The shift in how we pay may be sparing many children a trip to the emergency room. According to a new study, the rise of cashless payments in the UK appears to be associated with a surprising decline in the number of procedures performed to remove coins and other objects from the throats, noses, and windpipes of young children.

Between 2000 and 2022, researchers examined more than 79,000 cases of foreign body removal in the UK’s hospital system. The majority occurred in children under 14. But something changed after 2012 — a year that marked a tipping point in the British public’s relationship with cash. That’s when contactless payments began to take off. And so, it seems, did the coins from children’s pockets.

Fewer Coins, Fewer Emergencies. Thanks, Apple Pay?

“Our research shows that using cashless payment methods instead of coins has potentially helped keep children safe and reduced the need for surgery,” said Akash Jangan, the study’s lead author and an ear, nose and throat (ENT) registrar.

They’re small, they’re shiny, they’re everywhere. Coins are implicated in more than 75% of swallowed foreign bodies in children under the age of 6.

In 2006, 62% of all payments in the UK were made with cash. By 2021, that figure had fallen to just 15%. As debit cards and digital wallets became ubiquitous, physical coins started vanishing from daily life. The researchers wondered — could the disappearance of metal money be echoing in hospital records?

To find out, they turned to Hospital Episode Statistics, or HES, a vast NHS database that tracks hospital procedures. They focused on children 0–14 years old and sorted procedures into three categories: removal of foreign bodies from the alimentary tract (including the throat and esophagus), the respiratory tract (such as the windpipe), and the nasal cavity.

Then they looked at trends before and after 2012.

After 2012, the number of alimentary tract foreign body removals fell by about 28 procedures per year. Nasal cavity removals dropped by 53. Respiratory tract procedures also declined — albeit more modestly — by about 5 per year. All of these reductions were statistically significant.

Coin-cidence?

Despite the clever title of the paper — “Coin-cidence?” — the researchers are cautious about assigning direct blame (or credit) to disappearing coins.

They acknowledge such trends are likely multifactorial. In other words, cash might not be the only variable.

Indeed, while coins are frequently swallowed, they are rarely shoved into the nose. Yet nasal cavity foreign body removals also declined post-2012. That suggests broader changes may be afoot.

One possibility is improved awareness. Campaigns such as the UK’s “Susy Safe Project” have warned parents about choking hazards. In 2020, the Resuscitation Council launched new guidelines to help caregivers handle foreign body airway obstruction in children.

The COVID-19 pandemic may also have played a role. With schools closed and many parents at home, children might have been more closely supervised. And a general reduction in hospital admissions during the pandemic may have distorted data from the later years. Although one study from Italy during the pandemic found a significant increase in battery ingestions among children, which was attributed to increased time spent at home and greater use of electronic devices.

Even so, the timing aligns intriguingly with Britain’s shift to tap-and-go technology.

“Following the increase in cashless payments identified in 2012, we report a statistically significant reduction in the frequency of alimentary FB removal procedures,” the authors wrote.

This study isn’t the first to explore the unintended benefits of technological change. But it may be among the quirkiest.

It raises an important point: what we carry in our pockets — and what we let our children play with — can change with the times.

The findings appeared in The Annals of the Royal College of Surgeons of England.