Please Don't Eat the Buttons

Quite an ordeal over the last few days.

Wednesday, Spielberg, ManCub and one of their friends spent the entire evening moving furniture around in an effort to prepare my office. One of the rooms we emptied used to be the older girls' room. Evidently, Posie found a button on the floor in that room.

About 9 PM, she was sitting on my lap and starting choking. I turned her upside down and whacked her on the back. After just a couple smacks, up popped a tiny little button. It was yellow, with a smiley face on it. She continued to choke up mucus and act like something was still in there. Eventually, she finally was breathing, and she nursed. I asked the girls what the button was from.

Violet told me, "It used to be a sun."
"What do you mean?
"It used to have an orange ring around it to make it look like a sun."

Crap.

Posie continued to cry, point in her mouth and hurk up mucus. We took her in to a local ER. My first instinct was to take her to the Children's Hospital, but it was an additional 20 minutes drive and I figured that retrieving a swallowed object should be pretty standard possible treatment for any hospital.

They did three x-rays (remember this is a plastic button) assuring us they would be able to see it on x-ray. Guess what? They couldn't see anything. I was 90% sure there was still something in there, as she continued to vomit clear mucus. They sent us home, saying to come back if she developed breathing difficulties, fever, or if she continued to get worse. This evening was a major waste of time. I left that ER telling PreacherMan -- I am 90% sure she still has something in there.

We got home at 12:40 AM on Thursday, to find that Spielberg was having a crisis with his girlfriend (we're not fans, anyway) but we were up until 2 AM trying to help him. At 8:30 AM, a client came by for a fasting glucose check (fine). Then I had to go get my thyroid levels drawn. At noon, my assistant came by and we did more cleaning and moving, until 2 PM, when 2 kids had guitar lessons, then to SuperDoula's house for a visit. During this whole time, Posie ate no solid food, except two freeze dried snap peas (she gagged after eating them, but they went down). At SuperDoula's house, I gave her a frosted mini wheat. I was debating with SuperDoula to call the ped or not and we were waiting to see if the mini wheat went down. She ate it and swallowed. She walked around playing for a couple minutes, then stood next to me and hurked it up, chewed, but complete, in a wad of mucus. Enough. I called the ped who told us to go to Children's Hospital.

I called PreacherMan who said he'd meet me at home. It took him a bit to get home, and then we were off to the ER again. We got there around 6 PM. Fairly quickly we saw a clueless intern, the nice attending doc, then two senior peds surgery residents. These guys were talking about scoping her esophagus, but their attending said that they would not be scoping her without seeing the thing on a swallow. So the decision was made to do a barium swallow.

Posie wasn't terribly happy about this, as you can imagine. It looked to me on the xray screen as if the mouthful of barium would just sit in her upper throat for a second before going down. The radiologist however, felt that everything went down just fine with no issues. He said it was possible the button was still stuck against the wall of the esophagus, but he felt she had no problems swallowing and getting stuff down.

Back downstairs in the ER room, the senior resident said the attending wanted to admit Posie for "observation" and do the scope in the morning. I was finally able to nurse her, much to her and my relief. Nothing sadder than a toddler signing "milk" and looking at you beseechingly and having to tell her "no". We declined to stay the night, having six other children that we were not about to leave home alone, especially with no emergency. We were told to return at 9 AM to talk to the surgeon and to not let her nurse after 6 AM

We saw the surgeon Friday morning. We went back and forth over whether or not to do the scope. The surgeon kept debating because Posie looked good, the x-rays and barium swallow were negative, but the fact that she was vomiting solids was still concerning. He said our options were to wait and see if it came out in the stool or do the scope. We finally decided to because if the button WAS still in her esophagus, then it could erode through. He had two other cases before her, so it would be a little bit of a wait.

Finally we got called back to pre-op. They gave her some Tylenol with Versed to make her a little sleepy and so she wouldn’t be scared going back to surgery. It was sooooo funny! It made her really loopy. She had the goofiest grin on her face and she kept reaching into the air like she could see some imaginary butterflies.


I requested and was permitted to go back with her to the OR for the induction of anesthesia, which was by gas. Because of the Versed, she didn’t fight it which was nice for me and for her. Then PreacherMan and I went to the waiting room to wait.
About 15 minutes later, the surgeon came out carrying a biohazard bag. I said, “Well, it was in there.” We had told them that our estimate was the button was about 1 cm across with a hollow circular center. Since I had never seen it, I was going by Violet’s drawings and description. He sat down and showed us this:


I was so shocked! I couldn't believe it. He said it was stuck horizontally right at the base of her neck in the esophagus. It had already begun to erode the esophagus, but was not all the way through. I told him I could cry, thinking of what could have happened. He said he could cry too thinking he almost decided not to do the scope.

A few minutes later we were allowed to go back and see her. She was still sleeping, but soon woke up enough to nurse, and shortly after that woke up enough to start yanking on her IV and the pulse-ox meter.

After we got home, she ate some chips! and pizza and acted like nothing had ever happened. What a relief!

Moral of the story: Listen to mama's instincts and if a child needs help and you have one, go right to the children's hospital.