Foreign Bodies and Children – Small Objects, Serious Risks

By Dr Tariq Jagnarine

Fam Med, Endocrinology

Children are naturally curious. They explore their surroundings by touching, tasting, and placing objects in their mouths, noses, and ears. Unfortunately, ordinary household items such as coins, beads, food, toy parts, batteries, and magnets can become dangerous foreign bodies.
As a clinician, I have seen how quickly a normal day can become frightening for a family. A child may be playing happily and, within seconds, begin coughing, choking, or struggling to breathe. In other cases, no one witnesses the event, and the first clue may be unexplained drooling, persistent coughing, or an unpleasant discharge from one nostril.
Parents often arrive frightened and blaming themselves. My role is not only to assess the child, but also to reassure the family, establish what may have happened and determine whether urgent removal is required. These situations have taught me that even a child who appears comfortable may still have a dangerous foreign body.

Why are young children particularly vulnerable?
Children younger than five years are at the greatest risk because they have narrow airways, are developing chewing skills, and have limited awareness of danger. They may also be unable to explain what they swallowed, inhaled, or inserted.
Common foreign bodies include:

• Coins
• Beads and buttons
• Small toy parts
• Pen caps
• Seeds, peas, and pieces of sponge
• Fish or chicken bones
• Nuts, popcorn, sweets, and whole grapes
• Button batteries
• High-powered magnets
• Jewellery, screws, and pins

The level of danger depends on the type of object, its size, its location, and whether it is blocking breathing or damaging nearby tissues.

Foreign bodies in the airway
Food is one of the most common causes of choking in children. Peanuts, popcorn, hard sweets, whole grapes, chunks of meat, raw vegetables, and small bones may completely or partially obstruct the airway.
A child with complete airway obstruction may suddenly become unable to speak, cry, cough, or breathe. The child may clutch the throat, appear distressed, turn blue, or lose consciousness.
Not every inhaled object causes complete choking. An object may travel deeper into one lung and cause:
• Sudden coughing
• Persistent wheezing
• Noisy breathing
• Difficulty breathing
• Reduced air movement on one side of the chest
• Recurrent chest infections
Sometimes the initial coughing settles and the child appears normal. This can create false reassurance. A suspected inhaled object still requires urgent medical assessment because symptoms may return hours, days, or even weeks later (Royal Children’s Hospital Melbourne, 2024a).

What should you do if a child is choking?
If the child is coughing strongly, encourage continued coughing and watch closely.
If the child cannot breathe, speak, cry, or cough effectively, call 911 immediately while first aid is being administered.
For an infant younger than one year:
1. Give up to five firm back blows between the shoulder blades.
2. If the object is not expelled, give up to five chest thrusts.
3. Continue alternating back blows and chest thrusts until the object is expelled or the infant becomes unresponsive.
4. Never perform abdominal thrusts on an infant.
For a child older than one year:
1. Give up to five firm back blows.
2. If unsuccessful, give up to five abdominal thrusts.
3. Continue alternating these actions until the object is expelled or the child becomes unresponsive.
If the child becomes unresponsive, begin cardiopulmonary resuscitation if trained and follow the emergency dispatcher’s instructions. Never perform a blind finger sweep, as it may push the object deeper. Any child who receives chest or abdominal thrusts should be medically assessed, even if the object comes out (Resuscitation Council UK, 2025).

Swallowed objects
Many smooth objects eventually pass through the digestive system. However, caregivers should not assume that every swallowed object is harmless.
Seek urgent medical attention if the child develops:
• Excessive drooling
• Difficulty or pain when swallowing
• Refusal to eat or drink
• Repeated vomiting
• Neck, chest or abdominal pain
• Coughing or difficulty breathing
• Blood in vomit or stool
• Abdominal swelling
• Fever or unusual weakness
Sharp objects, large objects, magnets, batteries, and objects containing lead require urgent assessment.

Button batteries are medical emergencies
Button batteries are found in toys, watches, remote controls, calculators, hearing aids and electronic decorations. When lodged in the oesophagus, a battery can produce an electrical current and cause severe tissue injury within approximately two hours. Even an old or apparently flat battery may remain dangerous.
If a button battery may have been swallowed:
• Take the child to the nearest emergency department immediately.
• Do not wait for symptoms to develop.
• Do not induce vomiting.
• Do not allow the child to eat or drink unless advised by a healthcare professional.
If the child is at least 12 months old, can swallow normally and the battery was swallowed within the previous 12 hours, give two teaspoons, or 10 mL, of honey every 10 minutes for up to six doses while travelling to the hospital. Do not delay transportation to obtain honey. Honey may slow tissue injury, but it does not replace urgent removal. Honey must not be given to infants younger than 12 months (National Capital Poison Center, 2026).
A button battery placed inside the nose or ear is also an emergency.
Magnets can damage the bowel
High-powered magnets can attract each other through separate loops of bowel. This may trap the bowel wall, cut off its blood supply, and cause obstruction, perforation, infection or death.
Swallowing more than one magnet or swallowing a magnet with another metal object is particularly dangerous. Any suspected magnet ingestion requires urgent hospital assessment and imaging, even if the child appears well (Royal Children’s Hospital Melbourne, 2024b).

Objects in the nose or ear
Children commonly place beads, seeds, peas, paper, sponge, stones and toy parts into their noses or ears.
Possible warning signs include:
• Pain or discomfort
• Bleeding
• Nasal blockage
• Reduced hearing
• Ear or nasal discharge
• An unpleasant-smelling discharge from one nostril
In clinical practice, a persistent unpleasant-smelling discharge from only one nostril should always raise suspicion of a retained foreign body, particularly in a young child.
Do not insert cotton buds, tweezers, hairpins or other instruments into the nose or ear. Repeated attempts may push the object deeper, cause bleeding or damage the eardrum. Keep the child calm and seek medical care (NHS, 2021).

Foreign bodies in the eye or skin
Dust or a loose eyelash may sometimes be removed by gently rinsing the eye with clean water. The child should not rub the eye. Persistent pain, redness, sensitivity to light, blurred vision or an object embedded in the eye requires urgent assessment.
Do not pull out a large or deeply embedded object from the skin. Removing it may worsen bleeding or damage nearby structures. Cover the area carefully and seek medical attention. The wound should also be assessed for infection and the child’s tetanus vaccination status reviewed.

Prevention begins at home
As both a clinician and parent, I understand that it is impossible to watch a child every second. Prevention must, therefore, involve creating a safer environment. Parents and caregivers should:
• Store batteries, coins, magnets and small objects out of children’s reach
• Ensure battery compartments are secured with screws
• Select toys appropriate for the child’s age
• Check toys regularly for loose or broken parts
• Cut grapes and similar foods lengthwise into smaller pieces
• Avoid nuts, popcorn, and hard sweets in young children
• Ensure children sit calmly while eating
• Discourage running, laughing or playing with food in the mouth
• Teach older children to keep small toys away from younger siblings
• Learn paediatric first aid and cardiopulmonary resuscitation
Foreign body incidents can happen in any family. They are not always the result of poor supervision, but their consequences can be severe.
My advice to parents is simple: remain calm, do not repeatedly attempt to remove the object and seek help promptly. Button batteries, magnets, sharp objects and suspected inhaled objects should never be managed by waiting at home. Early recognition and appropriate action can prevent a minor accident from becoming a lifelong tragedy.

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