Rationalising the management of swallowed coins in children.

Abstract

To assess the management of swallowed coins in children and identify aspects that could be improved. Study of records of three hospital departments for 1986-90. Accident and emergency, radiology, and operating theatre departments in a children's hospital. 50 children reported to have ingested coins. Radiological investigations performed, position of coin, symptoms of child, and surgical intervention. 50 children were recorded to have swallowed coins during 1986-90. Five children had only chest radiography, five only abdominal radiography, and 40 had both. A coin was detected in the oesophagus in 15 children, six of whom had symptoms, and below the cardia in 26, none of whom had symptoms; no coin was seen in nine children. Eleven children had further abdominal radiographs despite the absence of gastrointestinal symptoms; one child had a coin removed from the stomach. Children are being unnecessarily exposed to radiation and surgical intervention, and a consensus on management of swallowed coins is needed. Most children require only a single chest and neck radiograph.