Continuing Education Activity

Children frequently swallow inedible foreign bodies. Mouthing and tasting environmental objects represent a normal developmental stage in early childhood, but accidental ingestion may occur. Commonly ingested items include coins, toys, batteries, and jewelry. Diagnosis often depends on a high index of suspicion, as symptoms may be minimal or absent. Ingestion of button batteries has become a growing concern due to their widespread presence in household items and potential for corrosive injury within the gastrointestinal tract. While most foreign bodies pass spontaneously without complication, some require urgent removal. Objects may become lodged or perforate the gastrointestinal wall, resulting in significant morbidity and mortality if not promptly identified and managed.

Therapy depends on the type, size, and location of the ingested object, with endoscopic removal indicated for high-risk items such as button batteries, magnets, or sharp objects. Prognosis is generally favorable, especially when ingestion is recognized early and managed promptly.

This activity for healthcare professionals is designed to improve learners' proficiency in evaluating and managing foreign body ingestion in children. Participants will deepen their understanding of the condition's risk factors, pathophysiology, and clinical presentation. Current diagnostic and therapeutic recommendations will also be discussed. Greater competence will empower clinicians to collaborate within an interprofessional team caring for affected individuals.

Objectives:

• Identify the signs and symptoms suggestive of foreign body ingestion in children.
• Select the most appropriate diagnostic tools to evaluate suspected foreign body ingestion in children.
• Implement personalized, evidence-based management strategies for pediatric cases of foreign body ingestion.
• Apply effective strategies to improve care coordination among interprofessional team members to facilitate positive outcomes for pediatric patients who have ingested foreign bodies.

Introduction

Children commonly swallow foreign bodies. Coins are the most frequently swallowed objects requiring medical attention in the U.S. Globally, common items include coins, jewelry, toys, batteries, and inedible food products such as small bones.[1] Swallowed objects may enter the airway or pass into the gastrointestinal tract. Most foreign bodies exit the gastrointestinal tract without incident, but some become lodged at anatomical narrowings, resulting in obstruction, caustic injury, or mechanical trauma to the gastrointestinal walls.[2][3][4] Management depends on the patient's symptoms, the location of the object, and the size and composition of the foreign body.

Etiology

Pediatric foreign body ingestion often occurs accidentally. Toddlers frequently place objects in their mouths—an expected developmental behavior—as they explore their surroundings. Due to underdeveloped dentition, infants and toddlers are more likely to swallow objects compared to older children.[5] Older children with psychological or neurodevelopmental disorders face elevated risk due to behavioral patterns associated with those conditions.

Functional or structural abnormalities of the gastrointestinal tract, such as strictures, scarring, fistulas, or diverticula, increase the likelihood of complications from foreign body ingestion by creating points where objects may become lodged. Button and disc batteries can cause severe injury when trapped in the esophagus, nasal cavity, external auditory canal, or other orifices, even after brief exposure. Lithium-based batteries carry the highest risk of tissue damage.

Small, high-powered magnets, commonly found in toys and household items, may lead to gastrointestinal injury. Multiple magnets can attract across tissue planes, eroding through intervening structures.[6] Ingesting a single magnet alongside another metallic object, particularly a battery, further increases the risk of serious complications.

Epidemiology

Over 50,000 cases of foreign body ingestion in children younger than 5 years were reported to the National Poison Data System in 2022.[7] Most ingestions occur in children aged 6 months to 3 years.[8][9] The majority of cases are witnessed and occur within the home. Mortality remains low overall.[10]

Older children with foreign body ingestions often have comorbid psychiatric or developmental conditions. The incidence of foreign body ingestion in adolescent boys surpasses that in adolescent girls. In younger age groups, both sexes experience similar prevalence.

