In Reply.—We would like to thank Dr Joseph for his comments and interest in our recently published article concerning coin ingestions.1
It was our impression, and Dr Joseph's letter supports this, that the practice of not obtaining a roentgenogram of the asymptomatic child following a coin ingestion is common nationwide. Part of the impetus to do this study was this discrepancy between published recommendations and actual practice. Dr Fulginiti further examined the determinants of standard care and standard practice in the accompanying editorial.2 We would like to address a few of the points mentioned by Dr Joseph.
Though it is tempting to conclude that all asymptomatic patients with an esophageal coin who had a chance to be observed for spontaneous passage into the stomach actually did pass the coin, the number of patients that did so was only three. It is impractical to make a practice