Duration: <2 h for esophageal battery · Esophageal battery: OR within 2 h · magnets/sharp/symptomatic: urgent same-shift · coordinate pediatric GI/surgery and anesthesia
• **Types of FB:** disk (button) battery — **emergency** · ≥2 magnets or magnet + metal — **urgent** · coin — often esophageal, X-ray · sharp/bone/needle — endoscopy · food bolus — trial of conservative measures, endoscopy if not passing · large gastric object >2.5 cm width — endoscopy if symptomatic (NASPGHAN, ESGE).
• **Esophagus — button battery:** **EMERGENCY** — remove within **2 h** (sooner if possible); tissue necrosis begins in 15–30 min; **never observe**; two-view X-ray (AP + lateral) to distinguish from coin (double ring/halo sign); activate endoscopy team immediately (NASPGHAN, NBIH, AAP).
• **Esophagus — magnets (≥2) or magnet + metal:** urgent endoscopy even if asymptomatic — risk of bowel necrosis, fistula, perforation if beyond stomach; esophageal location always urgent (NASPGHAN, AAP, ESGE).
• **Esophagus — coin:** remove if **symptomatic** (drooling, dysphagia, vomiting, pain) or child **unable to report symptoms** (<5 years); asymptomatic older cooperative child — observe up to **24 h** with repeat X-ray, remove if still esophageal (NASPGHAN, AAP).
• **Esophagus — sharp object / food bolus:** urgent endoscopy; do not attempt blind removal or bougienage; assess for underlying esophageal pathology (eosinophilic esophagitis, stricture) at endoscopy (ESGE, NASPGHAN).
Dose is calculated using the ampicillin component.
Max 2000 mg/dose (ampicillin) · Max 8000 mg/day · Duration: 7–10 days · Esophageal perforation, mediastinitis, or secondary peritonitis after FB complication — add urgent surgical consultation
• Antibiotics NOT indicated for uncomplicated successful endoscopic FB removal without perforation or infection (NASPGHAN, ESGE).
• Empiric IV antibiotics when esophageal perforation, mediastinitis, pneumomediastinum with sepsis, or peritonitis suspected — pair with urgent surgical consultation and broad imaging (NASPGHAN, SIS, IDSA IAI).
• Post-operative intra-abdominal infection after surgical FB complication: continue 7–10 days; narrow to culture sensitivities at 48–72 h.
• Failed endoscopy or clinical deterioration (worsening pain, fever, tachycardia, subcutaneous emphysema) — escalate to surgery; do not repeat blind attempts.
Enter weight on Kids to calculate doses
Clinical notes
• **Algorithm:** localize on two-view X-ray (neck/chest/abdomen) → FB in **esophagus** or critical type (battery/magnets/sharp/symptomatic) → **urgent endoscopy**; do NOT use routine contrast studies (NASPGHAN, ESGE).
• **Esophagus — symptoms:** drooling, refusal to feed, dysphagia, odynophagia, vomiting, chest/neck pain, cough, respiratory distress; asymptomatic with radiographic esophageal localization still requires management plan.
• **Imaging:** two-view radiograph (AP + lateral) for radiopaque objects; lateral essential for disk batteries; identify number of magnets; coin vs battery (step-off/double halo); consult poison control/battery hotline where available (NASPGHAN, NBIH).
