Foreign bodies being forced into the esophagus as a form of fatal child abuse is rare. A 4.5-month-old female infant presented to clinicians with respiratory distress. Several coins were recovered from the esophagus. One month later, she was found dead in her crib. At autopsy, there were three coins in the esophagus. In addition, there were cutaneous contusions of various ages, acute and partially healed fractures of the extremities, old aspirated foreign material in the lungs, and pulmonary fat emboli. Although the fat emboli may have contributed to the death, several potentially fatal mechanisms from the esophageal foreign bodies deserve consideration. These include vagal stimulation from esophageal distention, aspiration of swallowed fluids after esophageal obstruction, compression of the trachea or the heart by the coins, and cardiac compression or airway occlusion by the introducing finger.