Introduction: Over 100,000 cases of foreign body ingestions are reported each year in the U.S; 80% occur in children between the ages of 6 months and 3 years, and 98% of foreign body ingestions in children are accidental. Serial intentional foreign body ingestions are more prevalent in adults due to underlying psychiatric disorders, mental retardation, alcohol ingestion, or in prisoners seeking secondary gain (i.e., transfer to medical facility). We present a case of a 16-year-old female who started serial intentional foreign body ingestions at the age of 10. We describe the nature of progressive escalation and innovation of foreign bodies ingested. Case: The patient is a 16-year-old female with a history of depression, bipolar disorder, and posttraumatic stress disorder who presented with recurrent sel-mutilation behaviors and foreign body ingestions since 10 years of age. Despite being in a highly monitored inpatient psychiatric facility, she has continued to ingest foreign bodies intentionally for secondary gain. The patient self reports her ingestions so she can be transferred to a “safer” hospital. She initially started swallowing smaller, blunt objects such as coins, EKG leads, and AA batteries. Some of these objects were allowed to pass spontaneously and required no intervention. In order to meet urgent endoscopic criteria for foreign body removal, she quickly learned to start swallowing a variety of innovative long, sharp, and large foreign bodies such as sharpened coloring pencils (10 cm), pencils (6-10 cm), sharp razor blades (3 cm), broken CD pieces, sharp metal nails taken off walls, plastic spoons (6 cm), and broken toothbrush to create sharp edges (6 cm). Recently, she has learned to break and ingest sharp and long pieces of wood from a bookshelf. She has undergone 15 endoscopies in the past 4 months for foreign body retrieval. Thus far, patient has not required surgical intervention and survived with minimal morbidity. (Images to be included in presentation.) Discussion: Despite having complete supervision in an inpatient psychiatric facility, our 16-yearold enterprising pediatric patient started escalating foreign body ingestion patterns starting at 10 years of age and identified new techniques for ingesting longer, larger, and sharper foreign bodies, which are associated with higher complications rates. Although ingestions are usually accidental in the pediatric population, we describe a child who started ingesting foreign bodies intentionally, similar to adult patients. Pediatric and adult gastroenterologists caring for pediatric patients need to be aware of this behavior, as well as the endoscopic techniques for removal of intentionally ingested sharp foreign bodies.