Accidental ingestion of foreign bodies/harmful materials in children from Bahrain: A retrospective cohort study

doi:10.5409/wjcp.v12.i4.205

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World Journal of Clinical Pediatrics

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Retrospective Cohort Study

World J Clin Pediatr. Sep 9, 2023; 12(4): 205-219
Published online Sep 9, 2023. doi: 10.5409/wjcp.v12.i4.205

Table 1 Demographic data and clinical presentation of 153 children with accidental ingestion

Demographic data	*Total, n =* 153 (100)**	*FB, n =* 108 (70.6)**	*Caustic, n =* 31 (20.3)**	*Medication, n =* 14 (9.2)**	P value
Sex					0.513^a
Male	85 (55.6)	58 (53.7)	20 (64.5)	7 (50)
Female	68 (44.4)	50 (46.3)	11 (35.5)	7 (50)
Nationality					0.260^a
Bahraini	118 (77.1)	87 (80.6)	22 (71.0)	9 (64.3)
Non-Bahraini	35 (22.9)	21 (19.4)	9 (29.0)	5 (35.7)
Socioeconomic status (n = 95)					0.520^a
Low	32 (33.7)	26 (34.7)	3 (20.0)	3 (60.0)
Middle	31 (32.6)	25 (33.3)	5 (33.3)	1 (20.0)
High	32 (33.7)	24 (32.0)	7 (46.7)	1 (20.0)
Working mother	33/95 (34.7)	28/75 (37.3)	4/15 (26.7)	1/5 (20.0)	0.568^a
Number of siblings, (n = 94)	3 (2-4)	3 (2-4)	3 (2-4)	3 (2-4)	0.877^b
Age at presentation (yr), (n = 152)	2.8 (1.8-4.4)	3.4 (2.0-5.6)	1.8 (1.5-2.5)	2.6 (2.1-2.8)	< 0.001^b
Age categories (yr), (n = 152)					0.001^a
0-1	41 (27)	22 (20.6)	17 (54.8)	2 (14.3)
2-3	66 (43.4)	45 (42.1)	11 (35.5)	10 (71.4)
4-5	31 (20.4)	27 (25.2)	2 (6.5)	2 (14.3)
≥ 6	14 (9.2)	13 (12.1)	1 (3.2)	0 (0.0)
Time to presentation (h), (n = 139)	2.0 (1.0-6.0)	2.0 (1.0-6.0)	1.0 (0.3-5.0)	2.0 (1.0-4.0)	0.306^b
Length of stay (d)	1.0 (1.0-2.0)	1.0 (1.0-2.0)	1.0 (1.0-4.0)	1.0 (1.0-1.0)	0.063^b
Length of stay categories (d), (n = 146)					0.102^a
0-1	104 (71.2)	74 (71.8)	16 (55.2)	14 (100)
2-3	20 (13.7)	15 (14.6)	5 (17.2)	0 (0.0)
4-5	7.0 (4.8)	5 (4.9)	2 (6.9)	0 (0.0)
≥ 6	15 (10.3)	9 (8.7)	6 (20.7)	0 (0.0)
Number of ingested FBs/materials per patient					0.053^a
1	119 (77.8)	81 (75.0)	30 (96.8)	8 (57.1)
2-5	23 (15.0)	19 (17.6)	1 (3.2)	3 (21.4)
6-10	3.0 (2.0)	2 (1.9)	0 (0.0)	1 (7.1)
> 10	8.0 (5.2)	6 (5.6)	0 (0.0)	2 (14.3)
Clinical presentations (n = 150)
Symptomatic¹	86 (57.3)	52 (48.6)	26 (89.7)	8 (57.1)	< 0.001^a
Vomiting	44 (29.3)	23 (21.9)	18 (62.1)	3 (21.4)	< 0.001^a
Abdominal pain	25 (16.7)	21 (20.0)	2 (6.9)	2 (14.3)	0.240^a
Cough	13 (8.7)	7 (6.7)	6 (20.7)	0 (0.0)	0.029^a
Shortness of breath	11 (7.3)	6 (5.7)	5 (17.2)	0 (0.0)	0.060^a
Choking	11 (7.3)	8 (7.6)	3 (10.3)	0 (0.0)	0.475^a
Dysphagia/drooling of saliva	9 (6.0)	5 (4.6)	4 (12.9)	0 (0.0)	0.139^a
Convulsion	3.0 (2.0)	1 (0.9)	1 (3.2)	1 (7.1)	0.245^a
Others²	16 (10.6)	11 (10.2)	4 (12.9)	1 (7.1)	0.831^a
Asymptomatic	64 (42.7)	55 (51.4)	3 (10.3)	6 (42.9)	< 0.001^a
Presence of witness (n = 136)	58 (43.6)	38 (40.4)	14 (50.0)	6 (42.9)	0.667^a

^aPearson’s χ² test was used for categorical variables.

