Foreign Body Ingestion in child

Age: ‍ ‍monthsyears old

Gender: ‍malefemale



HISTORY:

Presents for a suspected ‍foreign body ingestion that occurred ‍ ‍minhoursdays ago

Onset was ‍gradualsudden, started ‍whileafter ‍eatingplaying

Suspected foreign body: ‍, ‍no batteries



Associated symptoms: *Try using right-click for negatives*

‍choking

‍coughing

‍drooling

‍difficulty swallowing

‍painful swallowing

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍gagging

‍decreased appetite

‍irritability

‍fever, up to ‍°, over ‍ ‍hoursdays

‍shortness of breath

‍wheezing

‍stridor

‍decreased fluid intake

‍decreased urine output



Contributing factors:

no history of: ‍developmental delay, ‍behavioral disorders

no use of: ‍medications related to developmental delay or behavioral disorders





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Throat: ‍normal, ‍palate intact, ‍redness

Mouth: mucosa ‍normal, dentition ‍normal

Neck: ‍normal, ‍lymphadenopathy, ‍nuchal rigidity, ‍torticollis, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Chest: ‍tenderness on ‍rightleft ‍

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Extremities: ‍normal inspection, ‍joints ‍normal, ‍limited ROM, ‍normal spine, Barlow ‍negative, Ortolani ‍negative, ‍normal pulses, cap refill ‍< 3> 3 sec

Neurologic: cranial nerves ‍grossly intact, overall motricity ‍normal for agelimb weakness, muscle tone ‍normal for age, gait ‍appropriate for age, reflexes ‍intact 2+

Mental status: ‍alert, ‍, reactive to ‍





ASSESSMENT:

‍Foreign Body Ingestion ‍likelysuspectedpossible

DDx: foreign body ingestion, esophageal foreign body, aspirated foreign body, anatomical abnormalities, psychosocial factors, trauma, ingestion of caustic substances, drug ingestion, button battery ingestion, magnet ingestion





PLAN:

Investigations:

- Abdominal X-ray

- CT scan of the abdomen

- Upper GI endoscopy

Treatments:

- Education on prevention of foreign body ingestion

- Monitor stool for passage of foreign body

Further care:

- Referral to pediatric gastroenterologist

- Referral to pediatric surgeon

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop such as abdominal pain

- Referral to ER if severe abdominal pain, severe vomiting, or fever