Kids explore their world through taste, touch, sound and smell — often, unfortunately, by stuffing things into their mouths, ears and noses. Especially during the holidays, floors tend to be littered with choking hazards, from runaway cranberries to Christmas tree ornaments.
It may be important to act quickly, advises Dr. Lewis First, chief of pediatrics at Vermont Children's Hospital at Fletcher Allen Health Care. But that's not always necessary. In some cases, parents — and their kids — can breathe easy knowing "This, too, shall pass."
KIDS VT: What object are kids most likely to swallow?
LEWIS FIRST: About 30,000 children each year swallow coins. Usually kids between six months and four years of age are the leading culprits in swallowing things that are not necessarily nutritious but interesting to put into their mouths. The good news is, if something is the size of a quarter or smaller, more than 90 percent of the time it will get through the narrowest passage, which is the exit from the stomach, and pass onward and outward.
KVT: Do parents need to monitor the object as it moves though the body?
LF: Maybe one in 10 children who swallow something smaller than a quarter will have it get hung up in the esophagus or trachea. Normally in those cases the problem is not subtle: Your child will have difficulty breathing, won't be able to talk, may be gasping, their color changes from red to blue, and they'll appear very panicked. That's an emergency, and families need to seek immediate help. The rule of thumb is, if it's anything but a disc battery and your child is asymptomatic, parents should wait at least a few hours before getting an X-ray, to let the object move through the stomach.
KVT: Why are disc or button batteries so problematic?
LF: When a disc battery lodges in the nose or food pipe, the battery presses against the moist walls of the esophagus or stomach generating a small current, which then causes erosion of the esophagus or stomach lining. That can begin within two hours. So the battery needs to be removed immediately at the hospital.
KVT: What can that do to the body?
LF: Combined with the chemicals inside the battery leaching out, the battery can destroy the lining of the esophagus, stomach and digestive system; cause perforations, infection and shock; and even be life threatening.
KVT: What about small magnets?
LF: When a child says he swallowed a magnet, you don't know how many went down. Sometimes there are multiple magnets in small toys. So seek medical attention and get an X-ray and try to identify if there's more than one magnet down there. If there are, those magnets need to be removed. They can stick to each other through the wall of the bowel and paralyze the bowel, possibly leading to an obstruction, irritation, infection or other complications.
KVT: How can parents gauge the size of objects that are safe for small kids?
LF: If you're giving an infant or toddler a toy and can't find a small-parts tester in the store, you can use a toilet paper roll as a gauge: If the toy is small enough to pass through that roll, it's probably too small for children under 4. Toys for infants and toddlers should be at least 1 3/4 inches in diameter and 2 1/2 inches in length.
KVT: What are some of the more unusual objects you've seen pass through kids?
LF: Safety pins and objects from workbenches, such as nails and screws. Sometimes insects can crawl inside ears. A child will know there's something in their ear, and for parents, most kids aren't going to be cooperative. The best thing parents can do if there's something up a nose, in ears or swallowed is to talk to their doctor or seek emergency help so they can provide appropriate advice and possibly sedation, rather than having a child jump back while trying to remove a bead from the nose or ear and have it go farther inside.
KVT: Any advice for heading off problems before they occur?
LF: Parents need to put their spare change in a piggy bank. When it comes to food, raw carrots, grapes, hot dogs or anything quarter-size or larger that can obstruct an airway should be cut into pieces no larger than a half inch to make them easier for kids to swallow and digest. Don't rush your children when they eat and don't let them run around with food in their mouths.
KVT: When kids swallow coins or other objects, do parents need to monitor their back end or listen for that telltale plunk in the toilet?
LF: They don't. Once the object is past the stomach, which usually takes six to 12 hours, it'll usually take anywhere from a few days to a week or two to come out. Keep in mind, there's also a risk of your kids getting radiation they don't need, so talk to your doctor first about when is the most appropriate time to get an X-ray to ensure the coin has moved onward. Our 911 system can instruct families on the fundamentals of the Heimlich maneuver. But most of the time, everything will come out fine in the end.