Indications for hepatitis B immunoglobulin for neonates of HBsAg carrier mothers.

In both these cases the nature of the foreign body in the palate defied diagnosis by either the parents or clinicians. Although this led to considerable delay in presentation, removal was simple and the palate left unscathed. The risks of dislodgement and aspiration of the plastic screwhead cap into the tracheobronchial tree, however, rendered this a potentially serious condition. Because screwhead caps look like small sweets they are attractive to children and their widespread use in the home makes them readily accessible. Ingestion of a cap into the alimentary tract would probably pass unnoticed, but if a cap was inhaled its size is such that it could obstruct the major airways. Though such plastic screwhead caps are not mentioned specifically in reports of foreign bodies in the tracheobronchial tree3 4 and do not figure in the series of 50 cases in this hospital (G H Welch, personal communication), we think that they present a considerable risk. This could be minimised by manufacturers including a warning in the instructions issued with furniture that is to be assembled at home. In our experience the central plastic retaining pin in screwhead caps can easily become distorted and therefore fail to fix the cap securely. Use of an adhesive would achieve better fixation.