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Am Fam Physician. 2003;67(2):252-254

to the editor: During a phone conversation with my wife, she informed me that our four-year-old son, Charlie, had swallowed a penny. I asked her the usual questions: “Is he okay?,” “Is he breathing all right?,” “Swallowing his saliva?,” “Talking?” She answered yes to all these questions, but added that he was scared and was crying.

My first thought was to have a radiograph taken to localize the penny. Then I had another thought. Because I was almost out the door to go home, I told my wife to keep Charlie calm. I told her that the main thing we needed to know was where the penny was in the gastrointestinal tract, and that if he was breathing, talking, and swallowing normally, the penny was at least past the vital areas. I told her I would try to locate the coin with the metal detector when I got home.

Arriving home about 15 minutes later, our 12-year-old son, John, greeted me at the door and said, “Dad, the penny is at the bottom of his chest, but not in his stomach.” I asked him to show me how he knew that. He asked Charlie, who thought the process pretty neat, to lie down on the floor on his back with arms and legs stretched out. John then moved the metal detector slowly back and forth over Charlie. When it got over the xiphoid, it beeped.

As a test, I then hid pennies under Charlie at other locations: hand, leg, and pelvis. The metal detector pinpointed each of them. I then had Charlie try to drink some liquid. After I was sure he was having no problem, I asked him to eat some semisolid, then solid foods. All went down fine. I decided to watch him until morning.

Just before bedtime, we checked Charlie again with the metal detector. The coin had moved into the stomach, as evidenced by beeps over an area 4 cm below the xiphoid near the midline. By morning, the coin had moved even further, as evidenced by metal detector beeps in the right lower quadrant. After lunch, Charlie had a bowel movement. He sat on a plastic grocery bag stretched over the toilet seat, and out came the penny with the stool.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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