Management of Penny Ingestion in a Healthy 8-Year-Old Girl
For a healthy 8-year-old who swallowed a penny, obtain an anterior-posterior and lateral chest/abdominal radiograph immediately to locate the coin, then observe for 8-16 hours if the coin is in the esophagus (as 25-30% pass spontaneously), or observe at home for 24-48 hours if the coin has passed into the stomach or beyond 1, 2.
Initial Assessment and Imaging
Obtain radiographs even if the child is asymptomatic, as 17% of children with esophageal coins have no symptoms 3. The radiograph must visualize from the teeth down to the abdomen on both anterior-posterior and lateral views 2. Coins are the most commonly ingested foreign body in all pediatric age groups 4, 5, and most coin ingestions are transient with the coin typically being swallowed into the gastrointestinal tract 6.
Management Based on Coin Location
If Coin is in the Esophagus:
- Admit for observation for 8-16 hours before proceeding to endoscopic removal 1
- Spontaneous passage occurs in 25-30% of cases during this observation period 1
- Older children and those with coins in the distal third of the esophagus are more likely to pass the coin spontaneously (56% vs 27% for proximal locations) 1
- At 8 years old, this patient falls into the favorable age group for spontaneous passage
- If the coin remains after 16 hours, proceed with endoscopic removal 1
If Coin is in the Stomach or Small Bowel:
- Manage conservatively with observation for 24-48 hours 4
- The coin will typically pass through the gastrointestinal tract without problems once it has crossed the duodenojejunal flexure 4
- In one tertiary care series, 74.7% of foreign bodies that crossed the duodenojejunal flexure were managed successfully with conservative observation 4
- Discharge home with return precautions
Specific Precautions for the Next 24-48 Hours
Monitor for these warning signs that indicate complications:
- Vomiting (suggests obstruction or inability to pass)
- Abdominal pain (may indicate perforation or obstruction)
- Drooling or difficulty swallowing (suggests esophageal lodgment)
- Chest pain (esophageal irritation or perforation)
- Choking or respiratory symptoms (airway compromise)
These symptoms correlate with positive radiographic findings and need for intervention 3.
Important Caveats
Do not assume the coin will pass just because the child is asymptomatic—14% of children with esophageal coins in one study had no symptoms or signs in the emergency department 3. The absence of symptoms does not rule out foreign body retention 2.
While brass and similar metals can undergo acid-induced corrosion after 48-72 hours of gastric exposure 7, standard U.S. pennies minted after 1982 are zinc-core with copper plating and typically do not pose the same dezincification risk as brass pendants. However, if the coin remains in the stomach beyond 48-72 hours, endoscopic removal should be considered to prevent potential complications.
This is distinctly different from button battery ingestion, which requires emergent endoscopy due to rapid tissue damage 5, 8. Coins do not carry the same time-critical risk.