Coins are the most frequently swallowed foreign body requiring medical attention in the U.S. and many developed countries. However, the ingestion of coins has decreased as their use has declined in everyday life. Younger children typically ingest smaller coins, while older children tend to swallow larger ones.[11] Magnet ingestion has risen in the U.S. over the past 2 decades, particularly among children younger than 5 years. Other frequently ingested objects include small toys and jewelry. In some countries, fish bones are the most commonly ingested foreign objects.[12][13]

Pathophysiology

The most common complication of foreign body ingestion in children is esophageal obstruction, although foreign bodies may also become lodged in other areas of the gastrointestinal tract. Once lodged, objects may partially or completely obstruct the lumen. Some may erode through the gastrointestinal tract walls, causing perforation and migration outside the lumen. Patients with anatomically or functionally abnormal gastrointestinal tracts are at a higher risk of complications. Infants and toddlers are particularly vulnerable due to the narrower esophageal and bowel lumens. Other high-risk patients include those with a history of upper gastrointestinal surgery, gastroesophageal reflux disease, eosinophilic esophagitis, neuromuscular disorders, or congenital gastrointestinal malformations.[14][15]

Several areas in the esophagus may trap foreign bodies. The most common site of obstruction is at the level of the thoracic inlet. Approximately 10% to 15% of foreign bodies lodge in the midesophagus, where the carina and aortic arch overlap. Objects may also become trapped at the gastroesophageal junction. Once a foreign body reaches the stomach, it is more likely to pass through the rest of the gastrointestinal tract. However, some may become stuck in the bowel, particularly near the ileocecal valve.

Batteries, especially button types, can create a local circuit with adjacent tissue, leading to burns and coagulative necrosis. These injuries may result in gastrointestinal tract perforation, mediastinitis, peritonitis, fistula formation, or scarring and strictures. Additionally, batteries may cause local obstruction, similar to other ingested objects.[16] A rare but potentially fatal complication of esophageal button battery impaction involves the formation of an aortoesophageal fistula, where tissue necrosis between the esophagus and aorta leads to arterial bleeding into the esophagus.

Magnets, particularly rare-earth magnets, pose a significant danger when multiple pieces are ingested together or one is ingested with another metallic object. These magnets can attract each other or other metals across tissues, causing pressure necrosis, which may potentially result in bowel perforation, peritonitis, fistula formation, or mechanical obstruction.[17]

History and Physical

The airway must be evaluated promptly in suspected foreign body ingestion. The oropharynx should be examined for foreign bodies, and any found should be removed if possible. After addressing any airway or breathing compromise, a thorough history and physical exam can follow.

Some patients with foreign body ingestion may exhibit no symptoms, while others may experience mild, nonspecific manifestations. Given the possibility of unwitnessed ingestions, foreign body ingestion should be considered in children with respiratory or gastrointestinal complaints. In a case series, only half of the patients with confirmed foreign body ingestion exhibited symptoms upon presentation.[18]

Symptomatic infants and young children are more likely to present with respiratory symptoms, while older children tend to show gastrointestinal symptoms. Symptom severity, physical examination findings, and vital sign abnormalities largely depend on the presence and extent of complications.

A foreign body obstructing or injuring the esophagus may cause chest pain, shortness of breath, odynophagia, dysphagia, coughing, or a sensation of a foreign body. Significant esophageal injury may lead to hematemesis or signs of mediastinitis. Young children with an esophageal foreign body may drool, gag, vomit, or refuse food.

Foreign bodies lodged in or perforating the stomach or bowel can cause abdominal pain, vomiting, hematemesis, or bloody stool. Foreign bodies retained for extended periods may result in fever or weight loss. Swallowed foreign bodies containing nickel may cause systemic symptoms, including rashes or pruritus, in patients with nickel sensitivity.

Evaluation

Evaluation for airway compromise due to proximal airway or esophageal obstruction is the priority when assessing a patient with suspected foreign body ingestion. Complete esophageal occlusion may lead to significant drooling, which can indirectly compromise the airway due to the accumulation of secretions. Immediate management of such airway threats must precede further history-taking or examination.

Plain radiographs provide a useful first-line imaging modality for suspected airway, esophageal, or gastric foreign bodies. Metallic foreign bodies are readily visible and can be roughly localized on plain films.[19][20][21] Batteries, coins, and most glass fragments appear on radiographs. Radiolucent objects, such as meat or plastic toys, may not be clearly visible but can sometimes be identified by their outlines or associated irregularities. Contrast radiography, computed tomography, or magnetic resonance imaging may offer better visualization of radiolucent objects.[22][23][24]

Button batteries and coins may be differentiated radiographically. Button batteries typically display a 2-layer appearance in lateral views or a circle-within-a-circle pattern in anteroposterior views, while coins appear as single-layer disks (see Image. Button Battery in the Upper Esophagus of a Child).

