Management of coin ingestion

Article Abstract:

Ingestion of coins is a fairly common occurrence in young children. There is some disagreement among pediatricians on the proper treatment of patients who have ingested coins, but who remain asymptomatic. One school of thought favors 'extended watchful waiting'. Proponents of this view hold that the child is likely to pass the coin; even if the coin is not passed, it will lodge harmlessly within the esophagus without producing symptoms. An X-ray need not be performed, since the costs and risks of the X-ray exceed the costs and risk of adverse effects from the ingested coin. Foods and fluids should be administered, and the diaper should be watched to see if the coin is passed. Should symptoms develop, which usually include stridor (a high-pitched sound during inhalation), bronchitis, pneumonia, or esophageal abscess, X-rays may be taken, and appropriate procedures can then be performed to remove the coin. The opposing view stresses that serious complications can arise should the coin erode into the esophagus and damage the tissue. If this occurs, a thoracotomy (chest surgery) or an esophagostomy (incision into the esophagus) may be required; these are costly and serious surgical procedures. To avoid this situation, the proponents of this view urge that an X-ray be obtained following coin ingestion, even if the child is asymptomatic. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Foreign bodies (Medical care), Foreign bodies

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Pediatric coin ingestion

Article Abstract:

There is some disagreement among pediatricians on the proper treatment of children who have swallowed coins, but who have no symptoms. One school of thought favors a policy of benign neglect, unless symptoms develop. However, other pediatricians, citing the risk of damage to esophageal tissue, urge that the coin be removed. In some cases, removal has been accomplished through thoracotomy, a surgical procedure which cuts through the chest wall; in other cases, endoscopy is used, which involves the insertion of a scope into the esophagus that locates and removes the coin. Endoscopy must be performed under general anesthesia. Some pediatricians remove coins using a Foley balloon catheter; this method involves inserting a type of balloon through the mouth and into the esophagus; the balloon is then inflated, and the coin is extracted when the catheter is withdrawn. This is a less invasive procedure, and does not require general anesthesia. Although this technique is relatively safe, suction equipment should be available, as well as surgical instruments to perform a tracheostomy (incision into the trachea) if the patient experiences a spasm of the larynx. Resuscitation equipment should also be on hand. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Clavicular fractures in neonates

Article Abstract:

The frequency of fractures of the clavicle, or collar bone, among newborns has not been accurately reported, with reported incidence ranging from 0.2 percent to 3.5 percent. These fractures are often difficult to diagnose in the hospital. A study of 626 infants who were born vaginally was conducted. The infants were evaluated twice in the hospital and once two weeks after birth. There were 18 fractures diagnosed, yielding a rate of 2.9 percent. The usual symptoms of clavicular fracture are irritability and crying during arm motion. The signs of fracture seen upon physical examination include instability, swelling, a grating sound at the site of fracture, or asymmetric reflexes. Only two babies had signs or symptoms of fracture. Seven of the 18 fractures were not diagnosed until two weeks after birth. It is suggested by this study that 80 percent of newborns with fractured clavicles are without symptoms or signs of the condition and may have minimal physical findings during the first few days of life. (Consumer Summary produced by Reliance Medical Information, Inc.)

Statistics, Infants (Newborn), Newborn infants, Birth injuries, Clavicle

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