Foreign-Body Ingestions of Young

Children Treated in US Emergency

Departments: 1995–2015
Danielle Orsagh-Yentis, MD,a Rebecca J. McAdams, MA, MPH,b Kristin J. Roberts, MS, MPH,b Lara B. McKenzie, PhD, MAb,c

describe the epidemiology of foreign-body ingestions (FBIs) of children ,6 years

OBJECTIVES: To
of age who were treated in US emergency departments from 1995 to 2015.
abstract
METHODS: We performed a retrospective analysis using data from the National Electronic Injury
Surveillance System for children ,6 years of age who were treated because of concern of FBI
from 1995 to 2015. National estimates were generated from the 29 893 actual cases reviewed.
RESULTS: On the basis of those cases, 759 074 children ,6 years of age were estimated to have
been evaluated for FBIs in emergency departments over the study period. The annual rate of
FBI per 10 000 children increased by 91.5% from 9.5 in 1995 to 18 in 2015 (R2 = 0.90; P ,
.001). Overall, boys more frequently ingested foreign bodies (52.9%), as did children 1 year of
age (21.3%). Most children were able to be discharged after their suspected ingestion
(89.7%). Among the types of objects ingested, coins were the most frequent (61.7%). Toys
(10.3%), jewelry (7.0%), and batteries (6.8%) followed thereafter. The rates of ingestions of
those products also increased significantly over the 21-year period. Across all age groups, the
most frequently ingested coin was a penny (65.9%). Button batteries were the most common
batteries ingested (85.9%).
CONCLUSIONS: FBIsremain common in children ,6 years of age, and their rate of ingestions has
increased over time. The frequency of ingestions noted in this study underscores the need for
more research to determine how best to prevent these injuries.

a
Department of Gastroenterology, Hepatology, and Nutrition and bCenter for Injury Research and Policy, The WHAT’S KNOWN ON THIS SUBJECT: Foreign-body
Research Institute, Nationwide Children’s Hospital, Columbus, Ohio; and cDivision of Epidemiology, College of ingestions are common in children. Button battery and
Public Health, The Ohio State University, Columbus, Ohio magnet ingestions can cause considerable harm and
Dr Orsagh-Yentis conceptualized and designed the study, conducted the analyses, drafted the initial have been the focus of much research and advocacy
manuscript, and reviewed and revised the manuscript; Ms McAdams conducted the analyses and to date.
reviewed and revised the manuscript; Ms Roberts and Dr McKenzie conceptualized and designed
WHAT THIS STUDY ADDS: The rate of foreign-body
the study and reviewed and revised the manuscript; and all authors approved the final manuscript
as submitted and agree to be accountable for all aspects of the work.
ingestion in children ,6 years of age increased by
91.5% during the 21-year study period. The items most
DOI: https://doi.org/10.1542/peds.2018-1988 frequently ingested were coins (61.7%), toys (10.3%),
Accepted for publication Feb 11, 2019 jewelry (7.0%), and batteries (6.8%).
Address correspondence to Danielle Orsagh-Yentis, MD, Department of Gastroenterology,
Hepatology, and Nutrition, Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH 43205.
E-mail: danielle.orsagh-yentis@nationwidechildrens.org
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2019 by the American Academy of Pediatrics To cite: Orsagh-Yentis D, McAdams RJ, Roberts KJ, et al.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to Foreign-Body Ingestions of Young Children Treated in US
this article to disclose. Emergency Departments: 1995–2015. Pediatrics. 2019;
143(5):e20181988
FUNDING: No external funding.

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PEDIATRICS Volume 143, number 5, May 2019:e20181988 ARTICLE
Young children are prone to putting
things in their mouths and
swallowing them.1 Children 5 years of
age and younger are responsible for
75% of all foreign-body ingestions
(FBIs),2 and 20% of children 1 to
3 years of age have ingested some
kind of foreign body.3 In 2016, FBIs
were the fourth most common reason
for calls to American poison-control
centers for children #5 years of age.
