What is the appropriate management for a 1 year and 8 month old child who presents to the pediatric emergency room (Peds ER) with a history (hx) of swallowing a toy object?

SOAP Note Questions for 1-Year 8-Month-Old with Foreign Body Ingestion

For a 1-year 8-month-old presenting with history of swallowing a toy object, the immediate assessment should focus on airway patency, respiratory status, and identifying the nature of the ingested object to determine appropriate management. 1

Subjective (History) Questions

About the Ingestion Event

• When did the ingestion occur? (Time is critical for management decisions)
• Was the ingestion witnessed? If so, by whom?
• What exactly was swallowed? (Size, shape, material, sharp edges)
• Is the object a battery, magnet, or sharp object? (These require urgent intervention)
• How large was the object? (Cylindrical, spherical, or ovoid objects approximately the same diameter as a child's airway pose the greatest risk) 1

Current Symptoms

• Is the child having any breathing difficulties? (Stridor, wheezing, coughing)
• Has the child been drooling excessively? (Suggests esophageal obstruction)
• Has the child been able to eat or drink since the incident?
• Has the child vomited since swallowing the object?
• Is the child crying normally or with a muffled/hoarse voice?
• Has the child had any episodes of choking, gagging, or color changes? 1

Past Medical History

• Does the child have any history of swallowing disorders or developmental delay? (Increased risk of choking) 1
• Any history of previous foreign body ingestions?
• Any known allergies or current medications?
• Birth and developmental history? (Premature birth may affect airway anatomy)

Objective (Examination) Questions

Vital Signs to Document

• Respiratory rate, heart rate, oxygen saturation, temperature
• Signs of respiratory distress? (Retractions, nasal flaring, grunting)

Physical Examination Focus

• Airway assessment: Is there stridor, wheezing, or abnormal breath sounds?
• Respiratory effort: Any increased work of breathing, use of accessory muscles?
• Oropharyngeal examination: Can the object be visualized? (Do not perform blind finger sweeps) 1
• Neck examination: Any swelling, tenderness, or crepitus?
• Chest examination: Any decreased breath sounds or asymmetry?
• Abdominal examination: Any tenderness, distension, or guarding?

Assessment Questions

• Is this an airway emergency requiring immediate intervention? 1
• Where is the foreign body most likely located? (Airway, esophagus, stomach, or beyond)
• What imaging studies should be ordered? (X-rays of neck, chest, abdomen)
• Is the child stable enough for imaging or does immediate intervention take priority?
• Is there evidence of complete or partial airway obstruction?
• Are there signs of esophageal obstruction?

Plan Questions

Immediate Management

• Does the child need immediate airway management? (Head tilt-chin lift, jaw thrust) 1
• Is the Heimlich maneuver or back blows with chest thrusts indicated? (For choking) 1
• Is supplemental oxygen needed?
• Should the child be kept NPO (nothing by mouth)?

Diagnostic Workup

• What imaging studies are needed? (AP and lateral neck/chest X-rays, abdominal X-rays)
• Is endoscopy indicated? (For esophageal foreign bodies or if location uncertain)
• Should the child be observed for passage of the object? (For small, smooth objects that have passed to stomach)

Disposition Planning

• Does this child require admission or can they be managed as an outpatient?
• What specialist consultations are needed? (ENT, GI, pediatric surgery)
• What follow-up imaging or examinations are needed?
• What discharge instructions should be given to parents regarding monitoring for complications?

Common Pitfalls to Avoid

• Not taking a witnessed ingestion seriously even if the child appears asymptomatic initially
• Performing blind finger sweeps which can push objects further into the airway 1
• Missing button batteries or magnets which require emergency removal due to risk of tissue damage
• Assuming an object has passed to the stomach without appropriate imaging
• Failing to recognize partial airway obstruction which can rapidly progress to complete obstruction
• Discharging without clear follow-up plans for confirming passage of the object

Remember that children under 4 years are at highest risk for choking-related complications, and this 1-year 8-month-old falls squarely in this high-risk category 1. The management approach must prioritize airway assessment and stabilization before proceeding to definitive care.