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Q: My two-year-old swallowed a penny. How long should it take a child his age to pass it? Should I take him for X-rays if I don't see it soon?
A: Your child is in the most common age range for swallowing a foreign body. Most of the problems with foreign bodies arise when they get wedged in the swallowing tube called the esophagus. Although round objects like coins rarely make a hole in the swallowing tube, problems can begin when there is long-standing contact.
Looking for where the foreign body might be in the GI (gastrointestinal) tract is important if your child has obvious symptoms such as choking, painful swallowing, chest discomfort, or cough. Fortunately, coins are made with radiopaque material, so they can easily be seen on Xray. Even if your child does not have any symptoms, it is still often recommended that an Xray be done to be sure it is not stuck somewhere along the way. Any object in the esophagus must be removed regardless of whether the child has symptoms or not.
Once in the stomach almost all coins will move through the GI tract and pass on their own. Parents can be reassured that straining of stools is a reasonable approach to finding the foreign body; it usually will be seen within 24 to 48 hours, regardless of age. If the coin has not passed on its own, some suggest using an enema to help move things along. If it were still in the stomach by four weeks, it would need to be removed electively.
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Henry Bernstein, M.D., is currently the associate chief of the Division of General Pediatrics and director of Primary Care at Children's Hospital, Boston. He also has an academic appointment at Harvard Medical School.