What is Caustic Ingestion?

Children are very curious and do not hesitate to place all types of things in their mouths. However, swallowing certain things can cause major damage to the tube going from the mouth to the stomach (esophagus).

Foreign Body Ingestion

When a child swallows an object, it can become stuck in the esophagus. Examples of objects that can cause damage include coins, pieces of toys, safety pins and paperclips. Small batteries or magnets from toys, remotes or watches can get stuck and cause severe tissue injury to the esophagus.

Caustic Liquid Ingestion

If liquids such as cosmetics, cleaning agents or other chemicals are swallowed, tissue damage may occur and create scarring in the esophagus. These scars make the inside of the esophagus very narrow and can make it hard to swallow. The more damage done to the wall of the esophagus, the worse the injury.

Symptoms

A child who has an object stuck in their esophagus or who has swallowed a caustic substance would have some or all of the following signs:

• Drooling
• Trouble swallowing
• Spitting up food
• Refusing food
• Weight loss
• Hoarse cry
• Having a hard time breathing
• Choking
• Pain

Diagnosis

Diagnosis and treatment depend on the type of ingestion and the severity of the injury. Chest and neck X-rays help evaluate the size and location of the swallowed object. X-rays show only metal objects, so other tests are done to evaluate the injury to the esophagus.

• An upper endoscopy (where a tube with a light attached is placed in the throat) helps show the extent of the damage.
• Two to three weeks after the injury, an esophagram study is done to check for any narrowing.

Treatment

Immediate treatment includes:

• Observe and keep the child from vomiting, choking or having liquid get into the lungs. Vomiting can cause more damage to the wall of the esophagus.
• Endoscopy, a procedure that allows the doctor to see the stomach and first part of the intestines (explained below). The child may have a nasogastric (NG) tube placed during endoscopy if the esophagus has extensive burns. This tube keeps the esophagus from closing off completely and provides a route for nutrition. Children are sedated during this test.

Long-term treatment may include:

• Esophageal dilations (explained below), to help treat the narrowing of the esophagus
• A gastrostomy tube, to help with long-term nutrition

Tests

Upper Endoscopy

The doctor uses a flexible tube that is passed through the mouth, into the stomach and first part of the intestines to look for signs of swelling or irritation. The doctor may remove small pieces of tissue during this test (biopsy). The tissue is examined under a microscope and the findings help the doctor with their plan for treatment.

Esophageal Dilation

During esophageal dilatation, a specialist uses a balloon catheter to stretch (dilate) the narrow, injured part of the esophagus. With the use of fluoroscopy (moving X-ray), the doctor can locate the narrowing and open the area up with an inflated balloon catheter.