The death of a 14-month-old boy who swallowed a battery prompted a change in the way pre-school age children are examined in Leicester's hospitals, an inquest heard.
Wsam Noorwali died from internal bleeding on August 19 last year, nine hours after being taken to Leicester Royal Infirmary by his parents, who had found him vomiting blood at the family home.
The three-volt disc battery had corroded an artery wall, causing the fatal haemorrhage.
However, it was not until a post-mortem examination was carried out that the battery, the size of a two pence piece, was discovered in the boy's stomach.
Giving evidence at Leicester Town Hall, yesterday, Timothy Coates, professor in emergency care at the hospital, said: "Because of the high impact of this case, we now do an X-ray of all pre-school age children who present with vomiting blood, regardless of the suspected cause."
He also alerted emergency clinicians across the NHS through national professional bodies.
Wsam, of Hamilton, Leicester, was first assessed by acute care trainee Dr Thomas Wright in accident and emergency at about 10.30pm on August 18, before being moved to the hospital's children's ward after consultation with Prof Coates.
His condition at first improved, but at 2.30am and again at 4am he suffered further bouts of vomiting blood.
With his condition deteriorating, Wsam was transferred to the children's intensive care unit and underwent two blood transfusions.
By that point, however, doctors said he was too weak for emergency surgery.
When Wsam's heart stopped they were unable to revive him and he died an hour later, at just after 7am.
Dr Wright said initial tests in A&E had indicated Wsam had an elevated heart rate but he was in no obvious distress.
"He was on his father's lap and playing, he was not crying," he said.
Further observations and tests failed to identify the cause of the vomiting blood.
Paediatric doctor Sarah Clarke, who was involved in Wsam's care on the ward, said tests did reveal "elevated urea" levels in the blood which could have been caused by "dehydration" or "internal bleeding". But she told the inquest that apart from when medical staff had tried to take blood from the child and he become distressed, he had appeared "settled" and his general demeanour and was "calm", even after the first bout of vomiting on the ward.
Earlier this week, dad Ammar, told the inquest he had repeatedly told medical staff that he was convinced his son had swallowed something.
He said that from the outset he had also pleaded with them to take an X-ray or investigate by putting a small camera down Wsam's throat – but to no avail.
Dr Wright said: "I have no recollection of having any discussion about him swallowing a foreign object, or of a request for an X-ray.
"I would have remembered if that had been the case."
Dr Clarke said she was also unaware of any such conversations with either Wsam's father or mother.
Prof Coates said medical staff had followed established procedures in place at the time to investigate the cause of Wsam's symptoms given the information available to them.
Earlier in the week the boy's parents said they had not seen him swallow anything, but he was prone to putting things in his mouth.
They believed Wsam could have swallowed the battery at the nursery he attended, but nursery owner James Stafford said that would not have been possible.
The inquest continues.
