Foreign body ingestion is very common in the pediatric population. Children with developmental delay are at an increased risk of foreign body ingestion for several reasons, including poor gross and fine motor control, prolonged oral phase, oral and pharyngeal dysphagia, impaired protective mechanisms, and difficulty communicating. Four patients between the ages of 3 and 18 years old with developmental delay presented with nonspecific gastrointestinal and pulmonary symptoms. Foreign bodies along the upper gastrointestinal tract were identified as the cause of these symptoms, and all four patients improved after endoscopic retrieval. A high index of suspicion should be had even in the absence of findings on routine imaging. Once symptoms are displayed, clinicians should aim to endoscopically or surgically remove the foreign body, depending on the location along the gastrointestinal tract. (C) 2015 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (hDp://crealivecommons.onnlicenseDbynnnnd/4.0/).