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Passing Swallowed Objects
Q: My six-year-old daughter swallowed a polished stone about the size of a nickel five days ago and even though she has had several bowel movements the stone has not reappeared. What should I do?
A: The first question you always want to ask yourself when you realize that a child swallowed an object is, "Was it truly swallowed or was it aspirated into the lung?" If it had actually gone into the windpipe or the lung I would expect that she would have symptoms of coughing and other respritory complaints. So presuming that none of those are present and you are pretty sure that she swallowed the stone, the next question is, "Has the stone moved along through the food pipe into the stomach and into the intestines in order for it to get down to the stool?"
There is a possibility that something the size of a nickel might not be able to get through the junction between the esophagus (the food pipe) and the stomach. Once it gets into the stomach it then needs to go through the duodenum, which is the very first part of the intestine and which is somewhat narrower than the rest of the intestine. If it gets through that part of the intestine then the rest of the intestine is fairly large and the stone should be able to travel through the rest of the intestine and you would expect to see it in the stool.
Usually you would expect this to happen within about 4 to 5 days so I am somewhat concerned that you have not seen it in the stool. I would recommend that you call your doctor and have your doctor see her in order to determine if there is a need to look for where the stone is. Depending upon what the stone is made of it may or may not be visible on a plain x-ray.
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Shari Nethersole is a physician at Children's Hospital, Boston, and an instructor in Pediatrics at Harvard Medical School. She graduated from Yale University and Harvard Medical School, and did her internship and residency at Children's Hospital, Boston. As a pediatrician, she tries to work with parents to identify and address their concerns.
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