Pediatric injuries in the United States, in general, increase during summer holidays (such as Labor Day) but decrease during seasonal holidays (such as Thanksgiving and Christmas). Since the winter holiday, Christmas, is associated with potential ingestible foreign bodies (such as Christmas ornaments) the authors of this study looked at trends of accidental foreign body ingestions in children during this specific holiday. The National Electronic Injury Surveillance System (NEISS) database was searched for specific foreign body ingestions that were related to Christmas items (Christmas tree lights, Christmas decorations) and that presented to the emergency department (ED) from 1997 to 2015. Subjects were included in the study if they were between 0 to 17 years old, had an injury documented as “ingestion/internal”, and the ingested object could be identified from the NEISS coding manual. National estimation of ingestions was determined by Taylor series linearization, and the Cochran Armitage test of trend was used to look for seasonal differences.

During the 18 year time period, it was estimated that 22,224 children presented to the ED with a Christmas-related foreign body ingestion (CFBI) which equaled 1235 encounters annually. Children who were 2 years of age or younger accounted for 84% of ingestions, and 60% of ingestions occurred in males. CFBI was noted to increase in a 7-week period around Christmas with a peak ingestion period occurring at a median of 13 days before or after Christmas (interquartile range 4-23 days). No increase in total foreign body ingestions (CFBI plus all other ingestions) was noted during this 7-week period. When ED visits associated with CFBI were evaluated monthly, a significant seasonal trend was noted during the winter holiday months. The most common CFBI were nonelectric Christmas decorations, and 95.8% of CFBI involved simple triage and discharge from the ED. A significantly lower percentage of CFBI required an escalation of care (defined as hospital admission or transfer from the ED to another hospital) compared to all other foreign bodies. This study demonstrates that medical providers should have increased awareness of the risk of foreign body ingestion during the Christmas holiday season which should translate into increased education and anticipatory guidance to parents, especially parents of young children.

Reeves P, Krishnamurthy J, Pasman E, Nydlund C. Pediatric ingestions of Christmas past, present, and future: a review of holiday trends, 1997 to 2015. Clinical Pediatrics 2019; 58: 571-577.