Child Swallowed Fruit Roll-Up Wrapper: Emergency Response Guide

Cellophane/plastic wrappers are indigestible and pose aspiration/obstruction risk.

Immediate Actions

1. Assess airway: Coughing, gagging, stridor, drooling, cyanosis → Call 911, perform age-appropriate choking rescue
2. If breathing normally: Do not induce vomiting – wrapper may aspirate
3. Offer fluids: Small sips water to promote passage
4. Monitor stools: Check for wrapper passage next 24–48 hrs

Warning Signs → Emergency Department

• Persistent vomiting, drooling, refusal to eat
• Abdominal pain, distension, tenderness
• No stool >24 hrs or ribbon-like stools
• Fever, lethargy
• Any respiratory symptoms

Size Matters

• <2 cm: Usually passes spontaneously
• >3 cm or irregular shape: Higher obstruction risk – lower threshold for imaging
• Multiple wrappers: Bezoar formation risk

Imaging if Indicated

• Abdominal X-ray (may not show thin plastic)
• CT abdomen/pelvis (better for radiolucent foreign bodies)
• Contrast study if obstruction suspected

When in doubt, err on side of evaluation. Pediatric GI endoscopy can retrieve if stuck.