A total of 67 771 such cases were
logged that year.4
Although many ingested items are
relatively innocuous and able to pass
through the gastrointestinal tract,
some can cause grievous harm,
necessitating intervention by
proceduralists or surgeons. According
to a single center’s 10-year
retrospective review of all its
esophagogastroduodenoscopies,
7.8% were done for foreign-body
removal alone.5 Adult literature has
revealed that 1% to 14% of patients
with FBIs require operative removal.6
The significant morbidity and
mortality resulting from ingestions of
magnets and button batteries (BBs)
have been well-documented over the
past 2 decades.7–9 When BBs become
lodged in the esophagus, they can
produce hydroxide radicals, leading
to caustic injury from high pH;
necrosis, perforation, and strictures
can then occur. Aortoenteric fistulas
and death have been reported.9–11
Between 1990 and 2009, the number
of patients presenting to US
emergency departments (EDs) for
BB-related injuries increased
significantly, particularly in the latter
half of that period. There was an
average of 3289 annual ED visits for
battery-related injuries over those
years.12 In 2012, the Centers for
Disease Control and Prevention
reported findings of the US Consumer
Product Safety Commission (CPSC),
relaying that nearly 75% of patients
seen for battery-related injuries were
,5 years of age, with 10% requiring
hospitalization. When the type of
battery causing these injuries was
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2 ORSAGH-YENTIS et al
able to be identified, BBs were
culpable 58% of the time. Between
1995 and 2010, BBs were responsible
for 14 fatalities, all involving young
children (7 months–3 years of age).8
Similarly, ingestion of magnets
(particularly the high-powered ones
composed of neodymium) can be
harmful. When .1 magnet is
ingested, the magnets can attract
across gastrointestinal walls, leading
to perforation, necrosis, sepsis,
obstruction, and death.9,11 The
ingestion of multiple magnets
appears to have an intestinal
perforation rate as high as 50%.13
Between 2002 and 2012, there was
a 7% increase in surgical
management for patients having
ingested magnets.14 Of the estimated
16 386 children who sought care in
EDs for suspected magnet ingestion
during that time frame, the majority
were ,5 years of age.7
Although unlikely to cause significant
harm, coins have been shown to be
the objects most frequently ingested
by children #14 years of age.
Between 1994 and 2003, there were
.250 000 such ingestions and/or
aspirations and 20 resultant deaths in
the United States.15 Children also
ingest a variety of other household
items such as toys and jewelry.16
Between 2010 and 2014, there were
.25 000 ingestions of jewelry among
children #18 years of age.17
Approximately 14 children ,5 years
of age sought care in US EDs each day
because of ingested or inhaled toys
between 1990 and 2011.18
Consumer groups, health care
providers, and the CPSC have
attempted to make toys, batteries,
and magnets safer for children. As of
2008, under the Consumer Product
Safety Improvement Act (CPSIA), the
CPSC requires that manufacturers
ensure that batteries are secured in
compartments of toys intended for
use by children ,3 years of age.19 For
that same age group, they also
banned any toy that could fit within
a choke-test cylinder (2.25 inches
long by 1.25 inches wide,
approximating the expanded size of
the throat of a child ,3 years of
age).20 In 2012, the CPSC issued
a recall of neodymium magnet sets.21
Most companies complied, but the
largest manufacturer of such
products refused.22 Despite that
company’s refusal, there were 24.8%
fewer magnet ingestions for children
#17 years of age between 2013 and
2015 than in the 3 years before the
ban.23
Previously published studies on FBIs
have been focused on a single type of
ingested object or on a short time
frame, and research has been limited
on the epidemiology of ingestions
beyond those of magnets, BBs, and
coins. Given that children ,6 years of
age are most likely to ingest foreign
bodies, we sought to explore the
trends of the pantheon of their
ingestions from 1995 to 2015. To our
knowledge, this is the first nationally
representative study used to examine
the epidemiology of FBIs in US
children presenting to EDs over
a 2-decade period.
