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Child Swallowed a Dime: Emergency Response, Risks, and Prevention

A swallowed dime (17.9 mm diameter, 1.35 mm thick) is a high-risk foreign body in children. Immediate action is required.

Immediate Steps

  1. Assess airway: If coughing, gagging, stridor, drooling, inability to speak → Choking emergency.
    • < 1 year: Back blows (5) + chest thrusts (5) alternating.
    • ≥ 1 year: Heimlich maneuver (abdominal thrusts) until expelled or unconscious.
    • Call 911 / EMS simultaneously.
  2. If NO airway symptoms: Do NOT induce vomiting. Do NOT give food/drink to "push it down" — may worsen impaction.
  3. Call Poison Control: 1-800-222-1222 (US) — they track foreign body protocols.
  4. Proceed to Emergency Department — even if asymptomatic. Coin location must be confirmed.

Why the ED (Not Wait-and-See)

  • Esophageal impaction: Coins lodge at 3 narrowing levels (cricopharyngeus ~C6, aortic arch ~T4, LES ~T10). Esophageal coins cause mucosal necrosis, perforation, fistula, stricture — time-critical.
  • Airway compression: Large coin in proximal esophagus → tracheal compression.
  • Asymptomatic ≠ safe: 20–30% of esophageal coins are asymptomatic initially.

ED Evaluation

  • X-ray (AP + lateral): Neck → abdomen. Coin orientation distinguishes esophagus (en face = "en face" = round) vs. trachea (edge-on = line). Actually: Esophageal coins appear round (en face); tracheal coins appear on edge (side view). Wait — correction: On AP view, esophageal coins are round (flat surface facing beam); tracheal coins are on edge (thin). Lateral confirms.
  • If in esophagus: Urgent endoscopic removal (within 2h if symptomatic; ≤ 24h if asymptomatic). Foley catheter / bougienage alternatives in resource-limited settings.
  • If in stomach: Observe; most pass in 3–5 days. Repeat X-ray weekly. Remove endoscopically if > 4 weeks, symptomatic, or > 2 cm (quarters, large tokens).
  • If passed pylorus: Will likely pass per rectum. Monitor stools.

High-Risk Coins

  • Quarters (24.3 mm) — higher esophageal impaction rate.
  • Button batteries — MEDICAL EMERGENCY (caustic necrosis in 2h). X-ray: double rim / halo sign.
  • Magnets (multiple) — bowel perforation/fistula.

Prevention

  • Coins out of reach (< 4 years: nothing < 1.25" / 3 cm).
  • Secure piggy banks, purses, change jars.
  • Teach "not food" concept; supervise play.
  • Button battery devices: screw-secure compartments; discard dead batteries safely.

Bottom line: Swallowed dime = ED visit for X-ray. Do not wait. Do not induce vomiting. Esophageal coins require urgent removal.

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