From the Guidelines
If your child has swallowed a penny that is visible in the stomach on an x-ray, you should contact your child's doctor immediately for guidance, as the most recent and highest quality study suggests that timely medical consultation is crucial to prevent potential harm from the corrosive effects of zinc in pennies minted after 1982 1.
Management Principles
The management of a child with a radiopaque foreign body, such as a penny, in the stomach involves careful monitoring and timely intervention to prevent complications. The key principles include:
- Watchful waiting with monitoring of the child's stools to ensure the penny passes through the digestive system naturally within 4-5 days without causing harm
- Ensuring the child eats normally and drinks plenty of fluids to help the penny move through the digestive tract
- Watching for warning signs that require immediate medical attention, including vomiting, abdominal pain, blood in stool, fever, or difficulty swallowing
Important Considerations
It is essential to note that pennies minted after 1982 contain zinc, which can be corrosive to stomach tissue if left too long, making timely medical consultation crucial 1. Additionally, the study highlights the importance of computed tomography (CT) scans in patients with suspected perforation or other foreign body-related complications, and emergent endoscopy is recommended for sharp-pointed objects, batteries, magnets, and complete esophageal obstruction 1.
Recommendations
The child's doctor may recommend watchful waiting with monitoring of the child's stools, and if the penny doesn't pass within a week, or if the child develops concerning symptoms, they may need to remove it via endoscopy 1. It is also important to note that laxatives should not be given unless specifically instructed by a healthcare provider, and attempting to make the child vomit to remove the penny could cause additional harm.
From the Research
Management of Radiopaque Foreign Body in the Stomach
- The management of a child with a radiopaque foreign body, such as a penny, in the stomach can be approached in several ways, depending on the specific circumstances 2, 3, 4, 5, 6.
- In general, if the foreign body is a coin and is in the stomach, it can be managed conservatively, with observation to see if it will pass through the gastrointestinal tract unaided 4, 6.
- Endoscopic removal of the foreign body is an option if it does not pass through the stomach or if it is causing symptoms 2, 6.
- Surgical intervention is typically reserved for complicated cases, such as if the foreign body is causing an obstruction or perforation of the gastrointestinal tract 3, 5.
- The decision to remove a foreign body endoscopically or surgically depends on the type of foreign body, its location, and the patient's overall condition 2, 4, 6.
Specific Considerations
- If the child has a history of pyloromyotomy, there may be an increased risk of prolonged gastric retention of the foreign body, and endoscopic or surgical removal may be necessary 3.
- If the foreign body is a battery, it is generally recommended to remove it endoscopically as soon as possible to prevent damage to the gastrointestinal tract 4, 6.
- If the foreign body is a sharp object, such as a needle, surgical removal may be necessary to prevent injury to the gastrointestinal tract 5.