OBJECTIVE: Is a watch and wait approach safe in asymptomatic patients presenting to the emergency department with a confirmed oesophageal coin on x-ray? METHODS: A retrospective case note review for children <16 years attending with a confirmed oesophageal coin on x-ray over a 7-year period (1 January 2004 to 31 December 2010). RESULTS: 89% (33/37) of coins in asymptomatic patients, who were conservatively managed, had passed spontaneously on repeat chest x-ray up to 18 h later. No patient who was discharged with a middle or lower oesophageal coin required a GA and no child who was treated conservatively developed any complications. CONCLUSION: In the UK asymptomatic children, with no history of tracheal or oesophageal disease and a confirmed oesophageal coin on x-ray should undergo a period of observation up to 18 h. This can be safely undertaken at home, followed by a repeat x-ray in the emergency department.