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
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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 participants, half female, aged 27 to 45 years, with a mean age of 36 years. The participants were adult pediatric health-care professionals.
Five of the six participants successfully found the LEGO head. One male participant searched through 13 stools over two weeks and never found it.
Key Result: A swallowed Lego head was recovered from the stool within around 2 days.
- Outcome: FART Score
- Among those who retrieved the Lego head, the average FART score was 1.71 days.
- The range was about 1.14 to 3.04 days, or roughly 27 hours to 73 hours.
The authors also compared pre-ingestion and post-ingestion stool patterns using the Stool Hardness and Transit (SHAT) score and found no significant change in bowel consistency after swallowing the Lego head.
They also examined whether looser or more frequent stools predicted faster retrieval. No significant correlation was found.
No one had complications.
1. Selection Bias: This study was open to any healthcare professionals working in the field of paediatric hospital care, but only included six adult paediatric healthcare professionals. The authors do not mention exactly how many participants were eligible. It is unclear if these six participants had certain qualities that led to self-selection or if they are representative of the entire population.
2. Generalizability: The average age in this study was 36 years. This does not reflect the pediatric population. Bowel transit, behaviour, diet, history reliability, and risk tolerance differ substantially between adult volunteers and toddlers. In addition, the study participants only swallowed a LEGO head: small, smooth, plastic, and blunt. These results should not be generalized to button batteries, magnets, sharp or long objects, or anything else that may cause symptoms.
3. Imprecise: There were only six participants, and only five successfully retrieved the object, making the study underpowered. A zero-complication result in six adults does not exclude rare but important complications, and it cannot meaningfully inform high-stakes pediatric ED decisions. The study was not designed to estimate rare complications. If something bad happens 1 in 1,000 times, this study cannot detect that. It can provide a memorable point estimate of transit time, not a robust estimate of risk.
4. Confounders: The authors also reported the number of stools to LEGO head retrieval. They did not account for the time each bowel movement took. In participants who may spend more time on the toilet, perhaps while using their mobile device, this may have falsely decreased the number of bowel movements required to retrieve the Lego head.
Also, we do not have data on whether participants chose to use laxatives or on their dietary practices, which may have also affected the results. To their credit, they tried to standardize some of this using the SHAT score, but we were unable to find a study that validated that instrument.
5. Confirmation of Passage: The primary outcome depended on participants finding the Lego head in the stool. Participants knew the exposure and outcome and used individualized stool-searching techniques, which are vulnerable to detection bias. Also, one participant never found it despite extensive searching. That does not necessarily mean the object did not pass.
The participant self-reported the presence of a LEGO head without any additional outside confirmation. It is also possible that a participant mistakenly identified what they thought was a Lego head and confused it with something else small, like a yellow, undigested piece of corn. The authors acknowledged that the population could not be blinded and that SHAT was not a perfect surrogate for the underlying bowel pattern.
SGEM Bottom Line: For a witnessed ingestion of a small, blunt plastic toy part in an asymptomatic patient, “everything is probably awesome,” but this tiny adult case series should reassure, not replace, standard ED risk stratification.
Case Resolution: The 2-year-old remains well appearing. No drooling. No vomiting. No abdominal pain. No respiratory symptoms. You explain to the parents that this kind of object will usually pass on its own. You give return precautions and tell them they do not need to search every diaper unless there is a specific clinical reason to do so. The parents are relieved. The toddler immediately tries to eat the discharge paperwork.
Clinical Application: This paper should not change how we manage dangerous ingestions. Button batteries, multiple magnets, sharp objects, or symptomatic children are different situations. But for the common ED scenario of a well-appearing child with a small, blunt, inert object ingestion, this study gives us a memorable way to reassure families. The most useful part of the paper may not be the exact FART score. It may be the permission it gives clinicians to say: “You do not have to search the poop.”
What Do I Tell the Patient? Based on what we know, small smooth plastic objects like this usually pass on their own, often within a few days. Your child looks well right now, which is reassuring. You do not need to check every stool to find it. Please come back right away if your child develops vomiting, belly pain, fever, trouble swallowing, drooling, coughing, breathing problems, blood in the stool, or starts acting very unwell.
Keener Kontest: Last week’s winner was Ryker Kiel from Wyoming. He knew an appendicolith is calcified stool in the appendix.
Other FOAMed:
- NPR: 6 doctors swallowed Lego heads for science. Here’s what came out
- Science News: These researchers swallowed Legos for science
- Smithsonian Magazine: It Takes 1.71 Days to Poop Out a Lego
- Huffington Post: Researchers Swallow Lego To Reassure Parents It Will Come Out The Other End
- The Guardian: Shit a brick – Doctors swallow Lego to allay parents’ fears
Remember to be skeptical of anything you learn, even if you heard it on the Skeptics’ Guide to Emergency Medicine.
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