METHODS
Data Source
Data of patients ,6 years of age who
were brought to US EDs for
suspicion of FBI between January 1,
1995, and December 31, 2015, were
obtained from the National Electronic
Injury Surveillance System (NEISS).
The CPSC operates the NEISS, which
provides data on consumer
product–related injuries treated in US
EDs. Approximately 100 hospitals,
including 8 children’s hospitals,
provide data to the NEISS, which then
represents a stratified probability
sample of the 6100 hospitals in the
country that have $6 beds and
a 24-hour ED. Urban, suburban,
and rural hospitals are included. By
using a validated method, data from
the NEISS are weighted by the CPSC
to derive national estimates of
product- and sports- and/or activity-
related injuries.24 NEISS coders at
each of the member hospitals review
every ED case with a diagnosis of any
type of injury. The coders update the
database daily, recording data on
patients’ demographics, products
involved, and disposition. A brief
narrative describing the incident is
included. Population estimates from
the US Census Bureau were used to
determine injury rates per 10 000
children ,6 years of age.25
Case Selection Criteria
All NEISS cases involving injuries
identified with a diagnosis code of 41
(signifying an “ingested foreign
object”) among children ,6 years of
age were reviewed (n = 35 957). After
a review of a subset of case
narratives, case inclusion and
exclusion criteria and variable
categories were developed. All case
narratives were reviewed to confirm
that the object in question had been
swallowed or ingested. Cases were
included in the analysis if (1) the
ingested object was within the
gastrointestinal tract beyond the
mouth and (2) the ingestion was
suspected via the use of the words
“possible,” “maybe,” and “allegedly” in
the case narrative. Any ambiguous
cases were reviewed by .1 author,
and disagreements were resolved via
consensus. Cases that involved (1)
ingestions of foods or liquids, (2) the
location of the object in the airway or
mouth, (3) aspiration, or (4)
“choking” (unless specified as having
resulted in an ingestion) were
excluded (n = 6063), as were case
fatalities (n = 1). The final number of
actual cases used in the analysis was
29 893.
Variables
The following variables provided by
the NEISS were coded into categorical
variables. Patient age was categorized
into 6 groups (,1, 1, 2, 3, 4, and
5 years of age). Disposition was
regrouped into 2 categories: (1)
hospitalized (ie, admitted, treated and
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PEDIATRICS Volume 143, number 5, May 2019
transferred to another hospital, or
held for observation) and (2) not
hospitalized (ie, treated and released,
examined and released without
treatment, or left against medical
advice). Location of injury was
grouped into 2 categories (home or
other). On the basis of the most
common NEISS product codes,
foreign-body product was grouped
into 9 main categories: (1) coins; (2)
toys; (3) jewelry; (4) batteries; (5)
nails, screws, tacks, or bolts; (6) hair
products; (7) Christmas decorations;
(8) kitchen gadgets; and (9) desk
supplies. Two additional categories
(not specified and multiple products)
were also created on the basis of
product codes.
The foreign-body products were
further categorized on the basis of the
type of object ingested. New variables
were created and coded on the basis
of keyword searches and review
and interpretation of case narratives.
Coin type was subdivided into 5
groups: (1) pennies, (2) nickels, (3)
dimes, (4) quarters, and (5) other.
There were 7 categories for toys: (1)
doll pieces, (2) game pieces, (3) balls,
(4) blocks, (5) marbles, (6) building
sets, and (7) other. Subcategories for
jewelry included (1) bracelets, (2)
earrings, (3) necklaces and/or chains,
(4) rings, and (5) other. Batteries
were subdivided into the following
categories: (1) button (eg, small or
disc batteries), (2) AA, (3) AAA, and
(4) other. The category of nails,
screws, tacks, or bolts had 8
subcategories: (1) nails, (2) tacks
and/or push pins, (3) bolts, (4)
screws, (5) hooks, (6) nuts, (7)
washers, and (8) other. Magnet
ingestion was coded separately as (1)
1 or (2) multiple magnets. If magnet
ingestion was not discussed in the
case narrative, the number of
magnets was set to missing.
