A 6-year-old boy arrived at a Saudi Arabian emergency department drooling and complaining of chest pain about four hours after swallowing a coin. X-rays showed it wedged in the lower part of his esophagus, a situation that often ends with a child under general anesthesia for endoscopic removal. Instead, doctors gave him a small dose of olive oil and let him drink as much water as he wanted. An hour later, the coin was out of his esophagus.
The case, published September 4 in Frontiers in Pediatrics by physicians at King Saud Medical City in Riyadh, is the first pediatric report of oral olive oil used this way, according to the authors' search of medical databases. They are careful to call it hypothesis-generating, not proof that the oil works.
From Drooling to Discharge in About Two Hours
His parents had watched him swallow the object. On arrival, he was calm, breathing normally, and had normal oxygen levels, but he was drooling and had central chest pain. Front and side X-rays showed a round metal object in the lower third of the esophagus. The absence of a double rim outline, a telltale sign of button batteries, supported the conclusion that it was a coin.
After an extensive discussion with his parents about the trial and the alternative of endoscopic retrieval under general anesthesia, doctors gave him olive oil at 1 milliliter per kilogram of body weight, followed right away by as much water as he could tolerate. He sat semi-upright under continuous heart and breathing monitoring, with suction and pediatric airway equipment ready.
About an hour later, his chest discomfort and drooling had resolved. Repeat X-rays showed the coin had traveled all the way to the junction of the small and large intestines. He was discharged roughly an hour after that and passed the coin in his stool within about 24 hours, with no complications.
Why Doctors Look for Ways to Avoid Endoscopy
Coins are among the most common objects children swallow. The authors cite U.S. poison center data recording 66,519 foreign-body ingestions in children under 5 in a single reporting year. In Saudi Arabia, a 2022 study found that the annual rate of pediatric rigid esophagoscopy for foreign-body removal rose more than fivefold after new coins were introduced between 2016 and 2017.
Guidelines disagree on how to handle coins that cause few or no symptoms. According to the report, European pediatric gastroenterology guidance recommends endoscopic removal in every case, while North American guidancecalls for urgent removal in children with symptoms and allows 12 to 24 hours of observation for those without them.
That leaves room for judgment, and coins sometimes move on their own. A 1999 study cited by the authors found that coins passed into the stomach without intervention in 28% of low-risk children, taking about five hours on average. In high-risk children, spontaneous passage did not occur at all.
The olive oil idea borrows from another emergency tactic. For button batteries, which can burn through tissue within hours, laboratory and animal studies have supported giving honey, and international guidance now includes it as a temporary protective step while endoscopy is arranged. The Riyadh team deliberately chose a small olive oil dose to limit the risk of aspiration in case the child still needed anesthesia.
Timing matters, too. The authors point to a retrospective comparison of daytime and overnight removal, suggesting that a period of observation may not compromise safety. They also note that most coins that reach the stomach pass through the digestive tract within one to two weeks, and that roughly 40% of swallowing incidents in children go unwitnessed, which can delay diagnosis.
The Coin Might Have Moved on Its Own
The authors spell out the limits. This is one patient, and spontaneous passage cannot be ruled out. The idea that olive oil lubricated the coin's way down has never been tested experimentally, and the best dose and timing are unknown.
The approach also does not apply to high-risk situations. Citing guidelines from the Royal Children's Hospital in Melbourne, the authors list button batteries in the esophagus, more than one magnet or a magnet with metal, sharp or large objects, and objects stuck in the throat as high risk. Children with digestive tract abnormalities, neuromuscular disease, or eosinophilic esophagitis are also excluded. The authors stress that doctors must keep a low threshold for endoscopy if a child worsens or the object does not move.
They call for randomized controlled trials to test whether olive oil truly helps low-risk children with coins lodged in the lower esophagus.
Not a Home Remedy
The trial took place in an emergency department after X-rays confirmed exactly what was swallowed and where it sat, with airway equipment at the bedside. Parents cannot know at home whether a child swallowed a coin or a button battery, or whether it is in the esophagus or the airway.
A child who may have swallowed an object and has drooling, chest pain, trouble swallowing, vomiting, coughing, or breathing difficulty needs emergency care. Poison centers can be reached at 1-800-222-1222.
Key Questions Answered
What happened to the boy?
A coin lodged in his lower esophagus. After a small dose of olive oil and water, it moved into his intestines within an hour and passed naturally within about a day.
Did the olive oil definitely work?
No. The authors say the coin may have passed on its own, and one case cannot prove the oil helped.
How is a stuck coin usually treated?
Often with endoscopic removal under general anesthesia. North American guidance allows 12 to 24 hours of observation for children without symptoms.
Should parents give olive oil at home?
No. The trial was done in an emergency department after X-rays and with airway equipment ready.
Which swallowed objects are most dangerous?
Button batteries, magnets, and sharp objects need urgent evaluation because they can cause serious injury quickly.
Published by Medicaldaily.com
