Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Sep 9, 2023; 12(4): 205-219
Published online Sep 9, 2023. doi: 10.5409/wjcp.v12.i4.205
Accidental ingestion of foreign bodies/harmful materials in children from Bahrain: A retrospective cohort study
Hasan M Isa, Shaikha A Aldoseri, Aysha S Abduljabbar, Khaled A Alsulaiti
Hasan M Isa, Shaikha A Aldoseri, Aysha S Abduljabbar, Department of Pediatrics, Salmaniya Medical Complex, Manama 26671, Bahrain
Hasan M Isa, Department of Pediatrics, Arabian Gulf University, Manama 26671, Bahrain
Khaled A Alsulaiti, Department of Radiology, Salmaniya Medical Complex, Manama 26671, Bahrain
Author contributions: Isa HM was the main contributor in study conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, software, supervision, validation, visualization, original draft writing, and manuscript review and editing; Aldoseri SA, Abduljabbar AS, and Alsulaiti KA were responsible for literature review, data collection, and manuscript drafting and revision; and all the authors have read and approved the final manuscript.
Institutional review board statement: This study was conducted in accordance with the principles of the Declaration of Helsinki, and it was ethically approved by the Secondary Health Care Research Committee, Salmaniya Medical Complex, Government Hospitals, Kingdom of Bahrain (IRB number: 88300719, July 30, 2019).
Informed consent statement: Consent was not needed as the study was retrospective without exposure to the patients’ data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data are available upon reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Hasan M Isa, MBChB, Associate Professor, Consultant Physician-Scientist, Department of Pediatrics, Salmaniya Medical Complex, 2904, Manama 26671, Bahrain.
Received: April 28, 2023
Peer-review started: April 28, 2023
First decision: May 25, 2023
Revised: June 9, 2023
Accepted: July 7, 2023
Article in press: July 7, 2023
Published online: September 9, 2023

Children like to discover their environment by putting substances in their mouths. This behavior puts them at risk of accidentally ingesting foreign bodies (FBs) or harmful materials, which can cause serious morbidities.


To study the clinical characteristics, diagnosis, complications, management, and outcomes of accidental ingestion of FBs, caustics, and medications in children.


We conducted a retrospective cohort study of all children admitted for accidental ingestion to the Department of Pediatrics, Salmaniya Medical Complex, Bahrain, between 2011 and 2021. Demographic data, type of FB/harmful material ingested, and investigations used for diagnosis and management were recorded. The patients were divided into three groups based on the type of ingested material (FBs, caustics, and medications). The three groups were compared based on patient demographics, socioeconomic status (SES), symptoms, ingestion scenario, endoscopic and surgical complications, management, and outcomes. The FB anatomical location was categorized as the esophagus, stomach, and bowel and compared with respect to symptoms. The Fisher’s exact, Pearson’s χ2, Mann-Whitney U, and Kruskal-Wallis tests were used for comparison.


A total of 161 accidental ingestion episodes were documented in 153 children. Most children were boys (n = 85, 55.6%), with a median age of 2.8 (interquartile range: 1.8-4.4) years. Most participants ingested FBs (n = 108, 70.6%), 31 (20.3%) ingested caustics, and the remaining 14 (9.2%) ingested medications. Patients with caustic ingestion were younger at the time of presentation (P < 0.001) and were more symptomatic (n = 26/31, 89.7%) than those who ingested medications (n = 8/14, 57.1%) or FBs (n = 52/108, 48.6%) (P < 0.001). The caustic group had more vomiting (P < 0.001) and coughing (P = 0.029) than the other groups. Most FB ingestions were asymptomatic (n = 55/108, 51.4%). In terms of FB location, most esophageal FBs were symptomatic (n = 14/16, 87.5%), whereas most gastric (n = 34/56, 60.7%) and intestinal FBs (n = 19/32, 59.4%) were asymptomatic (P = 0.002). Battery ingestion was the most common (n = 49, 32%). Unsafe toys were the main source of batteries (n = 22/43, 51.2%). Most episodes occurred while playing (n = 49/131, 37.4%) or when they were unwitnessed (n = 78, 57.4%). FBs were ingested more while playing (P < 0.001), caustic ingestion was mainly due to unsafe storage (P < 0.001), and medication ingestion was mostly due to a missing object (P < 0.001). Girls ingested more jewelry items than boys (P = 0.006). The stomach was the common location of FB lodgment, both radiologically (n = 54/123, 43.9%) and endoscopically (n = 31/91, 34%). Of 107/108 (99.1%) patients with FB ingestion, spontaneous passage was noted in 54 (35.5%), endoscopic removal in 46 (30.3%), laparotomy in 5 (3.3%) after magnet ingestion, and direct laryngoscopy in 2 (1.3%). Pharmacological therapy was required for 105 (70.9%) patients; 79/105 (75.2%) in the FB group, 22/29 (75.9%) in the caustic group, and 4/14 (28.8%) in the medication group (P = 0.001). Omeprazole was the commonly used (n = 58; 37.9%) and was used more in the caustic group (n = 19/28, 67.9%) than in the other groups (P = 0.001). Endoscopic and surgical complications were detected in 39/148 (26.4%) patients. The caustic group had more complications than the other groups (P = 0.036). Gastrointestinal perforation developed in the FB group only (n = 5, 3.4%) and was more with magnet ingestion (n = 4) than with other FBs (P < 0.001). In patients with FB ingestion, patients aged < 1 year (P = 0.042), those with middle or low SES (P = 0.028), and those with more symptoms at presentation (P = 0.027) had more complications. Patients with complications had longer hospital stays (P < 0.001) than those without.


Accidental ingestion in children is a serious condition. Symptomatic infants from middle or low SES families have the highest morbidity. Prevention through parental education and government legislation is crucial.

Keywords: Pediatric, Accidental ingestion, Foreign body, Caustic, Complication, Bahrain

Core Tip: Foreign body (FB) or harmful material ingestion is common in pediatric patients. These accidents occur more frequently among boys. Toddlers are at a higher risk of accidental ingestion because of their exploratory behavior. Batteries are the most commonly ingested FBs. Many ingestion incidents have occurred while playing and because of unsafe storage. The stomach is the most common anatomical location of FB loosening on radiography and endoscopy. Caregiver education regarding preventive methods and governmental execution of safe manufacturing of toys, magnets, and batteries is essential to prevent FB ingestion and the complications that might occur.