Foreign body ingestion, button batteries, EoE and achalasia in kids

Emergencies: button batteries, magnets and water beads

Start with AP and lateral X-rays of the neck, chest and abdomen for any suspected swallowed object. A button battery shows a double ring (halo) on AP view and a step-off on lateral view.

A button battery in the esophagus is removed at once: it causes burns within 2 hours. Do not wait for fasting time or symptoms. If the child is over 1 year and ingestion was within 12 hours, give honey or sucralfate on the way, without delaying removal.

• Never induce vomiting (ipecac): it risks aspiration and more esophageal injury.
• Objects longer than 5 cm or sharp objects: urgent endoscopic removal.
• Late diagnosis of an esophageal battery (more than 12 hours): CT for vascular injury before removal is suggested.

Magnets and water beads

• Two or more magnets, or a magnet plus a metal object, attract each other across bowel walls. This causes pressure necrosis, fistula or perforation, even in a child with no symptoms, so remove them urgently.
• Water beads (superabsorbent polymer) are usually invisible on X-ray and swell in the intestine, causing small bowel obstruction.
• Water beads, even in a well child seen soon after ingestion: urgent endoscopic retrieval while they are still in reach.
• Water beads with obstruction signs: emergency endoscopic removal and a surgical consult.

Coins

Coins are the most common object children swallow. In the esophagus they usually lodge at the upper esophageal sphincter (cricopharyngeus).

• Drooling, chest pain or inability to swallow: urgent removal.
• No symptoms: observe up to 24 hours and repeat the X-ray at 12–24 hours; many pass into the stomach.
• Still in the esophagus at 24 hours, or time of ingestion unknown: endoscopic removal.
• A coin left too long can cause stricture, perforation, or aortoesophageal or tracheoesophageal fistula.
• Coin in the stomach, child well: home, normal diet; remove if still there after about 4 weeks.

Caustics and pill esophagitis

• Caustic ingestion with symptoms (drooling, stridor, vomiting): stabilize the airway, then plan upper endoscopy at 12–24 hours to grade the injury.
• No symptoms does not always mean no injury; decide on endoscopy with GI and poison control.
• Pill esophagitis: doxycycline, NSAIDs or iron taken with little water, often at bedtime, cause odynophagia and retrosternal pain.
• Prevent it with a full glass of water and staying upright after the dose.

Bezoars

• Upper endoscopy shows the contents and can remove some bezoars.
• Risks: gastric outlet or bowel obstruction, mucosal ulceration with bleeding, perforation.

GERD in older children and teens

Teens with GERD describe heartburn and a sour taste, worse lying flat, like adults. They may also have hoarseness, cough or chest pain.

• Lifestyle changes plus a PPI for 4–8 weeks; PPIs heal esophagitis better than H2 blockers.
• No response after about 6 weeks, or alarm signs: upper endoscopy with biopsy.
• Long-term PPI risks: C. difficile and other enteric infections, pneumonia, fractures, low magnesium and B12.
• Weeks of fullness and vomiting of undigested food after a viral illness with a normal X-ray and upper GI suggest post-viral gastroparesis: small low-fat meals; it resolves over months.
• Rapid weight loss, spinal fusion or a body cast with bilious vomiting and early fullness suggests superior mesenteric artery syndrome.

Eosinophilic esophagitis and achalasia

Eosinophilic esophagitis (EoE) is a chronic non-IgE, Th2-driven allergic inflammation. It is the most common cause of solid-food dysphagia and food impaction in teens. Boys outnumber girls about 3:1, and most have other atopy. Infants and toddlers present with feeding refusal, vomiting and poor growth; school-age children eat slowly, chew a long time and drink with every bite.

Diagnosis: symptoms plus esophageal biopsy with ≥15 eosinophils per high-power field, after other causes are excluded. A PPI trial is no longer required first. Endoscopy shows linear furrows, rings, white exudates and strictures.

• High-dose PPI, about 1–2 mg/kg/day divided twice daily.
• Swallowed topical steroid: fluticasone puffs swallowed or budesonide slurry.
• Diet: remove cow milk first (the most common trigger), or a six-food elimination (milk, wheat, egg, soy, nuts, fish/shellfish). Skin-prick and IgE tests do not pick the foods.
• Dupilumab (IL-4/IL-13 blocker) is approved from age 1 year and 15 kg.
• Fibrotic stricture: endoscopic balloon dilation. Response is judged by repeat endoscopy with biopsies.
• Achalasia: dysphagia to solids and liquids, regurgitation of undigested food, weight loss; barium shows a dilated esophagus with a bird-beak. High-resolution manometry confirms it (absent peristalsis, the LES does not relax). POEM or laparoscopic Heller myotomy gives the best long-term result; dilation often needs repeating and botulinum toxin is brief.

Common questions

Sources

• NASPGHAN 2015: Management of ingested foreign bodies in children (JPGN)
• ESPGHAN 2021: Button battery ingestion in childhood (JPGN)
• AGA/JTF 2020: Clinical guidelines for eosinophilic esophagitis (Gastroenterology)
• NASPGHAN/ESPGHAN 2018: Pediatric gastroesophageal reflux guidelines (JPGN)

Written for Pedemy in our own words from the sources above; checked November 2026. For education only, not medical advice; check doses and local protocols before treating a patient. Pedemy is independent and not affiliated with or endorsed by the organizations cited.