There have been cases where swallowing gum has resulted in complications in young children requiring medical attention. A 1998 paper describes a four-year-old boy being referred with a two-year history of constipation. The boy was found to have "always swallowed his gum after chewing five to seven pieces each day", being given the gum as a reward for good behavior, and the build-up resulted in a solid mass which could not leave the body. A 1½-year-old girl required medical attention when she swallowed her gum and four coins, which got stuck together in her esophagus. A bezoar is formed in the stomach when food or other foreign objects stick to gum and build up, causing intestinal blockage. As long as the mass of gum is small enough to pass out of the stomach, it will likely pass out of the body easily, but it is recommended that gum not be swallowed or given to young children who do not understand not to swallow it.