Statistical Analyses
Data were analyzed by using SPSS
version 21 (IBM SPSS Statistics, IBM
Corporation, Armonk, NY) and SAS
version 9.4 (SAS Institute, Inc, Cary,
NC). A sample weight was assigned to
each case by the CPSC on the basis of
the inverse probability of selection,
and weights were used to generate
national estimates. Bivariate
comparisons were conducted via Rao-
Scott x2 tests, and strength of
association was assessed by using
relative risks (RRs) with 95%
confidence intervals (CIs). Statistical
significance was assessed by using
a = .05. Trend significance of the
rates of FBIs over time was analyzed
via linear regression. All statistical
analyses accounted for the complex
sampling frame of the NEISS. Data
reported in this article are national
estimates unless otherwise specified
as actual unweighted cases. A
minimum of 20 actual cases was
required for generation of national
estimates. This study was exempt
from review by the Institutional
Review Board at Nationwide
Children’s Hospital.
RESULTS
Demographics and Overall
Ingestion Trends
Between 1995 and 2015, an
estimated 759 074 (95% CI:
589 323–928 825) children ,6 years
of age sought care in US EDs for
suspected or confirmed FBIs
(Table 1). The number of estimated
cases increased by 93.3% from 1995,
when there were 22 206 ingestions,
to 2015, when there were 42 928. The
rate of FBIs per 10 000 US children
,6 years of age increased by 91.5%
over the study period, from 9.4 cases
per 10 000 children in 1995 to 17.9 in
2015 (R2 = 0.90; P , .001; Fig 1).
FBIs most frequently involved
children 1 year of age (21.3%) and
boys (52.9%). Coins accounted for
most of the objects ingested (61.7%).
Of patients, 10.3% were hospitalized
(Table 2). Of the 58.7% of cases for
which location was available, 97.2%
of ingestions occurred within
the home.
3
TABLE 1 Characteristics of FBIs Evaluated in US EDs Among Children ,6 Years of Age, 1995–2015 2008 (R2 = 0.90; P = .004), declined
Characteristic No. Estimated 95% CI from 2008 to 2011 (R2 = 0.96;
Actual National Estimate (%)a P = .020), and again increased from
2011 to 2015 (R2 = 0.97; P = .002;
Total 29 893 759 074 589 323–928 825
Sex Fig 3). The percentage of all FBIs that
Male 15 860 401 908 (52.9) 310 256–493 561 involved toys or toy parts remained
Female 14 033 357 165 (47.1) 278 461–435 870 stable over the study period (12.0%
Age, y in both 1995 and 2015). Three-year-
,1 3458 81 930 (10.8) 61 259–102 601
old children most frequently ingested
1 6479 161 542 (21.3) 123 485–199 600
2 5889 154 471 (20.4) 119 909–189 033 toys or toy parts (21.3%), followed by
3 5911 153 291 (20.2) 120 911–185 671 4-year-old children (20.2%). Boys
4 4878 124 070 (16.3) 94 873–153 266 were more likely to ingest toys or toy
5 3278 83 770 (11.0) 64 959–102 581 parts compared with girls (RR: 1.31
Disposition from ED
[95% CI: 1.19–1.44]). When the type
Hospitalizedb 4137 78 302 (10.3) 62 679–93 926
Not hospitalizedc 25 726 679 934 (89.7) 522 886–836 981 of toy could be determined, marbles
Location were most frequently ingested
Homed 17 011 463 717 (97.2) 349 693–577 741 (47.4%).
