An Evidence-Based Review Of Pediatric Retained Foreign Bodies

Rempe, Brian MD
Iskyan, Kara MD
Aloi, Mara MD
Callahan, James M. MD, FAAP, FACEP
Reed, Kevin MD, FACEP, FAAEM
Whiteman, Paula MD

¹Authors
²Associate Program Director, Department of Emergency Medicine, Allegheny General Hospital, Pennsylvania, PA
³Chief Resident, Emergency Medicine/Internal Medicine Residency, Department of Emergency Medicine, Allegheny General Hospital, Pennsylvania, PA
⁴Program Director, Department of Emergency Medicine, Allegheny General Hospital, Pennsylvania, PA
⁵Peer Reviewers
⁶Associate Professor of Clinical Pediatrics, Director, Medical Education Division of Emergency Medicine, Assistant Residency Director, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA
⁷Assistant Professor of Emergency Medicine, Georgetown University and Washington Hospital Center, Department of Emergency Medicine, Washington, DC
⁸Medical Director, Pediatric Emergency Medicine, Encino-Tarzana Regional Medical Center; Attending Physician, Cedars-Sinai Medical Center, Los Angeles, CA

Date of original release: December 1, 2009

Date of most recent review: November 10, 2009

Termination date: December 1, 2012

Medium: Print and Online

Method of participation: Print or online answer form and evaluation Prior to beginning this activity, see “Physician CME Information” on the back page.

Pediatric Emergency Medicine Practice 6(12):p 1-19, December 2009.

A 4-year-old girl is brought to the emergency department (ED) one night by her parents, who report unilateral foul-smelling nasal drainage for 4 weeks. The girl finally admitted to her mother that she put a wooden bead into her nose, and it had become painful. The parents attempted to remove the bead but were unsuccessful, and the child is now resistant to further attempts. You contemplate the equipment and personnel at your disposal on this busy Saturday night. Will moderate sedation be needed for something as seemingly insignificant as removal of a nasal foreign body? Should you inconvenience your ENT colleagues for a consult?

As you imagine the wrestling match you are about to have with your first patient, you pick up the next chart, which lists a chief complaint of “vaginal itching.” This sounds like an easy encounter until you realize that the patient is another 4-year-old child. How do you perform an adequate vaginal examination on a child without causing her significant discomfort or emotional distress? More importantly, what causes vaginal itching in a 4-year-old?

Later in your shift, a 2-year-old boy is brought in. The mother reports that the child put a quarter in his mouth earlier that evening, and she insists that he swallowed it. No vomiting or choking was witnessed. The child appears comfortable and is in no obvious respiratory distress. On examination the oropharynx is clear, and the lungs sound clear. Still, the mother insists the child swallowed the coin. A chest x-ray does show a circular image overlying the mediastinum on an anterior-posterior (AP) film. How should this situation be managed? Are consultants required? Is a period of observation warranted?