Factors Associated with Complications in Pediatric Foreign Body Ingestion: A Retrospective Cohort Study of 754 Children

Background/Objectives: Foreign body (FB) ingestion is a common reason for pediatric emergency department visits. Although most ingested FBs pass spontaneously, a minority cause serious complications, and rapid identification of high-risk ingestions is crucial. We aimed to describe the management strategies and to identify clinical and FB-related factors associated with complications. Methods: We retrospectively reviewed 754 children aged <18 years who presented to a tertiary pediatric emergency department with FB ingestion between 2016 and 2022. FB types, anatomical locations, clinical findings, interventions, and complications were analyzed. Univariate logistic regression was used to screen candidate variables, followed by a parsimonious multivariable model limited to a single non-redundant variable per clinical domain to identify factors independently associated with complications. Results: Of the 754 children, 434 (57.6%) were male, with a median age of 3.6 years. Coins were the most commonly ingested objects (41.8%). Spontaneous passage occurred in 572 (75.9%) cases, while 182 (24.1%) required intervention, most commonly endoscopy (18.0%). Complications occurred in 29 children (3.8%), including 9 (1.2%) with major complications. Major complications occurred almost exclusively with button batteries in the upper esophagus and with multiple magnets and sharp objects in the stomach or intestines. Although intervention was required in 22.5% of coin ingestions, the complication rate was only 0.3%. In multivariable analysis, vomiting (odds ratio [OR], 5.65), sharp or pointed objects (OR, 6.34), and pharyngeal or esophageal location (OR, 12.57) were independently associated with complications. Conclusions: These interrelated features may help emergency physicians identify children who need closer evaluation, but they require prospective validation before being used for clinical prediction.