“Spit it out, spit it out,” I say, prying open my 18-month-old daughter’s lips with my fingers. I frantically try to fish out the dime-sized object in her mouth.

She shoots me a defiant look—and swallows.

Three hours later, my husband and I wait in the hospital as our daughter has emergency surgery. She swallowed a round, “button” battery that powers one of the dozens of TV remote controls lying on our coffee table. And it is lodged behind her larynx.

Relief floods us when the surgeon approaches us with a grin. She successfully was no longer battery operated. They removed the battery, he says, and just in time. He holds up a cup. Inside it is the battery, already badly corroded after only a few hours inside her throat.

And this event could easily repeat itself during the frenetic gift unwrapping as toy pieces scatter across the floor—out of sight to grown-ups, in plain sight to small fries. Parents and other loved ones of toddlers remember: anything and everything can make it “into the mouths of babes.”

Open Mouth Policy

I later found out that our daughter’s swallowing incident, while terrifying, is not all that uncommon. To toddlers, the world is an exciting place—and a tasty one. They explore their environment by putting nearly everything they encounter in their mouths—from rocks and building blocks to spare change. Coins are especially zesty and tangy.

Most swallowed items will pass harmlessly through the gastrointestinal tract until they are eliminated. However, other items like button batteries, can be deadly. There is also a chance that your child may have breathed in, or aspirated the object into his or her trachea—the other pipe— potentially blocking an airway.

“The safest thing to do, is once you think your child has swallowed or aspirated a foreign body, go right away to the hospital and let the physicians decide whether this is an emergency or not,” says Dr. Kevin Pereira, a professor of otolaryngology and pediatrics at The University of Texas Medical School at Houston and chief pediatric otolaryngologist at Memorial Hermann Children’s Hospital in Houston.

Pereira says pennies are the most common foreign body that he and his colleagues remove from toddlers. Peanuts, popcorn kernels and hard vegetables top the list of airway foreign bodies he removes from babies who haven’t mastered the art of chewing.

Keep your cool

Looking back on how we handled the situation, it seems we did everything wrong. When my daughter swallowed the battery, she immediately began to cough. I took it as a sign that she was choking, turned her face down and started hitting her back to dislodge the object. I should have just let her cough, Pereira says.

“The cough is called the watchdog of the lungs,” Pereira says. “If your child is coughing, let him cough. That is the body’s way of trying to get rid of whatever was in there.”

“Most swallowed items themselves aren’t all that dangerous,” he continues. “What makes them dangerous is when parents begin slapping the child on the back, doing the Heimlich, things like that. You can dislodge a partially obstructing foreign body and convert it into one that totally obstructs the airway. Back blows and abdominal thrusts should be used only in the event of complete airway obstruction.”

In complete airway obstruction, no air can be sucked in to launch a cough reflex. Take home message: coughing is good.

In my daughter’s case, the battery lodged firmly behind her larynx. She was in extreme discomfort, but was able to breathe. We were lucky.

If you suspect a child is choking and cannot breathe, use choking first aid (http://www.nlm.nih.gov/medlineplus/ency/article/000047.htm) to clear your child’s airway, and have someone call 911. The Heimlich maneuver isn’t recommended for children under age one.

At the hospital

Once at the hospital, an ENT (ear, nose, and throat) doctor will take a chest x-ray of your child to see exactly where the object is. The doctor may also thread a tiny, fiberoptic scope through your child’s nose to determine the object’s location. It helps the doctor if you can describe the object in as much detail as possible. Better yet, bring something the same size as the object with you.

“Bring a replica of the object if you can,” Pereira says. “That, right away tells us what we are dealing with and how to choose our forceps. If it is a battery, bring another battery so we can tell what voltage it is. The higher the voltage, the more dangerous the battery.”

If the object is in the gastrointestinal system, the doctor may decide to let it pass, or to remove it. Objects that are sharp, corrosive or may move and block the airway must be surgically removed.

Doctors use optical forceps, long forceps with a telescope attached to them, to view and remove the object. The whole procedure takes only a few minutes, but is still considered major surgery because the child must be fully anesthetized.

Afterwards, depending on the type of foreign body and the difficulty encountered during removal, the doctor may want to keep your child in the hospital for a day or two for observation. Your child’s throat will also feel sore for a few days, and your child may feel less like eating.

Two months after the swallowing incident, my daughter is a happy and healthy 20-month old. Yes, she still gets cravings for rocks, sticks, blocks and even the occasional dustbunny. But, she seems to have lost her taste for batteries.

Last Updated: 12-07-2005

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