Treatment / Management

Management depends on the foreign body’s location and composition. The key decision involves determining whether endoscopic or surgical removal is necessary. Approximately 10% to 25% of ingested foreign bodies require endoscopic retrieval. Magnets and batteries carry a higher likelihood of requiring endoscopic or surgical intervention and are more frequently associated with bowel resection or multiple operations.

Conservative management with serial imaging and observation may be appropriate for otherwise healthy, asymptomatic children who have ingested small, inert objects. Many of these children may be monitored at home or safely discharged from the emergency department without intervention. Observation may be less suitable for children with a history of gastrointestinal diseases or structural abnormalities, given the increased risk of obstruction and tissue injury. When managed expectantly, patients and caregivers should be advised to obtain immediate medical care at the onset of symptoms, as foreign body removal may become necessary.[25][26][27]

Low-risk objects in the stomach or bowel often pass spontaneously in asymptomatic children. Expectant management may be appropriate for coins and other small, inert objects located near the gastroesophageal junction in otherwise healthy patients, as these typically enter the stomach within hours and progress through the bowel without complication. The onset of symptoms warrants prompt intervention—endoscopic retrieval for gastric foreign bodies or surgical removal for bowel obstructions. Gastroenterology or surgical consultation is necessary following ingestion of high-risk objects, such as large or pointed items, batteries, or multiple magnets.

Large or obstructive foreign bodies in the esophagus generally require endoscopic removal. Endoscopy allows for the safe extraction of sharp, pointed, or otherwise high-risk objects from the esophagus or stomach. Some specialized centers may use a bougie or balloon catheter to remove small esophageal foreign bodies, such as coins, without endoscopy. Any button battery in the esophagus demands urgent removal. When endoscopy cannot be performed immediately, oral honey administration has been proposed as a protective measure to limit tissue damage surrounding the battery.[28]

Button battery ingestions require urgent management due to the risk of tissue necrosis and perforation. Depending on the location, immediate gastroenterology or surgical consultation is necessary, with most cases requiring prompt removal. Asymptomatic patients who present more than 12 hours after ingestion or in whom the battery has passed into the bowel may be monitored for spontaneous passage. In such cases, follow-up imaging after 7 to 14 days is necessary to track battery progression. Symptom development at any point warrants emergency reassessment and likely surgical intervention.[29] Institutional practices may differ, though treatment algorithms for button and disc battery ingestion are widely available.[30]

Expectant management with serial imaging may be considered for asymptomatic patients who have ingested multiple magnets. Suggested imaging intervals range from every 6 to 12 hours. Surgical intervention is typically pursued when no progression through the bowel occurs or when symptoms arise.

Medical management with emetics or laxatives is not advised. Emetics, muscle relaxants, and meat tenderizers are ineffective and may be harmful.[31] Although laxatives are sometimes used to facilitate intestinal passage, this approach remains unproven and should not be employed without specialist input.

Differential Diagnosis

Pediatric foreign body ingestion can present with nonspecific symptoms that overlap with several other conditions. Clinicians must consider a broad differential diagnosis, including the conditions below, especially when complications such as obstruction or perforation are suspected.

• Esophagitis
• Laryngitis
• Pharyngitis
• Globus sensation
• Esophageal web or stricture
• Esophageal rupture
• Pyloric stenosis
• Bowel obstruction
• Bowel perforation
• Appendicitis
• Intussusception
• Volvulus
• Gastroenteritis
• Colitis

Recognizing clinical features that differentiate these conditions from foreign body ingestion is essential for accurate diagnosis and timely intervention. A thorough history, physical examination, and clinically appropriate imaging help distinguish ingestion-related pathology from mimicking disorders.

Prognosis

Outcomes following pediatric foreign body ingestion are generally favorable, with most children tolerating spontaneous passage of ingested objects without requiring intervention. Even when removal becomes necessary, morbidity and mortality remain low when identification and extraction occur promptly. High-risk ingestions, such as those involving button batteries, magnets, or sharp objects, carry a greater risk of complications and, in some cases, may result in death.[32][33]

The prognosis depends on the severity of resulting complications. Children who pass objects spontaneously tend to recover fully without lasting effects. In contrast, cases involving severe outcomes such as mediastinitis from esophageal perforation, aortoenteric fistula, or bowel perforation with peritonitis require a cautious outlook and close follow-up.

