Episode Details

Date: June 23, 2026 Reference: Tagg A, et al. Everything is awesome: Don’t forget the Lego. J Paediatr Child Health. 2019 We recorded this SGEM episode live at the Don't Forget the Bubbles conference in Glasgow, Scotland. Dennis and I had just given an hour presentation on how to build better critical appraisal skills. It was a wonderful experience, and we would like to thank Dr. Tessa Davis, Dr. Andy Tagg, and the entire DFTB team for putting on an amazing event.  Case: A 2-year-old boy is brought to the emergency department (ED) after swallowing a foreign body. His sister was playing with some of her plastic LEGO pieces. After cleaning up, she noticed one of the minifigures was missing its head. The boy’s mother thinks he may have swallowed one. On exam, he looks comfortable and is playful.  Vital signs are stable.  Abdominal exam is benign. An X-ray obtained does not demonstrate any radio-opaque foreign body. He drinks and eats a snack in the ED without any issues. As you get ready to send the family home, his parent asks, “Do you think he’s going to be ok? When do you think this thing is going to come out?” Kids eat a lot of weird stuff. The world is an adventure that they like to explore, sometimes with their mouths. Sometimes kids also swallow non-nutritive items, such as glue, coins, or toy parts. Foreign body ingestion is very common in children aged 6 months to 3 years. We get worried if it’s an object like a button battery or two magnets, as they can cause significant damage to the gastrointestinal (GI) tract. Button batteries stuck in the esophagus can burn through it. Magnets can pinch off the bowel and cause necrosis. Fortunately for the many swallowed foreign bodies I’ve encountered in the ED, the kids tend to do fine. Clinical Question: How long does it take for an ingested LEGO figurine head to pass through the gastrointestinal tract in healthy adult volunteers, and are there any complications? Reference: Tagg A, et al. Everything is awesome: Don’t forget the Lego. J Paediatr Child Health. 2019 Population: Six pediatric healthcare professionals were recruited. Exclusion: Previous GI surgery, inability to swallow a foreign object, or, my favourite, aversion to searching through faecal matter. Intervention/Exposure: Ingestion of a LEGO head. The authors also standardized pre-ingestion bowel habit using a 3-day stool diary and their Stool Hardness and Transit score, mercifully abbreviated SHAT.   Comparison: I mean, I don’t think they tried to see who pooped it out first. The study included a within-person pre/post comparison of stool consistency using pre-SHAT and post-ingestion SHAT. Outcome: Found and Retrieval Time, or FART score, defined as the time from ingestion until the Lego head was found in stool.   Type of Study: Prospective, international, uncontrolled case series/self-experiment with a small within-subject before-and-after component for stool consistency. Author’s Conclusion: “A toy object quickly passes through adult subjects with no complications. This will reassure parents, and the authors advocate that no parent should be expected to search through their child’s faeces to prove object retrieval.” Quality Check List for Observational Studies: Did the study address a clearly focused issue? Yes Did the authors use an appropriate method to answer their question? Unsure Was the cohort recruited in an acceptable way? No Was the exposure accurately measured to minimize bias? Yes Was the outcome accurately measured to minimize bias? Unsure Have the authors identified all important confounding factors? No Was the follow up of subjects long enough? Yes How precise are the results? Not very precise. Do you believe the results? Yes Can the results be applied to the local population? No Do the results of this study fit with other available evidence? Yes Who funded the trial? Not funded Conflicts of Interest: None Results: The study included six parti