The Case of the Missing Coins

(or “Sister can you spare a dime“)

You started your collection of coins from around the world 20 years ago. Your precious metallic gems range in value from mere cents to thousands of dollars and in age from days to hundreds of years old. All together, they are visually stunning, specifically arranged in glass displays in a special room in your house. You take great pride in this collection and every visitor gets a detailed tour. You have spent hours describing the currencies to your twins, who at the age of 5, can already nimbly distinguish a Peso from a Krona from a Guilder.

As you do on all Saturday mornings, you enter the sanctum to commence the weekly cleaning ritual. The shimmer of the Shekels and the brilliance of the Bolivianos are matched by the radiance of Rupees. You smile as you admire the shine of the Shillings and the dazzle of the Dalasi. Then it happens…you notice a faint shadow on the cushion where the original mint, 500 Yen coin should be sitting. Your eyes dart through the room when you see that the 1853 O Seated Liberty Dime is also missing. You let out a shriek!

From downstairs, your husband comes running up to you followed by the twins and your pediatrician. At first you are surprised to see the doctor, but then you remember that you had called your Concierge Pediatrician to come for a Home Visit to examine your daughter who has been drooling a little since last night and says it is uncomfortable to swallow. As they enter the room, you explain what has happened. A small tear comes down your cheek as you point out the two vacancies. That’s when you see the pediatrician smiling.

She asks if your daughter has a fever, diarrhea, vomiting, mouth or stomach pain. You state that it is just the increased drooling and trouble swallowing. She has no trouble breathing. Then the pediatrician inquires about locks on the room and whether the girls have unsupervised access. The twins look down sheepishly. They admit that yesterday they both put a coin in their mouths and dared each other to swallow them, which they did.

The pediatrician tells you that your drooling daughter swallowed the Yen and she must go to the emergency room. Your other daughter swallowed the dime and nothing more needs to be done for her.

She knew this because:

  • The point most likely to trap swallowed objects is the Thoracic Inlet. This is located roughly at the bottom of the neck
  • Sharper or larger objects such as the Yen can get lodged at the thoracic inlet or other points along the esophagus (the tube from your mouth to your stomach).
  • Common symptoms include discomfort, trouble swallowing and excessive drooling. The children cannot swallow their saliva so they drool. Trouble breathing is a rare finding.
  • Objects that get stuck, must be removed by endoscopy in the hospital.
  • Smaller, smoother objects like the Dime tend to get through the thoracic inlet. Once they hit the stomach, most of the time, they will pass through with the stool.
  • You should call the doctor for smaller object however if you suspect your child has swallowed a battery which can be corrosive, magnets which can pinch together and get stuck or form a larger object, sharp items that may get lodged in the intestines, or items that contain toxins such as Lead.
  • If your child is NOT having trouble breathing, it is a good idea to call your doctor for advice. Poison Control 1-800-222-1222 can also be helpful to determine if the object is dangerous.
  • If your child is having trouble breathing, call 911 immediately for help.

My child got a plum pit stuck in his throat when he was about 18 months old. What items has your child swallowed and what was the result? Send your story to mail@ngpeds.com. Just put Greenwich Pediatrician in the subject line.

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