Coins are the most common esophageal foreign body in children. We prospectively evaluated 52 consecutive children who had swallowed coins to determine the incidence of asymptomatic esophageal coins and the rate of spontaneous passage. All patients had a roentgenogram; coins were removed from the esophagus if the patient was symptomatic. children with asymptomatic esophageal coins were allowed less than 24 hours to pass the coin to the stomach. Thirty children had esophageal coins; of these, 9 (30%) were asymptomatic. The presence of symptoms was significantly associated with esophageal coins, but the absence of symptoms did not reliably exclude the possibility of an esophageal coin. All children who swallow coins should undergo roentgenographic evaluation.