You are asked to recommend therapy for an asymptomatic 2 year old who swallowed a small alkaline watch battery 4 hours ago. A plain film shows the intact battery in the intestine beyond the stomach. The best course of therapy is?

d. Cathartics and a follow-up plain film in 48 hours if the child remains asymptomatic

Passage of an ingested foreign body beyond the gastroesophageal junction is associated with a 95% probability of uneventful distal transit. The character of the foreign body is largely irrelevant but batteries, particularly alkaline disk batteries, present a potentially serious hazard to children and may require an aggressive approach. A number of reports have documented the unique risk of intestinal perforation resulting from disruption of the battery casing and associated spillage of the toxic contents. Although some have advocated routine immediate removal, this does not appear necessary. If the battery is endoscopically accessible in the esophagus, it should be removed when recognized. Cathartics and enemas may help expedite passage of batteries discovered when already in the small or large bowel. Delay for more than a few days, casing rupture on plain radiograph, or symptoms of any kind require extraction. Despite the risks, most batteries pass without these sequelae.