What to do if your child swallows a coin

Tasha, two, is as playful as her agemates. Eager to discover the world around her, she will at times get out of her mother or nanny’s view.

On this day, a nearby diaper bag seemed an exciting plaything and the roll of cotton wool, even more alluring. She pinched, rolled it into a smooth ball into her mouth and inserted it into one of her tiny nostrils.

Two days later, her mother Margaret notices an incessant flow of mucus from one of Tasha’s nostrils and wondered whether another bout of cold was on the way, a week after her most recent medication.

“I looked into the nostril and noticed a white solid object lodged on one side and tried to get it out with a cotton bud but couldn’t,” Margaret narrates.

They ended up at the emergency room.

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Curiosity

At the hospital, the object was finally removed using forceps.

Ear, Nose and Throat specialist Mbira Gikonyo lists coins, buttons, hair beads, pins, screws, beans, pen and bottle caps and toy parts as the commonest foreign bodies inserted, inhaled or swallowed in the food and air passages of children aged between one and three. Insects, stones and marbles are other obscure items that find way to the mouths of these little ones.

While keys and jewellery have smooth edges, sharp foreign objects like needles, nails and pins cause more concern because they can perforate body tissues as they travel down, Mbira warns.

He attributes such accidents common in households to increased mobility of the children and their intrinsic need to explore their surroundings.

“When in the oral stage of development they tend to put anything they come across into their mouths. In later stages, they tend to put items into their noses and ears,” says Mbira. Some cases are solved immediately but others need more intense medical attention.

Mbira recalls a four-year-old who swallowed a piece of paper that was lodged in the chest.

“The child developed a continuous cough but as we prepared to go to theatre, he coughed out the paper saving both the parents and us the trouble and cost of surgery,” he says.

“Another four-year-old accidentally inserted an ear ring in the nose and attempts to remove it at a local clinic worsened it because it was pushed further into the nose. We had to rush the child to the theatre where she underwent a specialised endoscopic laser surgery,” he says.

Danger signs

So what are the signs to look out for if you suspect a child has swallowed, inserted or inhaled a foreign object?

They include pain, fever, swelling and a close observation of stool to check whether the foreign object has been expelled.

Dr Mbira says the Sh10 coin, is one of the most notorious objects that send toddlers to emergency rooms.

Inasmuch as insertion of these objects seem a small thing, the doctor warns that parents and caregivers should treat it like as an emergency because it can result in death.

“Any foreign body in the respiratory system is an emergency,” says Mbira.

And the age that these little ones are most likely to engage in these mischievous yet hazardous games is between one and four years old.

Mbira says because children are increasingly curious at this stage, parents and guardians should be extra vigilant.

Mother kiss remedy

So what do you do in case it happens?

A technique known as ‘the mothers kiss,’ a century-old home remedy is recommended.

The mother or guardian places their mouth over their child’s mouth while holding the unaffected nostril closed with one finger, she blows into the child’s mouth forcing the object out.

If that doesn’t work, Mbira advises parents to rush the child to the nearest medical facility.

The doctor also cautions parents to be careful when attempting to remove the trapped objects.

Great care must be exercised if the child is agitated and restless.

“Items in the ear, can get stuck in the ear canal, and in the nose, they may move beyond where they are easily accessible. Swallowed objects are often out of reach of a mother,” he explains.

So in what instances should one attempt to remove the object?

“When an object is easily visible in the nose or ear, and the child co-operative. You can do this using cotton ear buds or paper clip,” says Dr Mbira.

For swallowed coins, he recommends an operation as it can block the air passage leading to death.

“A few can prove difficult to remove and require actual cutting open of the chest which is a major high risk surgery,” he says.

There are other signs that a parent can look out for to establish whether a child has something inserted in the nose or ears.

“One-sided nasal discharge and foul smell from the nose or mouth, ear pain, itchiness or even poor hearing may also indicate that a foreign object is lodged in the ear,” Mbira says.

Ultimately, prevention is always better than cure.

Parents should be extra vigilant around their children. One way to be safe is to make sure you clear all potentially harmful objects — the beads, the coins, the buttons — away from the child’s reach.

Also empower the child to know what is safe and what is harmful to their health.

“As soon as children start to develop language, teach them that inserting foreign objects in their nose and ears is dangerous,” he says.

Finally, it helps for parents, caregivers and older siblings to be armed with basic first aid skills.