CORRESPONDENCE

The simple bread tag - a menace to society? More warnings in our digital era

To the Editor: We read with great interest the article on the public health issue of 'The simple bread tag - a menace to society?' in the May 2015 issue of the SAMJ.^[1]

We are delighted that the authors have directed the medical fraternity to one of the most common public health problems in early childhood, and agree that these bread tags should be removed from use.

Ingestion of a foreign body is the fifth most common presentation to paediatric emergency departments. Analysis of figures from our institution previously found that the number of ingestion injuries was comparable with the number of assaults as a cause for trauma unit attendance; although falls, motor vehicle accidents and burns were more frequent.

Toddlers and young children are inquisitive and tend to explore objects with their mouths, and are therefore inherently prone to ingestion accidents. Button batteries are a particular concern owing to their ability to cause transmural ulceration; however, the range of potentially ingestible objects is vast.

We recently treated an 8-month old female infant who presented with non-bilious vomiting for 2 days. She was mildly dehydrated and had a fever of 37.9°C. No haematemesis or diarrhoea were reported. Two weeks earlier, her mother had witnessed her grasp and swallow a SIM card, but had not noted any further sequelae or sought medical advice.

An abdominal radiograph demonstrated a mobile phone SIM card at the level of T11 (Fig. 1). It was decided the SIM card should be removed as it had not passed within 2 weeks and was confounding the clinical picture.

Under general anaesthesia, flexible endoscopy visualised the SIM card within the stomach, lodged at the level of the pylorus (Fig. 2). Manipulation was challenging, but eventually the card was removed with the aid of a rigid oesophagoscope and appropriate retrieval forceps.

Widespread availability, exchange, smaller size and disposal of SIM cards are resulting in infants being increasingly exposed to them. This situation is becoming more prevalent in developing societies as the mobile phone becomes the primary system of communication, and SIM card purchase is cheap and often unregulated. The shiny microchip surface makes them attractive to young children at a stage when they are developing hand-to-mouth skills.

We recommend that all parents of young infants are reminded of these dangers to increase vigilance within the home. Resources and information on child safety topics are nowadays widely available from the internet.^[2]

A B van As, R J England, A Numanoglu

Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital and Faculty of Health Sciences, University of Cape Town, South Africa. sebastian.vanas@uct.ac.za

References

1. Karro R, Goussard P, Loock J, Gie R. The simple bread tag - a menace to society? S Afr Med J 2015;105(5):342-344. DOI:10.7196/SAMJ.8996        [ Links ]

2. Childsafe South Africa. Safety tips. http://www.childsafe.org.za (accessed 4 February 2016).         [ Links ]