Complications

Esophageal obstruction is the most frequently encountered complication in pediatric foreign body ingestion.[34] In rare cases, certain foreign bodies may perforate the alimentary tract or migrate into surrounding structures, resulting in life-threatening outcomes, including the following:

• Esophageal, gastric, or bowel wall perforation
• Pneumothorax
• Mediastinitis
• Mucosal erosion
• Gastrointestinal bleeding
• Aortoenteric fistula
• Esophageal or bowel wall pressure necrosis
• Failure to thrive and dehydration secondary to decreased oral intake

Prompt identification and intervention remain critical in preventing serious complications. Although severe outcomes are rare, delayed recognition may lead to devastating consequences.

Deterrence and Patient Education

Prevention of pediatric foreign body ingestion relies heavily on caregiver education and maintaining a safe environment. Small objects such as coins, batteries, magnets, and toy parts should be kept out of reach of young children. Manufacturers and regulatory agencies can help reduce risk through product design modifications and clear safety labeling. Early education of caregivers about the dangers of high-risk objects and prompt medical evaluation after suspected ingestion is essential in reducing morbidity and mortality.

Enhancing Healthcare Team Outcomes

The treatment of children who have swallowed foreign bodies requires an interprofessional approach. Physicians, nurses, poison control specialists, radiology technologists, child life specialists, and emergency medical services personnel must collaborate to deliver continuous, developmentally appropriate care.

Preventing foreign body ingestion is essential. Team members should educate caregivers about the risks posed by small objects, with particular emphasis on the dangers of button or disc batteries, small magnets, and sharp items. Caregivers should also be reminded that children may access objects placed in trash containers or unsecured storage areas.[35][36]

Unusual or recurrent episodes of foreign body ingestion should prompt evaluation for developmental delay, psychiatric conditions, or possible child neglect. Some cases reflect risk-taking or attention-seeking behaviors, while others may involve psychiatric illness. For example, a child with bulimia may unintentionally swallow a toothbrush used to induce vomiting. Ingesting drug packets to avoid law enforcement may also occur. Mental health or social work consultation may be appropriate when these concerns arise.

Review Questions

• Access free multiple choice questions on this topic.
• Click here for a simplified version.
• Comment on this article.

References

1.

Powers K, Baldassari C, Lucas J. Pediatric Esophageal Foreign Bodies and Caustic Ingestions. Otolaryngol Clin North Am. 2024 Aug;57(4):623-633. [PubMed: 38519292]

2.

Bolton SM, Saker M, Bass LM. Button battery and magnet ingestions in the pediatric patient. Curr Opin Pediatr. 2018 Oct;30(5):653-659. [PubMed: 30188872]

3.

Prasad V, Samuel V, Ramakrishnan M, Ravikumar D, Sharna N. Management of foreign body ingestion in children with cerebral palsy: Need for proper trauma management protocol. J Family Med Prim Care. 2018 May-Jun;7(3):638-641. [PMC free article: PMC6069660] [PubMed: 30112324]

4.

Lavin JM, Wiedermann J, Sals A, Kato K, Brinson D, Nytko A, Katsogridakis Y, Krug S, Ida J. Electronic medical record-based tools aid in timely triage of disc-shaped foreign body ingestions. Laryngoscope. 2018 Dec;128(12):2697-2701. [PubMed: 30229937]

5.

Saw-Aung M, Kong RM, Cipriano N, Daniels A, Newen NL, Goldstein NA, Plum AW. National Trends of Pediatric Aspirated/Ingested Foreign Bodies. Clin Pediatr (Phila). 2024 May;63(4):531-540. [PubMed: 37377192]

6.

Hussain SZ, Bousvaros A, Gilger M, Mamula P, Gupta S, Kramer R, Noel RA. Management of ingested magnets in children. J Pediatr Gastroenterol Nutr. 2012 Sep;55(3):239-42. [PubMed: 22785419]

7.

Gummin DD, Mowry JB, Beuhler MC, Spyker DA, Rivers LJ, Feldman R, Brown K, Pham NPT, Bronstein AC, DesLauriers C. 2022 Annual Report of the National Poison Data System^® (NPDS) from America's Poison Centers^®: 40th Annual Report. Clin Toxicol (Phila). 2023 Oct;61(10):717-939. [PubMed: 38084513]

8.

