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# Foreign bodies in the airway and oesophagus, including button batteries

- Emergency

Choking, aspiration into the lungs and objects stuck in the oesophagus need different first steps; a button battery in the oesophagus is always an emergency.

Updated Nov 5, 2026

## Key points

- Choking with no cough or voice: infants under 1 year get back blows and chest thrusts; older children and adults get back blows and abdominal thrusts.
- Never do a blind finger sweep: it can push the object deeper.
- Aspiration: sudden cough, unilateral wheeze and reduced breath sounds; a normal chest X-ray does not exclude it; rigid bronchoscopy treats it.
- A button battery shows a «double ring» or halo on the frontal X-ray and a step-off on the lateral view; in the oesophagus it means immediate endoscopic removal.
- Delayed battery complications include tracheo-oesophageal fistula, perforation and fatal aorto-oesophageal fistula weeks later.

## What it is

Foreign bodies in the aerodigestive tract are most common in children between about one and three years old and in older adults. In the airway the danger is suffocation now (choking) or a missed object later (recurrent pneumonia). In the oesophagus the danger depends on the object: coins often pass, while button batteries, multiple magnets and sharp objects burn or perforate. A button battery stuck in the oesophagus causes a chemical burn within hours and must be removed endoscopically at once, even if the child looks well.

## How to recognise it

- Choking: sudden distress during eating or play, hands to the throat, no voice.
- Aspiration: a witnessed or suspected choking episode followed by cough, wheeze or recurrent pneumonia in the same lobe.
- Oesophageal object: drooling, refusal to eat, pain on swallowing, vomiting; inability to swallow saliva means complete obstruction.
- Many inhaled objects (nuts, seeds, plastic) are radiolucent; expiratory or decubitus films may show air trapping on the affected side.

## Step-by-step management

- Choking with effective cough: encourage coughing and watch closely; do not interfere.
- Choking without effective cough, conscious: back blows, then chest thrusts in infants or abdominal thrusts in older children and adults, repeated.
- Unconscious patient: start cardiopulmonary resuscitation and look in the mouth for a visible object before rescue breaths.
- Suspected aspiration in a stable child: chest X-ray (inspiratory and expiratory) and rigid bronchoscopy under general anaesthesia by ENT or a pulmonologist.
- Suspected ingestion: frontal and lateral X-rays of neck, chest and abdomen to find and identify the object; avoid barium.
- Button battery in the oesophagus: nothing by mouth and immediate endoscopic removal; afterwards look for burns and plan follow-up imaging.
- Other oesophageal objects: endoscopy urgently or as an emergency according to type, symptoms and time stuck.

## How urgent is an ingested object?

| Object | Main risk | Urgency |
| --- | --- | --- |
| Button battery in the oesophagus | Burn, perforation, fistula | Emergency: immediate endoscopic removal |
| Two or more magnets, or magnet with metal | Bowel walls trapped between them, perforation | Emergency: discuss with surgery and endoscopy at once |
| Sharp object in the oesophagus | Perforation | Emergency endoscopy |
| Food bolus with drooling | Complete obstruction, aspiration | Urgent endoscopy; look for an underlying stricture or eosinophilic oesophagitis |
| Coin in the oesophagus, no symptoms | Pressure injury if it stays | Urgent; many pass, removal if it does not move |

## Red flags

- Complete obstruction: no cough, no voice, cyanosis, loss of consciousness.
- Stridor or respiratory distress after a choking episode.
- Drooling and inability to swallow saliva.
- Haematemesis, chest pain, fever or neck swelling after an ingestion (perforation or fistula).
- Any suspected button battery or multiple magnets, even without symptoms.

## Next step / Initial management

- First workup: frontal and lateral X-rays from the nose to the anus in children with unknown ingestion; CT if an aspirated object is suspected and X-ray is normal.
- Management is mechanical: first aid manoeuvres, then rigid bronchoscopy for the airway and endoscopy for the oesophagus; antibiotics only for established infection.
- Refer as an emergency, the same moment: any button battery or multiple magnets, complete oesophageal obstruction, airway distress, or a sharp object in the oesophagus.
- Refer urgently, the same day: suspected aspiration with a history of choking even if the X-ray is normal.

## Test yourself

Think of the answer, then tap the question to see it.

## A 2-year-old swallowed «a coin»; the frontal X-ray shows a round object in the oesophagus with a double ring. What is it and what is the next step?

A button battery. It needs immediate endoscopic removal, even without symptoms, because it burns the oesophageal wall within hours.

## A 3-year-old had a coughing fit while eating peanuts; now there is right-sided wheeze and the chest X-ray is normal. What is the next step?

Refer the same day for rigid bronchoscopy. Most nuts are radiolucent and a normal X-ray does not exclude aspiration.

## How do first aid manoeuvres for choking differ between an infant and an adult?

Infants under 1 year get back blows alternating with chest thrusts; older children and adults get back blows and abdominal thrusts. No blind finger sweep in either.

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## Connections

## Related 1

- [Upper airway obstruction: recognition and first steps](https://durgical.com/en/ent/upper-airway-obstruction-recognition-and-first-steps/)

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Educational content; it does not replace a medical assessment and is not a clinical instruction. For a real case, follow current guidelines and specialist advice.

Sources: [Foreign Body Aspiration (StatPearls)](https://www.ncbi.nlm.nih.gov/books/NBK531480/) (StatPearls Publishing, NCBI Bookshelf, 2026); [Choking (StatPearls)](https://www.ncbi.nlm.nih.gov/books/NBK499941/) (StatPearls Publishing, NCBI Bookshelf, 2026); [Foreign Body Airway Obstruction (StatPearls)](https://www.ncbi.nlm.nih.gov/books/NBK553186/) (StatPearls Publishing, NCBI Bookshelf, 2026).

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Source: https://durgical.com/en/ent/foreign-bodies-in-the-airway-and-oesophagus-including-button-batteries/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ent/foreign-bodies-in-the-airway-and-oesophagus-including-button-batteries/