^bKruskal-Wallis’s test was used for continuous variables.

¹Patients might have more than one symptom.

²Dizziness, chest pain, nausea, tarry stool, and throat discomfort, each in two patients; fever, fatigue, nose swelling, tongue and lips swelling, abdominal bloating, noisy breathing, cyanosis, drowsiness (chlorpheniramine ingestion), reduction in activity, and lip ulcer, each in one patient (two patients of them had two symptoms).

Boldface indicates a statistically significant difference with P < 0.05. Values are presented as number (%) or median (interquartile range). FB: Foreign body.

Table 2 Types of foreign bodies and harmful materials accidentally ingested by 153 children

Type	Patients, n (%)
Foreign bodies	108 (70.6)¹
Battery	49 (32)
Metal/sharp object	31 (20.3)
Magnets	16 (10.5)
Coin	8 (5.2)
Others²	5 (3.3)
Chemicals/corrosive solutions	31 (20.3)
Alkaline corrosives	19 (12.4)
Acid corrosives	5 (303)
Others³	6 (3.9)
Medications	14 (9.2)

¹One patient ingested both magnet and disc battery.

²Marble (n = 2), intact grape, olive, and pistachio nut (n = 1 each).

³Kerosene in two, and comfor oil, mercury, car oil, and superglue in one patient each.

Values are presented as number (%).

Table 3 Scenario of foreign body/material ingestion in children (n = 131)

Ingestion scenario	*Total, n =* 131¹ (100)**	*FB, n =* 90 (68.7)**	*Caustic, n =* 27 (20.6)**	*Medication, n =* 14 (10.7)**	P value^a
While playing	53 (40.5)	50 (55.6)	3 (11.1)	0 (0.0)	< 0.001^b
Unsafe storage	46 (35.1)	13 (14.4)	26 (96.3)	7 (50)	< 0.001^b
Missing objects	18 (13.7)	12 (13.3)	0 (0.0)	6 (42.9)	< 0.001^b
Told by patient/relative	13 (9.9)	12 (13.3)	0 (0.0)	1 (7.1)	0.118
Accidental ingestion	4 (3.1)	4 (4.4)	0 (0.0)	0 (0.0)	0.391
Incidental finding on X-ray	3 (2.3)	3 (3.3)	0 (0.0)	0 (0.0)	0.497
Food bolus impaction	3 (2.3)	3 (3.3)	0 (0.0)	0 (0.0)	0.497
Suicidal attempt	1 (0.07)	0 (0.0)	1 (3.7)	0 (0.0)	0.144

¹Some patients had more than one scenario.

^aPearson’s χ².

^bIndicating a statistically significant difference with P < 0.05.

Data are presented as number (%). FB: Foreign body.

Table 4 Anatomical locations of ingested foreign bodies based on radiological and endoscopic findings

Foreign body location	*On X-ray, n =* 123/153 (80.4)**	*In endoscopy, n =* 91/152 (59.9)**
Esophagus	14 (11.4)	13 (14.3)
Stomach	54 (43.9)	31 (34.0)
Small intestine	18 (14.6)	22 (24.2)
Large intestine	16 (13.0)	1.0 (1.1)
Others¹	2.0 (1.6)	0.0 (0.0)
Not seen/normal	19 (15.5)	24 (26.4)

¹Nose and throat (n = 1 each).

Data are presented as number (%).

Table 5 Endoscopic and surgical complications in children with accidental ingestion based on type of ingested materials (n = 153)

Complication	*Total, n =* 148¹ (96.7)**	*FB, n =* 104 (70.3)**	*Caustic, n =* 30 (20.3)**	*Medication, n =* 14 (9.6)**	P value^a
Erythema	16 (10.8)	8 (7.7)	8 (26.7)	0 (0.0)	0.005^b
Ulcer	14 (9.5)	10 (9.6)	4 (13.3)	0 (0.0)	0.369
Mucosal erosions	9 (6.1)	9 (8.7)	0 (0.0)	0 (0.0)	0.132
Hemorrhage	6 (4.1)	6 (5.8)	0 (0.0)	0 (0.0)	0.266
Perforation	5 (3.4)	5 (4.8)	0 (0.0)	0 (0.0)	0.335
Airway edema	5 (3.4)	2 (1.9)	3 (10.0)	0 (0.0)	0.074
Stricture	2 (1.4)	0 (0.0)	2 (6.7)	0 (0.0)	0.019^b
Total	39 (26.4)	28 (26.9)	11 (36.7)	0 (0.0)	0.036^b

¹Some patients had more than one complication.