Wyllie R. Foreign bodies in the gastrointestinal tract. Curr Opin Pediatr. 2006 Oct;18(5):563-4. [PubMed: 16969173]

9.

Banerjee R, Rao GV, Sriram PV, Reddy KS, Nageshwar Reddy D. Button battery ingestion. Indian J Pediatr. 2005 Feb;72(2):173-4. [PubMed: 15758543]

10.

Simic MA, Budakov BM. Fatal upper esophageal hemorrhage caused by a previously ingested chicken bone: case report. Am J Forensic Med Pathol. 1998 Jun;19(2):166-8. [PubMed: 9662114]

11.

Mantegazza C, Destro F, Ferraro S, Biganzoli D, Marano G, Quitadamo P, Nardo GD, Malamisura M, Chiarazzo G, Renzo S, Scarallo L, Fava G, Ichino M, Panceri R, Sala D, Pellegrino M, Macchini F, Gandullia P, Tantari G, Bramuzzo M, Saccomani MD, Illiceto MT, Orizio P, Gatti S, Pizzol A, Felici E, Romano C, Iuliano S, Marinari A, Marseglia A, Oliva S. Recent trends in foreign body ingestion (FBI) epidemiology: A national cohort study. Dig Liver Dis. 2025 Feb;57(2):595-602. [PubMed: 39477708]

12.

Krom H, Visser M, Hulst JM, Wolters VM, Van den Neucker AM, de Meij T, van der Doef HPJ, Norbruis OF, Benninga MA, Smit MJM, Kindermann A. Serious complications after button battery ingestion in children. Eur J Pediatr. 2018 Jul;177(7):1063-1070. [PMC free article: PMC5997112] [PubMed: 29717359]

13.

Sasso R, Bachir R, El Sayed M. Suffocation Injuries in the United States: Patient Characteristics and Factors Associated with Mortality. West J Emerg Med. 2018 Jul;19(4):707-714. [PMC free article: PMC6040911] [PubMed: 30013708]

14.

Kramer RE, Lerner DG, Lin T, Manfredi M, Shah M, Stephen TC, Gibbons TE, Pall H, Sahn B, McOmber M, Zacur G, Friedlander J, Quiros AJ, Fishman DS, Mamula P., North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Endoscopy Committee. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr. 2015 Apr;60(4):562-74. [PubMed: 25611037]

15.

Smith CR, Miranda A, Rudolph CD, Sood MR. Removal of impacted food in children with eosinophilic esophagitis using Saeed banding device. J Pediatr Gastroenterol Nutr. 2007 Apr;44(4):521-3. [PubMed: 17414157]

16.

Paediatric Surgery Trainee Research Network. Magnet and button battery ingestion in children: multicentre observational study of management and outcomes. BJS Open. 2022 May 02;6(3) [PMC free article: PMC9164827] [PubMed: 35657136]

17.

Middelberg LK, Funk AR, Hays HL, McKenzie LB, Rudolph B, Spiller HA. Magnet Injuries in Children: An Analysis of the National Poison Data System from 2008 to 2019. J Pediatr. 2021 May;232:251-256.e2. [PubMed: 33516676]

18.

Arana A, Hauser B, Hachimi-Idrissi S, Vandenplas Y. Management of ingested foreign bodies in childhood and review of the literature. Eur J Pediatr. 2001 Aug;160(8):468-72. [PubMed: 11548183]

19.

Seikel K, Primm PA, Elizondo BJ, Remley KL. Handheld metal detector localization of ingested metallic foreign bodies: accurate in any hands? Arch Pediatr Adolesc Med. 1999 Aug;153(8):853-7. [PubMed: 10437760]

20.

Muensterer OJ, Joppich I. Identification and topographic localization of metallic foreign bodies by metal detector. J Pediatr Surg. 2004 Aug;39(8):1245-8. [PubMed: 15300537]

21.

Younger RM, Darrow DH. Handheld metal detector confirmation of radiopaque foreign bodies in the esophagus. Arch Otolaryngol Head Neck Surg. 2001 Nov;127(11):1371-4. [PubMed: 11701077]

22.

