Portal de Periódicos da CAPES

Fidget Spinners Can Be a Pain in the Neck

2017; Lippincott Williams & Wilkins; Volume: 66; Issue: 4 Linguagem: Inglês

10.1097/mpg.0000000000001810

1536-4801

Amber McClain, W. Daniel Jackson, Jacob Robson,

Airway Management and Intubation Techniques

See "Commentary: Button Batteries in Fidget Spinners: Is It Time to Push the “Panic Button”?" by Bousvaros and Rufo on page 557. The fidget spinner craze is sweeping the United States. This “it” toy, initially marketed as a therapeutic tool for children with autism, now has a low price-point and widespread availability. Unfortunately, as fidget spinner sales have boomed, so too have urgent calls to pediatric gastroenterologists because this toy has many small parts that can be easily removed and ingested by young children. We present a case of a fidget spinner part ingestion, presenting as acute dysphagia. CASE PRESENTATION Our patient is a 3-year-old, 15-kg boy, with a medical history of prematurity (24-week gestation), cerebral palsy, spina bifida, aspiration of liquids, and formula feeding via a gastrostomy. The patient had been making strides from with oral intake, working with feeding therapy, and starting to take solid foods. His babysitter saw him remove a circular plastic piece from a fidget spinner and swallow it. Immediately, he seemed uncomfortable, struggling to swallow and with increased oral secretions. He was urgently evaluated at an outside hospital and transferred to our service because of inability to tolerate PO and drooling. On arrival, he had normal vital signs and no respiratory distress. Chest x-ray was normal. Owing to concern for a radiolucent esophageal foreign body, an esophagram was obtained. Although contrast passed the entire esophagus, there was some delay in the thoracic esophagus and a disc shaped foreign body was identified (Supplemental Images 1 and 2, Supplemental Digital Content 1 and 2, https://links.lww.com/MPG/B177, https://links.lww.com/MPG/B178). Per the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition foreign body ingestion guidelines (1), the patient underwent urgent esophagogastroduodenoscopy with 24 hours of ingestion. Equipment used was an Olympus endoscope, model GIF-Q180 and 8.8-mm diameter. The fidget spinner piece was identified (Fig. 1) and removed with rat-tooth grasping forceps. The endoscope was reinserted and revealed bilateral longitudinal linear erosions, edema, and erythema at the point where it had been lodged in the esophagus; the stomach and duodenum were normal. After prompt removal and minimal esophageal damage, the patient was observed postoperatively, and with no respiratory distress or further trouble swallowing, he was discharged home.FIGURE 1: Plastic center piece from fidget spinner lodged in the esophagus.DISCUSSION This case demonstrates the potential danger of these popular toys. There is 1 citation on NCBI pubmed.gov for “fidget spinner(s)”, but this is the first case documenting the potential harm from ingestion. Parents must be educated as to the potential harm of esophageal foreign bodies, many of which are unwitnessed and can be asymptomatic (2). Several small pieces can come off of the spinner, some of which are radiolucent. Typical foreign body radiographs may or may not be useful in these cases and an esophagram or empiric endoscopy may be indicated to confirm an esophageal foreign body in a patient without a clear ingestion history or minimal symptoms. Child safety warnings are variably included on fidget spinner packaging. All safety events around fidget spinner ingestions should be reported to the Consumer Product Safety Commission (http://www.cpsc.gov). These products may also contain small batteries to power lights; these are of particular concern for causing esophageal mucosal injury (3). Ingestions of battery-powered portions should be reported to the National Battery Ingestion Hotline (202-625-3333, http://www.poison.org/battery).