Evaluation and Management of Suspected Coin Ingestion in Children
Initial Assessment
- Coin ingestions account for approximately 13% of all choking episodes in children, making them the most common non-food foreign bodies ingested 2, 3
- Children aged 3 years or younger account for more than three-fourths (77.1%) of choking episodes 3, 1
- Coin-related choking episodes are usually transient, with the coin typically being swallowed rather than aspirated 2, 4
- Most coins that are swallowed will pass through the gastrointestinal tract without problems, but they may lodge in the esophagus 5, 4
Diagnostic Approach
- Obtain biplanar radiographs (AP and lateral views) to confirm the presence of the coin, distinguish between esophageal and tracheal location, and identify the exact anatomical level of impaction 1
- Common locations for coin impaction include the upper esophageal sphincter (cricopharyngeus muscle) 1 and the thoracic esophagus at the level of the aortic arch 6, 1
Management Algorithm
Symptomatic Patients
- For coins causing complete obstruction, emergent endoscopic removal within 2-6 hours is recommended 1
- Rigid endoscopy is preferred for coins in the upper esophagus 1
Special Considerations
- Children with developmental or neurologic impairment may be at higher risk for complications 3
Potential Complications
- Prolonged retention of coins can lead to pressure necrosis 1, mediastinitis 1, and aspiration risk if the coin dislodges and enters the airway 1
Prevention Strategies
- Pediatricians should provide choking-prevention counseling to parents as part of anticipatory guidance 7
- Parents should be educated about age-appropriate toys and supervision 8
- Cardiopulmonary resuscitation and choking first aid should be taught to parents and caregivers 7