From the Guidelines
For a 5-year-old female who swallowed a penny, the recommended management is watchful waiting, as the coin will likely pass through the digestive tract naturally within 4-5 days. Parents should monitor the child's stools to confirm passage and watch for symptoms such as vomiting, abdominal pain, difficulty swallowing, drooling, or respiratory distress, which would warrant immediate medical attention 1. No special diet is needed, but maintaining normal food and fluid intake is important. X-rays may be performed if there is concern about the coin's location, particularly if it appears to be lodged in the esophagus, which would require prompt endoscopic removal. Coins that reach the stomach typically pass without intervention. Parents should not induce vomiting or give laxatives, as this can cause more harm than good. If the penny doesn't pass within a week or if concerning symptoms develop, medical evaluation is necessary. Most ingested coins in children pass harmlessly because the acidic environment of the stomach doesn't significantly degrade modern pennies, and the smooth edges allow for passage through the intestines without causing damage. It's essential to note that choking rates are highest among infants, and although the child in question is 5 years old, vigilance is still crucial, as indicated by the Centers for Disease Control and Prevention report 1.
Some key points to consider in the management of a child who has swallowed a penny include:
- Monitoring for symptoms that may indicate the coin is lodged in the esophagus or causing other complications
- Avoiding interventions that could push the coin further into the digestive tract
- Maintaining a normal diet and fluid intake to help the coin pass naturally
- Seeking immediate medical attention if symptoms such as vomiting, abdominal pain, or respiratory distress occur
- Understanding that most ingested coins pass without causing significant harm, but vigilance is necessary to address any potential complications promptly.
Given the information from the study published in Pediatrics 1, it's clear that while choking is a significant concern among children, the management of a swallowed penny can often be conservative, focusing on watchful waiting and monitoring for symptoms that may indicate a need for more urgent intervention.
From the Research
Management of a 5-year-old Female who Swallowed a Penny
The management of a child who has swallowed a foreign object, such as a penny, depends on various factors including the location of the object, the presence of symptoms, and the child's medical history.
- Initial Assessment: The child should be evaluated for any symptoms such as vomiting, abdominal pain, or difficulty swallowing 2.
- Imaging Studies: A chest and abdominal X-ray should be performed to determine the location of the penny 2, 3.
- Location of the Penny: If the penny is located in the esophagus, it should be removed endoscopically or with a balloon catheter to prevent complications such as erosion or stricture formation 4, 3.
- Penny in the Stomach: If the penny is in the stomach, it can be managed conservatively, and most will pass through the gastrointestinal tract without any issues 2, 3.
- Special Considerations: Children who have undergone pyloromyotomy may be at risk for prolonged gastric retention of the penny, and surgical intervention may be required 5.
- Monitoring: The child should be monitored for any signs of complications, such as abdominal pain, vomiting, or fever, and follow-up X-rays should be performed to ensure the penny has passed through the gastrointestinal tract 2, 3.