Pediatric foreign body ingestion comes with a dichotomous presentation to the ED — the child in extremis with a clear need for immediate intervention vs. the well-appearing child with unknown ingestion. This creates a challenge for the emergency medicine provider to use a combination of history, physical examination, different imaging modalities, and overall clinical picture to verify ingestion over aspiration and, furthermore, to determine whether there is any need for immediate intervention. The decision-making tree surrounding foreign body ingestion changes based on time course, type of object, location in the gastrointestinal tract, and size. Therefore, a regimented and practical approach to foreign body ingestions is warranted.
It is imperative for the emergency provider to be aware of common agents that can cause life-threatening toxicity or death should accidental ingestions occur. This article focuses on substances that are potentially catastrophic if ingestions occur and how to manage them accordingly.
Patients with toxic ingestions most often will present to the emergency department as either a well-appearing patient with a known ingestion or as an ill-appearing patient with an unknown or suspected ingestion. This article will present the approach to both of these circumstances, discussing treatment and monitoring of specific overdoses as well as the initial approach to an ill child with a suspected overdose. The focus will be on common and accidental ingestions of toxins by pediatric patients.