A child was brought to our ED after ingesting beads from a magnetic bracelet her mother had been wearing. Usually children are just monitored when they ingest such small objects, but this child was sent to the OR for removal despite being asymptomatic. What are the concerns with magnet ingestion?-C.K., ARIZ.

Bridget Powell, BSN, RN, and Bridget Parsh, EdD, RN, reply: Foreign body (FB) ingestion is a common but potentially serious condition for young children. Of over 100,000 FB ingestions each year, more than three-quarters occur in children under age 5 years.1 While not all such ingestions pose a serious threat, the ingestion of magnets can be lethal because of the damage they can do to the gastrointestinal (GI) tract.2,3 When a magnet is swallowed with another magnet or a piece of metal, the magnetic attraction can pin the bowel walls together, leading to potentially deadly volvulus and bowel perforation.2,4 In 2006, the CDC issued a warning regarding the hazards of button batteries and other small magnets found in building sets and other toys and recommended that children under age 6 years not have access to them.4

Prompt identification of any ingested FB is needed to determine the appropriate course of management.5 Nurses should obtain an in-depth history including type of FB ingested, number of items ingested, and the time of ingestion, if known.1,5 However, caregivers and patients may not be able to provide this information as children may ingest an FB while unsupervised, be too young to communicate, or have developmental issues.2,3 Radiographic studies may be indicated to determine the number and location of FBs ingested.5

Signs and symptoms of FB ingestion may include vomiting, sensation of something being stuck in the neck or upper chest, odynophagia, and dysphagia, but some children are asymptomatic.5,6

After an FB has been identified as magnetic, prompt intervention may be warranted. A single magnet ingested alone may resolve spontaneously, requiring monitoring but not intervention. However, ingestion of multiple magnets or a single magnet ingested with another metallic FB may require immediate removal to prevent injuries such as mucosal pressure necrosis, intestinal obstruction, fistula, and perforation injury.1 Ingestion of even a single high-powered magnet may also warrant removal because of the potential for attraction to an external metallic object, such as a belt buckle.6 Untreated, these risky magnet ingestions can cause severe GI morbidity even in patients who present asymptomatically.7

If an ingested magnet is located in the stomach, it may be removed via endoscopy or a catheter with a magnetic tip. If it has progressed further down the GI tract, however, a laparotomy may be needed for removal.7 It is critical that providers develop a treatment plan that considers all factors associated with the FB ingestion and not delay endoscopic and surgical interventions when indicated.3

Remind parents and other caregivers to keep magnets away from young children and those with developmental issues such as autism, neurologic issues, or attention-deficit/hyperactivity disorder.4 If caregivers believe a child has swallowed a magnet, tell them to take the child to a healthcare facility or call the national poison control hotline at 1-800-222-1222. Warn them not to induce vomiting or let the child eat or drink. If the child is having trouble breathing, they should call 911.2

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