Feast or Famine: A National Stay-at-home Order Is Associated with an Increase in Pediatric Foreign Body Ingestions Presenting to Emergency Departments in 2020 Compared to 2011-2019

Background: Foreign body ingestion among children is a well-known, potentially hazardous injury that can prove fatal. A recent single–center report demonstrated an increased frequency of caustic/toxic ingestions during the pandemic, but the trend in foreign body ingestions has yet to be evaluated. Our study aims to investigate whether the stay–at–home order during the COVID-19 pandemic associated with an increase in foreign body ingestion frequency.

Methods: We used the National Electronic Injury Surveillance System (NEISS) database to evaluate the frequency of suspected-foreign body ingestions (FBI) in children ages 0-17 years of age for years 2017–2020. For the purposes of our analyses, we identified 2017-2019 and 2020 as the pre-COVID-19 and COVID-19 periods, respectively. FBI frequencies were then annualized based on the number of years contained within each period. We used the NEISS coding manual to assign classes to the consumer products implicated in FBI including: electronics (including cylindrical and button batteries), magnets, coins, toys, desk supplies, bathroom items, jewelry, fasteners (screws, nails, etc.) and holiday items (Christmas ornaments, holiday décor, etc.). Escalation of care was defined as hospital admission or transfer. All reported values are populations national estimates generated from actual FBI encounters at NEISS sampled emergency rooms and were calculated using the NEISS-supplied weights and variance variables. Rao-Scott Chi-square was used for all categorical comparisons.

Results: The majority of FBI occurred in children age 0-5 years. During the COVID period, 57% of ingestions occurred in males. There was no significant decrease in estimated total FBI between the pre-COVID-19 and COVID period (59,933 (95% confidence intervals (95% CI) 42,978-76,888) vs 54,926 (95% CI 39,532-70,319); P=0.06).The estimated number of ingestions occurring in school decreased from pre-COVID-19 (2,678 (95% CI 1,855-3,501)) compared to COVID-19 (1,189 (95% CI 579-1,800), P=0.008). The estimated number of children requiring escalation of care due to FBI increased between the two time periods (6,923 (95% CI 4,605-9,241) vs 8,041 (95% CI 5,305-10,777); p=0.0016). The estimated frequency of magnet ingestions increased significantly between the two time periods (2,891 (95% CI 1,861-3,921) vs 4,816 (95% CI 3,213-6,419), P<0.0001).The number of estimated electronics FBI also increased significantly (5,757 (95% CI 3,833-7,681) vs 6,881 (95% CI 4,417-9,344), P=0.001).

Conclusion: While there was no significant increase in the frequency of total foreign body ingestions during the pandemic, the proportion of the most dangerous ingestion subtypes (magnets and electronics) up trended significantly. As expected, the frequency of FBI that occurred at school significantly decreased. The injury patterns described in this analysis, particularly with respect to electronics and magnets, provides an opportunity for targeted advocacy and education of patients, parents, educators, and other caregivers. This should guide future pandemic public health campaigns to increase home safety and prevent future FBI.