^aPearson’s χ².

^bIndicating a statistically significant difference with P < 0.05.

Data are presented as number and percentage. FB: Foreign body.

Table 6 Predictors of complications in children with accidental ingestion based on type of ingested materials (foreign body or caustic material)

Variable	*FB complications, n =* 104**		P value	*Caustic complications, n =* 31**		P value
Variable	*Yes, n =* 28 (26.9)**	*No, n =* 76 (73.1)**	P value	*Yes, n =* 11 (35.5)**	*No, n =* 20 (64.5)**	P value
Sex			0.661^a			1.000^a
Male	16 (57.1)	39 (51.3)		7 (63.6)	13 (68.4)
Female	12 (42.9)	37 (48.7)		4 (36.4)	6 (31.6)
Nationality			0.775^a			0.199^a
Bahraini	24 (85.7)	61 (80.3)		10 (90.9)	12 (63.2)
Non-Bahraini	4 (14.3)	15 (19.7)		1 (9.1)	7 (36.8)
Socioeconomic status (n = 74)			0.028^b			0.059^b
Low	9 (42.9)	16 (30.2)		2 (28.6)	1 (12.5)
Medium	10 (47.6)	15 (28.3)		4 (57.1)	1 (12.5)
High	2 (9.5)	22 (41.5)		1 (14.3)	6 (75.0)
Working mother (n = 74)	4/21 (19.0)	24/53 (45.3)	0.061^a	1/7 (14.3)	3/8 (37.5)	0.569^a
Number of siblings, (n = 74)	3 (2-4)	3 (2-4)	0.355^c	3 (1-5)	3 (3-4)	0.779^c
Age at presentation (yr), (n = 103)	2.8 (1.5-4.2)	3.4 (2.2-5.7)	0.069^c	1.5 (0.9-2.5)	1.9 (1.6-2.7)	0.185^c
Age group (yr) (n = 103)			0.042^b			0.181^b
0-1	11 (39.3)	11 (14.7)		8 (72.7)	9 (47.4)
2-3	9 (32.1)	35 (46.7)		2 (18.2)	8 (42.1)
4-5	4 (14.3)	20 (26.7)		0 (0.0)	2 (10.5)
≥ 6	4 (14.3)	9 (12.0)		1 (9.1)	0 (0.0)
Presence of ingestion witness (n = 93)	12/27 (44.4)	25/66 (37.9)	0.643^a	4/10 (40)	10 (55.6)	0.695^a
Time to presentation (h), (n = 96)	3 (1-8.5)	2 (1-5)	0.325^c	1 (0.3-3.0)	2 (0.5-6.0)	0.155^c
Length of stay (d), (n = 102)	2 (1-4)	1 (0-1)	< 0.001^c	7 (2-12)	1 (0-2)	< 0.001^c
Number of ingested FBs/materials per patient^c			0.372^b			1.000^b
1	18 (64.3)	60 (78.9)		11 (100)	18 (94.7)
2-5	6 (21.4)	12 (15.8)		0 (0.0)	1 (5.3)
6-10	1 (3.6)	1 (1.3)		0 (0.0)	0 (0.0)
> 10	3 (10.7)	3 (3.9)		0 (0.0)	0 (0.0)
Type of FBs			0.384^b	NA	NA	NA
Battery	15 (53.6)	34 (44.7)	0.508^a	NA	NA	NA
Metal/sharp object	6 (21.4)	23 (30.3)	0.464^a	NA	NA	NA
Magnets	6 (21.4)	9 (11.8)	0.224^a	NA	NA	NA
Coin	1 (3.6)	7 (9.2)	0.679^a	NA	NA	NA
Food bolus¹	0 (0.0)	3 (3.9)	0.562^a	NA	NA	NA
Anatomical location			0.682^b	NA	NA	NA
Esophagus	3 (11.1)	13 (17.3)	0.550^a	NA	NA	NA
Stomach	16 (59.3)	38 (50.7)	0.504^a	NA	NA	NA
Bowel	8 (29.6)	23 (30.7)	1.000^a	NA	NA	NA
Clinical presentations			0.027^a			1.000^a
Symptomatic	19 (67.9)	32 (42.1)		9 (90)	17 (89.5)
Asymptomatic	9 (32.1)	44 (57.9)		1 (10)	2 (10.5)

^aFisher’s exact test was used for categorical variables.