Othere 541 13 450 (2.8) 10 317–16 583
Foreign-body product
Coins 18 699 468 575 (61.7) 365 408–571 742 Jewelry
Toys 2868 78 544 (10.3) 58 559–98 529
Jewelry 2066 53 459 (7.0) 41 312–65 606 A total of 7.0% of patients ingested
Batteries 2148 51 477 (6.8) 37 121–65 833 jewelry. The rate of jewelry
Nails, screws, tacks, or bolts 1730 48 149 (6.3) 37 321–58 978 ingestions increased from 0.7 cases
Hair products 699 16 109 (2.1) 11 560–20 658
per 10 000 children in 1995 to 1.5 in
Christmas decorations 564 14 896 (2.0) 11 207–18 586
Kitchen gadgets 543 13 191 (1.7) 9075–17 307 2015 (R2 = 0.54; P , .001; Fig 3).
Desk supplies 493 12 909 (1.7) 9430–16 388 Girls were 2.5 times as likely to
Not specified 61 1228 (0.2) 598–1859 ingest jewelry when compared with
Multiple products 22 536 (0.1) 144–927 boys (95% CI: 2.22–2.81). Children
No. magnetsf
#1 year of age accounted for 46.8%
1 576 14 696 (86.7) 10 895–18 497
.1 114 2256 (13.3) 1342–3170 of jewelry ingestions. Earrings
a
comprised 33.7% of jewelry
Some categories do not total 100% because of rounding.
b “Hospitalized” includes admitted, treated and transferred to another hospital, or held for observation. ingestions when the type of jewelry
c “Not hospitalized” includes treated and released, examined and released without treatment, or left against medical
could be determined.
advice.
d “Home” includes manufactured or mobile home, farm, and apartment or condominium.
e “Other” includes industrial place, school, sports or recreation place, and other public property.
f The presence of magnets was determined via interpretation of case narratives. Magnet ingestions represented just 2.2% Batteries
of cases. If a child ingested a magnet, it was then determined if $1 magnet was ingested.
A total of 6.8% of children ingested
batteries. The rate of battery
Coins quarters (16.0%) were the most ingestions increased from 0.01 cases
The rate of coin ingestions increased common. Quarter ingestions per 10 000 children in 1995 to 1.5 in
from 6.3 cases per 10 000 children in increased with age, from 4.4% of 2015, with a peak rate of 2.2 cases in
1995 to 10.5 in 2015, with a peak children ,1 year of age to 21.9% of 2013 (R2 = 0.89; P , .001; Fig 3).
rate of 12.1 cases in 2011 (R2 = 0.74; children 5 years of age. Children who Battery ingestions represented 0.14%
P , .001; Fig 2). Coins accounted for ingested quarters were almost twice of all FBIs in 1995 and 8.4% in 2015.
67.0% of all FBIs in 1995 and 58.5% as likely to be hospitalized when Batteries were most frequently
of ingestions in 2015. Of all patients compared with those who ingested ingested by children who were 1 year
who were hospitalized over the study other coins (RR: 1.87 [95% CI: of age (33.2%). Batteries were the
period, 79.7% ingested coins. When 1.62–2.12]), and children who second most common foreign-body
compared with children who ingested ingested pennies were less likely to product (6.1%) among all patients
all other products, those who be hospitalized (RR: 0.52 [95% CI: who were hospitalized. Of all patients
ingested coins were 2.43 times as 0.45–0.59]). who ingested batteries, 9.2% were
likely to be hospitalized (95% CI: hospitalized. Of the cases in which the
2.14–2.75). Of the case narratives in Toys type of battery could be determined,
which the type of coin could be The rate of toy and toy-part BBs were most frequently ingested
determined, pennies (65.9%) and ingestions increased from 2003 to (85.9%).

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4 ORSAGH-YENTIS et al

FIGURE 1
Overall rate of FBIs by children ,6 years of age, 1995–2015.
