Introduction: Foreign bodies (FBs) are common in young children aged 3 months to 6 years, and FBs in the esophagus can present with a wide variety of symptoms. We present an extremely rare case of chronic open safety pin (SP) in an 8-month-old child who was asymptomatic for 8 weeks and then presented with cough and neck spasms. Case history: An 8-month-old baby girl presented to us referred from a pediatrician with an incidental finding of open SP in the esophagus when a chest X-ray was performed to diagnose nonresponding cough. Patient had constant neck deviation towards right side without any other symptoms for 8 weeks, when X-ray diagnosed the FB. Flexible and rigid endoscopical removal were unsuccessful since the sharp end of the pin was buried in the luminal wall with granulation tissue surrounding it. Open neck exploration with esophagostomy and extraction of the SP under general anesthesia had to be done. The child is now asymptomatic with normal neck posture postprocedure. Conclusion: Open SP can have delayed presentation, and a high index of suspicion is required to diagnose the presence of an FB. Chronic FBs can penetrate the luminal wall of the esophagus resulting in granulation tissue, and this further leads to fixation of the FB making it extremely difficult to remove endoscopically. We advocate open neck exploration and esophagostomy for safe removal of chronic sharp FB like open SP.