^bPearson’s χ² test was used for categorical variables.

^cMann-Whitney U test was used for continuous variables.

¹Intact grape, olive, and pistachio nut (n = 1 each).

Boldface indicates a statistically significant difference with P < 0.05. Data are presented as number (%) or median (interquartile range). FB: Foreign body; NA: Not applicable.

Table 7 Summary of foreign body ingestion in children from neighboring counties and worldwide

Ref.	Country	n	Age (yr)¹	Sex	Two most common FBs (%)	Two most common symptoms (%)	Two most common sites of FB (%)
Our study	Bahrain²	153	2.8 (1.8-4.4)	M > F	Battery (32), metals/sharps (21)	Vomiting (29), abdominal pain (16)	Stomach (44), small intestine (15)
Al-Salem et al[11], 1995	Kingdom of Saudi Arabia	40	8.5 (5 mo-8)	M > F	Coins (43), metallic dog toy	NR	Esophagus (60), stomach (38)
Dereci et al[13], 2015	Turkey	64	5.7 ± 4.6	M > F	Coin (37), pin (8)	Dysphagia (24), cough (8)	Esophagus (56), stomach (16)
Kalra et al[16], 2022	India	100	5.0 ± 14.4	M > F	Coin (65), battery cell (13)	FB sensation (55), vomiting (54)	Just below the cricopharynx (89)
Lee et al[10], 2016	Korea	76	3.1 ± 3.1	M > F	Coins (22), button battery (16)	Chest discomfort, abdominal pain (9)	FBs: Stomach (40), unknown (28). Batteries: Duodenum (50), stomach (42)
Chan et al[9], 2002	Taiwan	25	2.6 ± 1.8	M > F	Button battery	Abdominal pain (8), dyspnea (4)	Stomach (52), small intestine (8)
Lin et al[15], 2007	Taiwan	87	3.4 (6 mo-13)	M > F	Coins (57), button battery (22)	Odynophagia, cough (84)	Esophagus (51), stomach (45)
Khorana et al[17], 2019	Thailand	194	43.5 (21-72) mo	M > F	Coin (41), button battery (17)	Vomiting (45), dysphagia (27)	Esophagus (37), stomach (29)
Uba et al[7], 2002	Nigeria	108	3.0 ± 0.8	M > F	Coins (80), bottle caps (7)	Drooling (34), regurgitation (17)	Esophagus (52), hypopharynx (33)
Adedeji et al[12], 2013	Nigeria	28	32.1 (2-75)	M > F	Alkali (79), acid (14)	NR	NR
Diaconescu et al[14], 2016	Romania	61	3.3 ± 4.7	M > F	Coins (26), metals (13)	Abdominal pain (56), vomiting (34)	NR
Antoniou and Christopoulos-Geroulanos[2], 2011	Greece	675	3.3 (4 mo-14)	M > F	Coins (32), safety pins (21)	Retrosternal pain, drooling	Stomach (58), bowel (33)
Speidel et al[4], 2020	Germany	1199	3.3 ± 3.2	M > F	Coin (19), metal (16)	Retching and vomiting (30), coughing (8)	NR
Little et al[8], 2006	United States	555	3.2 (2 mo-19)	M > F	Coins (88), round batteries	Dysphagia (37), drooling (31)	Esophagus (99)
Orsagh-Yentis et al[6], 2019	United States	29893	< 6	M > F	Coins (62), toys (10)	NR	NR

¹Age is presented as either median (range) or the mean ± SD.

²The present study.

FB: Foreign body; NR: No record; M: Male; F: Female.

Citation: Isa HM, Aldoseri SA, Abduljabbar AS, Alsulaiti KA. Accidental ingestion of foreign bodies/harmful materials in children from Bahrain: A retrospective cohort study. World J Clin Pediatr 2023; 12(4): 205-219
URL: https://www.wjgnet.com/2219-2808/full/v12/i4/205.htm
DOI: https://dx.doi.org/10.5409/wjcp.v12.i4.205