Other Products
A total of 6.3% of patients ingested
nails, screws, tacks, or bolts. Boys
(59.7%) and children 1 year of age
(31.8%) most commonly ingested
items in this group. Screws accounted
for the majority of these ingestions
(52.7%) when the type could be
determined. Hair products
represented 2.1% of all ingestions
and were more commonly ingested
by girls (83.6%). Christmas
decorations represented 2.0% of all
ingestions, with children #1 year of
age accounting for 75.6% of them.
Kitchen gadgets and desk supplies
TABLE 2 Hospitalization by Product Type for Children ,6 Years of Age Presenting to US EDs for FBIs,
1995–2015
Actual
Total
Coins
Batteries
Toys
Jewelry
Nails, screws, tacks, or bolts
Hair products
Kitchen gadgets
Desk supplies
Christmas decorations
a Some categories do not total 100% because of rounding and the need to exclude any categories in which the total
number of actual cases was ,20. Items with actual frequencies of ,20 are not statistically sound to generate national
estimates via the NEISS.
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PEDIATRICS Volume 143, number 5, May 2019
and toys are readily found around the
home. Children in this age group are
prone to putting objects in their
mouths,26,27 enticed by the various
colors, shapes, and sizes of the items
investigated in this study. Children
aged 1 to 3 years accounted for the
majority (61.9%) of all ingestions,
likely related to their developmental
stage and curiosity about their
surroundings.
Overall, this study revealed a 4.4%
annual increase in the rate of FBIs
over the 2 decades. This rate increase
was mirrored in every product
category, although the increases in
coin and battery ingestions were
most conspicuous. Although any
inferences made into the increase in
rate of FBIs are speculative, it seems
that the increase is likely
each represented 1.7% of all
multifactorial. Some of the products
ingestions. A total of 2.2% of children
investigated in this study are
were evaluated for suspected magnet
increasingly being used in household
ingestion, with 13.3% of them
items or have seen an advent on the
ingesting .1 magnet. Hospitalization
marketplace. The NEISS is also likely
was required for 71.1% of children
capturing more ED ingestions than in
who ingested multiple magnets.
previous years.
DISCUSSION Coins were the objects most
frequently ingested, and children who
During the 21-year study period,
ingested them were most often
nearly 800 000 children ,6 years of
hospitalized. Our study revealed,
age were estimated to have sought
however, that the percentage of all
care for FBIs in US EDs (an average of
FBIs represented by coins decreased
99 children each day). This number
slightly over time. Pennies comprised
likely reflects the accessibility of
the majority of coin ingestions.
these objects because coins, jewelry,
Previous research revealed that
pennies are the most frequently
ingested coins, and the percentage of
penny ingestions found in this study
No. Estimated 95% CI is similar to that reported
National previously.15,26,27 Older children were
Estimate (%)a
more likely to ingest quarters,
4119 78 128 63 083–93 172 whereas younger children were more
3298 62 370 (79.8) 50 240–74 500 likely to ingest smaller coins. That
241 4744 (6.1) 3231–6256
173 3441 (4.4) 2456–4426
younger children disproportionately
141 1359 (2.8) 1359–3073 ingested smaller coins likely reflects
109 2450 (3.1) 1754–3145 their esophageal anatomic constraints
62 1135 (1.5) 585–1685 and ease of swallowing smaller items.
43 630 (0.8) 306–953 Children ingesting quarters were
27 692 (0.9) 329–1054
22 424 (0.5) 92–755
more frequently hospitalized than
those ingesting smaller coins. Coins
.23.5 mm (such as the quarter) may
have difficulty passing the pylorus
5

FIGURE 2
Rate of coin ingestions per 10 000 children ,6 years of age, 1995–2015.
and are more likely to become
impacted, particularly in the youngest
children.11
Toys and toy parts were the second
most frequently ingested objects.
Interestingly, toy ingestions increased
FIGURE 3
Rate of toy, battery, and jewelry ingestions per 10 000 children ,6 years of age, 1995–2015.
