Caregiver reports indicate that using the combined Ditto protocol was most effective in reducing children's pain experiences while undergoing IV cannulation in the ED. The use of Ditto offers a promising opportunity to negotiate barriers to the provision of nonpharmacological approaches encountered in the busy ED environment, and provide nonpharmacological pain-management interventions in pediatric EDs.

This case highlights a rare but important presentation of aorto-oesophageal fistula caused by a concealed foreign body. Primary prevention strategies are needed to address the danger associated with button batteries.