Tag Archives: ingestion

ESPGHAN Position Paper: Management of Foreign Bodies (2026)

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O Ledder et al. J Pediatr Gastroenterol Nutr. 2026;83:539–554. Open Access! Foreign body ingestions in children and adolescents: A position paper of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) endoscopy special interest group

In 2015, NASPGHAN’s endoscopy committee published a report on the management of foreign bodies (see: Foreign Bodies in Children -Expert Guidance). This was quite helpful. This ESPGHAN position paper provides updated guidance though many of the recommendations are unchanged.

Overall Treatment Algorithm:

Button Batteries

Blunt Objects/Benign Foreign Bodies

  • Superabsorbent polymers (SAP) Since these items are translucent, imaging is useful only for identifying the sequelae of the ingestion, but not the SAP itself… In cases of witnessed or suspected ingestion of SAP, emergency endoscopy should be performed to attempt retrieval of the material. If this is unsuccessful, or not completely retrieved, the child should be admitted for close observation with surgical support.

Magnets:

  • On table fluoroscopy has been suggested to confirm removal of all magnets if there is doubt whether all have been retrieved. (My personal experience is that fluoroscopy is particularly helpful if a colonoscopy is needed.)

Sharp Objects

My take: These guidelines are similar the previous NASPGHAN endoscopy committee recommendations from 2015. They are still worth a read for more context and there are a lot of endoscopy pointers in this report.

Related blog posts:

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Water Beads in the News and in JPGN

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NBC News 3/20/24: New health warning issued about the dangers of water bead toys

“The absorbent polymer beads are often marketed as colorful, slimy, sensory items for kids to play with. They can be as small as a stud earring  — little enough to swallow — but grow to the size of a marble or even a golf ball when immersed in water. Once inside a child’s body, they can cause gastrointestinal blockages. The CPSC (Consumer Product Safety Commission) recorded nearly 7,000 water bead-related ingestion injuries in emergency rooms between 2018 and 2022.”

EA Pasman, MA Khan, NT Kolasinski, PT Reeves. JPGN 2024;79:752–757. Water bead injuries by children presenting to emergency departments 2013−2023: An expanding issue

CPSC issued a recall of more than 50,000 Chuckle & Roar Water Beads Activity Kits in 2023 after a 10-month-old child reportedly swallowed one of the water beads and died. (Ref: AAP News (American Academy of Pediatrics). Water bead toy kits recalled following death of 10-month-old child. Accessed Sept 21, 2024)

Methods: The authors used the National Electronic Injury Surveillance System (NEISS) to identify water bead injuries from 2013 to 2023. The nationally representative NEISS database catalogs ED encounters for injuries related to consumer products over a nationwide census and captures 500,000 injury-related encounters annually. The authors used more stringent criteria than CPSC; thus the numbers of injuries from water beads in their study are less than those reported by CPSC.

Key findings:

  • Children under age 2 years comprised 29% of injuries.
  • There was a significant uptrend in water bead injury frequency after 2020.

Discussion: Published NASPGHAN recommendations include “‘urgent’ endoscopy (<24 h from presentation, following usual NPO guidelines) for any absorptive object ingested and found to be in the stomach or small bowel. The report recommends emergent upper endoscopy for any absorptive object impacted in the esophagus causing sialorrhea.” 

My take: The database captures only a fraction of these ingestions.  These objects, even if they do not cause acute injury, could pose long-term harms due to potential carcinogenicity.

Related blog post: Foreign Bodies in Children -Expert Guidance