4 within 16 hours of observation. Based on a spontaneous passage rate of 25% to 30% and on the absence of complications, they stated that an 8- to 16-hour period of observation is an appropriate management in children with esophageal coins assuming that the child is asymptomatic, the ingestion is recent, and the child has no underlying esophageal or tracheal abnormality. In Waltzman’s intent, this approach would have obviated the need for anaesthesia and endoscopy, with no increase in risk. In a subsequent paper, he suggested that in symptomatic patients with an esophageal coin, immediate removal via endoscopy is recommended whereas for asymptomatic patients with an esophageal coin, data supported an expectant management for a period of 12–24 hours [26]. In 2008’s editorial, Conners compared endoscopical removal of esophageal coins and spontaneous passage [27]. He conﬁrmed previous studies stating that the non interventional method can be preferred when there are no physical, functional, or postsurgical abnormalities, stressing the potential utility of low-tech solutions like a drink of water or a piece of bread when dealing with low-risk patients. Although most gastric objects pass without complication and can be observed in the outpatient setting, approximately 70% of esophageal objects remain entrapped, especially those in the upper or mid-esophagus [21]. In our series, we have observed just one case with complications, but that cannot be a reason not to mention the extreme hazardousness of the injury. Particularly, among the most dangerous ingested foreign bodies, batteries cover one of the leading places and must be mentioned when dealing with children’s FB ingestion. The frequency of ingested button batteries is about 10 per million population per year, and one in every 1,000 battery ingestions causes serious injuries [28]. The incidence of button batteries ingestion has increased during the past several years [29]. Before 1983, there were only 6 cases of button battery ingestion in medical literature [30, 31]. In battery ingestion, the mechanism of injury occurs by four diﬀerent means including direct corrosive action due to leakage, toxic eﬀect due to absorption of substances, low voltage burns, and pressure necrosis [32–34]. Liquefaction necrosis and perforation can occur in 4 to 6 hours after a disk battery is lodged in the esophagus [35–37]. In the wide range of batteries, button batteries are those with peculiar characteristics that make them particularly dangerous for children, both from behavioural and anatomical points of view. Prompt endoscopical intervention is the gold standard for all complicated or high-risk situations, with particular relevance to sharp and pointed foreign bodies, such as denture with protruding hooks, shaving blades, and open safety pins, which increase the danger of perforation. These objects extraction requires special attention and experience. As previously mentioned in our study, just one complication was observed, therefore removal techniques other than endoscopy were preferred. In planning the extraction, one of the important points to consider is the proper choice of the instruments. In our study, the greatest part of the extraction was performed through Magill forceps in general anaesthesia, and it showed a very low percentage of complications. The International Journal of Pediatrics use of Magill forceps was seen in 286 cases. Magill forceps is a well-studied technique for the extraction of foreign bodies from the upper and medium part of the esophagus [38– 40]. The use of esophageal forceps, performed in 34 cases, is preferred when dealing with distal foreign objects not requiring endoscopy. As showed from all the studies here mentioned, the retrieved foreign bodies were objects usually available at home such as coins or plastic pieces, instead of toys or speciﬁc children’s objects. That seems to reassure about the safety granted from the regulations imposed to toy’s production, having the SPTF (Small Part Test Fixture) the most widely used test to deﬁne which objects might lead to injuries and which can be labelled as safe, as analyzed in the literature [6, 16]. Furthermore, the type of object causing injury was correlated with the age of the child injured as previously shown, following the proven strict linkage between injuries and children’s development. Furthermore, the anatomy of gastrointestinal tract considerably changes in the ﬁrst few years of life as maxillofacial structures extend forwardly and inferiorly and the larynx drops. These anatomical changes aﬀect the risk associated with choking, aspiration, or ingestion of toys, toy parts, and FBs in general. The clinical management of patients is eﬀective in removing FBs and in reducing the impact of the accident. This is not directly impacting the rate of hospitalization, which is often seen as a precautionary measure, in particular complying to the age of the involved children. An expectant management for a period of 12–24 hours can be chosen when dealing with low-risk patients. Adult presence was recorded in the preponderance of cases, and the most common activity that the children were performing while they ingested the FBs was playing. Prevention of FB ingestion is not addressed adequately in families, both in terms of stressing the need of active supervision of children when playing, eating or interacting with objects inadequate to their age and not supposed to be within reach and also in informing about the necessity of a prompt intervention, since FBs ingestion is often not perceived as an accident requiring an urgent and specialized treatment. The inadequacy of adult supervision has been largely reported [41, 42] and shows the importance of the imple- mentation of education campaigns meant to properly esti- mate the overall risks decrease in preventing FBs ingestion. In this context, doctors’ role is fundamental in educating adults dealing with children, not only from a preventive point of view, but also in diminishing the impact that this kind of injuries has on Public Health. References [1] P. Nandi and G. B. Ong, “Foreign body in the esophagus: review of 2394 cases,” British Journal of Surgery, vol. 65, no. 1, pp. 5–9, 1978. [2] M. Wai Pak, W. Chung Lee, H. Kwok Fung, and C. A. Van Hasselt, “A prospective study of foreign-body ingestion in 311 children,” International Journal of Pediatric Otorhinolaryngol- ogy, vol. 58, no. 1, pp. 37–45, 2001.