RATIONALIZING THE MANAGEMENT OF SWALLOWED COINS IN CHILDREN

Objective - To assess the management of swallowed coins in children and identify aspects that could be improved. Design - Study of records of three hospital departments for 1986-90. Setting - Accident and emergency, radiology, and operating theatre departments in a children's hospital. Subjects - 50 children reported to have ingested coins. Main outcome measures - Radiological investigations performed, position of coin, symptoms of child, and surgical intervention. Results - 50 children were recorded to have swallowed coins during 1986-90. Five children had only chest radiography, five only abdominal radiography, and 40 had both. A coin was detected in the oesophagus in 15 children, six of whom had symptoms, and below the cardia in 26, none of whom had symptoms; no coin was seen in nine children. Eleven children had further abdominal radiographs despite the absence of gastrointestinal symptoms; one child had a coin removed from the stomach. Conclusions - Children are being unnecessarily exposed to radiation and surgical intervention, and a consensus on management of swallowed coins is needed. Most children require only a single chest and neck radiograph.