Libânio D, Garrido M, Jácome F, Dinis-Ribeiro M, Pedroto I, Marcos-Pinto R. Foreign body ingestion and food impaction in adults: better to scope than to wait. United European Gastroenterol J. 2018 Aug;6(7):974-980. [PMC free article: PMC6137585] [PubMed: 30228884]

23.

Jahshan F, Sela E, Layous E, Levy E, Assadi N, Shilo E, Ibrahim N, Maayan D, Ronen O. Clinical criteria for CT scan evaluation of upper digestive tract fishbone. Laryngoscope. 2018 Nov;128(11):2467-2472. [PubMed: 29446458]

24.

Laya BF, Restrepo R, Lee EY. Practical Imaging Evaluation of Foreign Bodies in Children: An Update. Radiol Clin North Am. 2017 Jul;55(4):845-867. [PubMed: 28601182]

25.

Zhang X, Zhang X, Tu C, Yu Q, Fu T. Analysis of the management and risk factors for complications of esophageal foreign body impaction of jujube pits in adults. Wideochir Inne Tech Maloinwazyjne. 2018 Jun;13(2):250-256. [PMC free article: PMC6041575] [PubMed: 30002759]

26.

Yuan F, Tang X, Gong W, Su L, Zhang Y. Endoscopic management of foreign bodies in the upper gastrointestinal tract: An analysis of 846 cases in China. Exp Ther Med. 2018 Feb;15(2):1257-1262. [PMC free article: PMC5774343] [PubMed: 29434711]

27.

Rosenfeld EH, Sola R, Yu Y, St Peter SD, Shah SR. Battery ingestions in children: Variations in care and development of a clinical algorithm. J Pediatr Surg. 2018 Aug;53(8):1537-1541. [PubMed: 29486889]

28.

Athanassiadi K, Gerazounis M, Metaxas E, Kalantzi N. Management of esophageal foreign bodies: a retrospective review of 400 cases. Eur J Cardiothorac Surg. 2002 Apr;21(4):653-6. [PubMed: 11932163]

29.

Machta J, Hyer W. Diagnosis, management and prevention of button battery ingestion in childhood: a European Society for Paediatric Gastroenterology Hepatology and Nutrition position paper. Arch Dis Child Educ Pract Ed. 2023 Aug;108(4):292-295. [PubMed: 36410940]

30.

Khalaf RT, Gurevich Y, Marwan AI, Miller AL, Kramer RE, Sahn B. Button Battery Powered Fidget Spinners: A Potentially Deadly New Ingestion Hazard for Children. J Pediatr Gastroenterol Nutr. 2018 Apr;66(4):595-597. [PubMed: 29369847]

31.

ANDERSEN HA, BERNATZ PE, GRINDLAY JH. Perforation of the esophagus after use of a digestant agent: report of case and experimental study. Ann Otol Rhinol Laryngol. 1959 Sep;68:890-6. [PubMed: 13793315]

32.

Uyemura MC. Foreign body ingestion in children. Am Fam Physician. 2005 Jul 15;72(2):287-91. [PubMed: 16050452]

33.

Yardeni D, Yardeni H, Coran AG, Golladay ES. Severe esophageal damage due to button battery ingestion: can it be prevented? Pediatr Surg Int. 2004 Jul;20(7):496-501. [PubMed: 15221361]

34.

Shivakumar AM, Naik AS, Prashanth KB, Yogesh BS, Hongal GF. Foreign body in upper digestive tract. Indian J Pediatr. 2004 Aug;71(8):689-93. [PubMed: 15345868]

35.

Leinwand K, Brumbaugh DE, Kramer RE. Button Battery Ingestion in Children: A Paradigm for Management of Severe Pediatric Foreign Body Ingestions. Gastrointest Endosc Clin N Am. 2016 Jan;26(1):99-118. [PMC free article: PMC5425245] [PubMed: 26616899]

36.

Dray X, Cattan P. Foreign bodies and caustic lesions. Best Pract Res Clin Gastroenterol. 2013 Oct;27(5):679-89. [PubMed: 24160927]

Disclosure: Kathleen McMahon declares no relevant financial relationships with ineligible companies.

Disclosure: Gregory Conners declares no relevant financial relationships with ineligible companies.

Disclosure: Michael Mohseni declares no relevant financial relationships with ineligible companies.