30 Nov The Case of the Toddler Who Suddenly Stopped Eating

A concerned mother recently brought her young toddler to my office because he suddenly stopped eating. Her child had a history of acid reflux. The acid reflux had been under excellent control, but the mother was concerned that acid reflux was the cause of the sudden refusal to eat.

The mother reported that her child had refused dinner the night before and did not eat breakfast and lunch that day. He was only taking small sips of liquid. He seemed to be drooling more than usual but was otherwise acting normal. On further questioning, the mother stated that her child had been eating a normal amount until the night prior. She did forget to give him his acid-lowering medication, and she was very worried that this caused his acid reflux to worsen in a short time period.

Missing one dose of medication would not typically cause such a severe reaction, so I inquired further. The toddler had been playing while the mother was preparing dinner for the family. The mother did recall hearing intermittent coughing while her toddler was playing but did not recall any other unusual activity.

Based on the information the mother provided, I was very suspicious that her toddler swallowed something and that it was stuck in his food pipe. The toddler was sent for an x-ray. The x-ray revealed a coin about the size of a penny sitting in the esophagus.

Coins—pennies, dimes, nickels, and quarters—are the most common objects ingested by young children. Children see the shiny, metallic coins as something appealing. Young children explore their world with their mouths, so it is natural for them to want to taste the coin. Young children will happily swallow the coin without worrying about the consequences. Luckily, most coins will pass easily through the digestive tract without any complications.

Concerning Signs

• Trouble swallowing
• Excessive drooling
• Coughing
• Noisy breathing or trouble breathing
• Vomiting

If a child has no symptoms and a coin is stuck in the esophagus, then it is acceptable to wait 24 hours to see if the coin will spontaneously pass into the stomach. However, if a child is having symptoms, the coin should be removed immediately with an upper endoscopy.

Coins that are found in the stomach on x-ray will usually pass within through the digestive tract within one to two weeks. Parents are asked to look for the coin in the stools, and a repeat x-ray is obtained every one to two weeks to document that the coin has passed. However, if the coin is still present in the stomach after four weeks, then upper endoscopy with coin removal is recommended.

If a coin is in the small or large intestine, then it will most likely pass spontaneously into the stool without problems.

So What Happened to the Toddler?

Since the young toddler was drooling and refusing food and almost 24 hours had passed since the coughing started, the coin was removed with an upper endoscopy. The coin turned out to be a shiny 2015 penny that was most likely too irresistible for the toddler to not explore. He did extremely well after the procedure and was back to eating and drinking within a few hours.