensory beads that can grow to almost 100 times their original size when wet. They claim to be non-toxic, but they can be very dangerous if swallowed. These beads are associated with thousands of ER visits every year. If the beads are ingested they can continue to grow inside the body. This can cause severe discomfort, vomiting, intestinal blockage and life-threatening injuries.
As an aside, they are probably helping put many plumbers’ kids through college. Your pipes will thank you for not letting these into your home.
Is it sharp?
If the something that they have swallowed has a point or sharp edge, keep an extra close eye on your child. Feel the tummy to see if it is nice and soft. Look for blood in spit up or drool. Keep an eye on the stools.
If your child seems to have a rigid painful belly or has any dark, tarry poop or bright red blood they will need to be seen right away.
You may as well laugh
Some of the stories of what kids ingest are worth a giggle once everyone gets the all clear. One episode that I remember was a 3 year old patient who managed to swallow one of her Grandma’s one carat diamond stud earrings. It did pass through and was retrieved with no harm at all to the swallower. However, Grandma didn’t want it back; it was reunited with the mate and is in a safe deposit box waiting until the little girl is 18.
Most of the time, like the earring, it is simply a matter of watching for whatever it was to pass through. I have seen all sorts of stuff get swallowed and pooped out without incident. I think I have seen enough change to put a kid through college. Most coins smaller than a quarter go through fairly easily.
Here is a fun fact. I am more concerned about a penny that is newer than 1982. Why? Because these newer pennies are more zinc than copper, and the Zinc can be more reactive with the stomach acid.
However, when a worried parent would call me to report a swallowed penny, asking them what year it was, was unlikely to be helpful.
Nurse Judy’s ‘corn in the poop’ tip
Okay, so they have swallowed something, what’s the next step?
Once it is clear that nothing is stuck, let’s encourage a quick passage! Increase the amount of fluids that your child drinks. Perhaps add prunes. If your child is old enough that they are beyond simple pureed food, consider giving some corn kernels (you won’t see that in any textbook). Have you figured it out yet? For those of you who need this spelled out, corn kernels are usually fairly recognizable after they have been pooped out. They can act as a marker. That bright yellow kernel of corn can help you track the transit time.
(Lauren gave Coby corn as directed, but then didn’t look too carefully to see if the penny passed. In all fairness, Coby was in the process of potty training himself, so some poops were in the potty, and one was messy enough that she ended up simply tossing the training underwear rather than having to deal with it.)
When do we need to start paying extra attention to this ‘oral’ behavior?
Once in a while just about every kid is going to do some exploration, but if your child is old enough to know better and seems inclined to continue to put non food items in their mouth, this might be a condition known as Pica. Pica is the persistent eating of substances such as dirt or paint that have no nutritional value. This is worth pointing out to your doctor. There might be a nutritional deficit or something else going on. Low iron levels or high lead levels could be part of the issue.
Choking
Up until now, we were discussing things that went into the esophagus.
If the object goes into the trachea it may block the airway and you have a choking situation on your hands, or it could get aspirated into the lungs. Neither is good.
Your child will clearly be having breathing difficulties if this has happened. It is important to note that if someone has a blocked airway, they can not speak or make sounds. They will likely have a color change and look pale or blue.
It is critically important that all parents and caregivers are trained to do a choking rescue. Of course with any emergency you should call 911
Prevention!
To avoid this happening on your watch, do your best to keep little items away from the young kids. Anything that can fit into a toilet paper tube is too small for an infant or young child to be handling. Food pieces should be soft or cut into long strips rather than round pieces.
Encourage safe eating: sitting instead of running around, chewing and swallowing rather than shoving in wads of food. Parents, please model good behavior!
So what about the new devices that can help if your child is choking? These are relatively new and get mixed reviews. Alas these are not geared to children less than 22 pounds, but might still be a nice piece of mind for older toddlers.
A final note on the penny.
I had seen countless patients who swallowed pennies without any complications, so I was not terribly concerned.
But then….Coby got a fairly significant rash.
There were a few Xs in the equation. He had just finished a course of Amoxicillin, which was the likeliest culprit. It also could have been viral. But just to make things interesting, there was also the remote possibility that it could have been a reaction to the zinc or copper.
Fortunately the rash resolved and we are assuming that the penny is somewhere in the plumbing system as opposed to being stuck somewhere.
And now Coby is eagerly retelling his version of this story: “mama heard something in my mouth… it was a coin…. I swallowed it!”
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Me: Lauren, can I get a photo of Coby holding a penny, for my blog?
Lauren: You think I would trust him with a penny!?!?
This photo will have to do.
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