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6 ORSAGH-YENTIS et al
rapidly through the beginning years
of this study period, reaching a peak
in 2008, at which time the CPSIA
went into effect (along with its small
parts ruling). The dramatic decrease
in toy ingestions through 2011 is
likely in part related to the CPSIA and
the increased pressure on
manufacturers to package items
appropriately for children ,3 years
of age. The fact that toy ingestions
again increased after 2011 is more
difficult to reconcile, but it may be
related to the overall trend of
increased FBIs.
The findings of this study reveal how
ingestion patterns differ by sex and
age. Jewelry and hair products were
disproportionately ingested by girls,
presumably because girls have more
access to these items. Boys more
frequently ingested screws and nails.
Children #1 year of age were
considerably more likely to ingest
Christmas decorations and small
objects such as earrings and screws,
again demonstrating that children
ingest accessible and easy-to-
swallow items.
Batteries and magnets may have
represented just 6.8% and 2.2% of all
cases, respectively, but they can both
enact considerable damage when
ingested. Although they were only the
fourth most commonly ingested
product, batteries were implicated
second most frequently among
patients who were hospitalized.
Battery ingestions increased rather
dramatically over the study period, as
did their representation among all
FBIs. Previous research from the
Centers for Disease Control and
Prevention revealed a 2.5-fold
increase in such ingestions between
1998 and 2010,5 but our data
revealed a 150-fold increase over the
21-year study period. The advent of
BBs is likely culpable for this
increase. Although such batteries
have been used for nearly 30 years,11
the increase in ingestions is likely
related to their increased use in
electronic devices.28 Furthermore, the
past 3 decades have seen increased
morbidity and mortality resulting
from BB use, likely related to
increased battery diameter and
a move to lithium cells,28 which have
longer shelf lives and carry more
voltage than previous cells.11 These
batteries can enact more mucosal
destruction and are more likely to
become impacted. Given the potential
for harm with BB ingestion, the
American Academy of Pediatrics
(AAP) designed a task force to
develop strategies to decrease these
ingestions.29
During the study period, the vast
majority of magnet ingestions
consisted of a single magnet, and
those patients were likely to be
discharged after their ingestion.
Advocacy efforts continue to be
focused on the sale of high-powered
magnets. In 2012, the North
American Society for Pediatric
Gastroenterology, Hepatology, and
Nutrition (NASPGHAN) surveyed its
members on neodymium-magnet
ingestion and reported its findings to
the CPSC.30 Later that year, the CPSC
proposed the ban on the production
and sale of magnet sets; magnet
ingestions decreased thereafter.23,31
In 2016, the US Court of Appeals for
the Tenth Circuit lifted the restriction
on the production and sale of high-
powered magnet sets, and now these
magnet sets can be sold if marketed
for purposes other than play.32 Both
the AAP and NASPGHAN have alerted
their members to the dangers
inherent in high-powered magnet
ingestion.33,34
This study has several limitations.
Given that the NEISS captures only
the patients who presented to its EDs,
the total number of FBIs during the
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
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PEDIATRICS Volume 143, number 5, May 2019
study period was likely
underestimated. Children who
remained at home, sought care at
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Furthermore, we did not include
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AAP: American Academy of
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CI: confidence interval
CPSC: Consumer Product Safety
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FBI: foreign-body ingestion
NASPGHAN: North American
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 Foreign-Body Ingestions of Young Children Treated in US Emergency
Departments: 1995−2015
Danielle Orsagh-Yentis, Rebecca J. McAdams, Kristin J. Roberts and Lara B.
McKenzie
Pediatrics 2019;143;
DOI: 10.1542/peds.2018-1988 originally published online April 12, 2019;

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 Foreign-Body Ingestions of Young Children Treated in US Emergency
Departments: 1995−2015
Danielle Orsagh-Yentis, Rebecca J. McAdams, Kristin J. Roberts and Lara B.
McKenzie
Pediatrics 2019;143;
DOI: 10.1542/peds.2018-1988 originally published online April 12, 2019;

The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/143/5/e20181988

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