Rationalising 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.