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Pediatric Magnet Ingestion Algorithm

  1. Known magnet ingestion or GI symptoms with known magnets available to child.
  2. Obtain abdominal X-ray (1 view), then lateral view if magnets seen.
  3. Follow algorithm below based on what is seen1

Single Magnet Seen

In the stomach or esophagus:

  1. Consult GI for removal
  2. May elect for serial outpatient X-rays with good parental education
    • Remove nearby magnetic objects
    • Avoid clothing with metallic objects (belts, buckles)
    • Remove metal objects and magnets from home environment.

Beyond the stomach:

  1. Consult GI for removal if possible
  2. Follow with serial X-rays as outpatient with good parental education
    • Remove nearby magnetic objects
    • Avoid clothing with metallic objects (belts, buckles)
    • Remove metal objects and magnets from home environment.
  3. Confirm passage with serial xrays
  4. If progression is delayed, may use laxative (Miralax -PEG 3350)

Multiple Magnets (or Single Magnet + Metal FB)

In the stomach or esophagus:

  1. <12 hours from ingestion : consult GI for removal or transfer
    • If endoscopic removal unsuccessful, consult surgery
  2. >12 hours from ingestion : consult surgery prior to endoscopy

Beyond the stomach:

  1. If symptomatic, consult surgery
  2. If asymptomatic
    • May remove via enteroscopy or colonoscopy if no signs or obstruction or perforation (with surgery consultation prior to removal)
    • May follow serial xrays q4-6 hours (possibly in ED for short time)
      1. No progression = admit to hospital, serial xrays q8-12 hrs, + laxatives, surgical removal if no change.
      2. Progression = educate parents, continue close outpatient follow up and serial xrays until confirmed passage.

Background

The algorithm above is a summary of the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition1 recommendations for pediatric magnet ingestion. They were originally published in the Journal of Pediatric Gastroenterology and Nutrition in 2012. Since that time, the U.S. Consumer Product Safety Commission began tracking neodymium (rare-earth) magnet ingestions and helped pass laws banning their use in consumer products due to their propensity to cause bowel perforation after ingestion. Unfortunately, that ban was repealed in 2016, allowing the rare earth magnets to return to consumer products like desk toys.

An excellent review titled Case Discussions and Radiographic Illustration of Magnet-Related Injuries in Children2 was published in the Journal of Emergency Medicine in June, 2020. A comprehensive series of radiographs and cases were included in the review.


Sources

  1. Hussain SZ, Bousvaros A, Gilger M, Mamula P, Gupta S, Kramer R, Noel RA. Management of ingested magnets in children. J Pediatr Gastroenterol Nutr. 2012 Sep;55(3):239-42. Full Text , PubMed
  2. Strickland M, Diamond IR, Rosenfield D. Case Discussions and Radiographic Illustration of Magnet-Related Injuries in Children. J Emerg Med. 2020 Jun;58(6):902-909. PubMed

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