The aim of this study was to determine the incidence and risk factors for esophageal foreign body obstruction (EFBO) after esophageal atresia/tracheoesophageal fistula (EA-TEF) repair.A Case-control chart review was conducted from 1987 to 1999.EFBO occurred in 14 of 108 patients (13%) with EA-TEF. Mean follow-up was 31 months. Alimentary debris was the most common foreign body. Mean time between operation and EFBO was 25 months. EFBO recurred in 50%. Sixty-one percent of patients required endoscopic FB removal. Esophageal stenosis was present in 57% of EFBO patients, and 80% of stenoses presented initially with EFBO. The incidence of gastroesophageal reflux (GER; 50%), type C anomaly (100%), anastomotic leak (21%), major associated anomalies (50%), and encephalopathy (14%) were not significantly different between the EFBO group and the total EA-TEF population. There was no difference in the need for antireflux surgery (57%) between those with EFBO and GER and the total EA/TEF population with GER.Esophageal foreign body obstruction occurs in at least 13% of patients after EA-TEF repair. Because no reliable risk factors were identified that could predict foreign body obstruction, all families should be warned about this possibility during the first 5 years, particularly once the child begins eating solid foods.