The Journal of Pediatrics Volume 164, Issue 1 , Pages 4-5.e1, January 2014
Advocating for Child Health: How the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Took Action against High-Powered Magnets
Athos Bousvaros, MD, MPH , Camille Bonta, MHS , Mark Gilger, MD , R. Adam Noel, MD
Sometimes, events take you in a direction you were not expecting. In 2012, this was the case for members of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN), which is composed primarily of pediatric gastroenterologists and gastroenterology nurses. The society's primary roles in the past have included developing practice guidelines, planning educational programs such as our annual meeting, managing The Journal of Pediatric Gastroenterology and Nutrition, and awarding research grants through the NASPGHAN Foundation to promising fellows and junior faculty. Establishing visibility through government advocacy also has been an important goal of NASPGHAN. We had previously talked with Congressional leaders about making medical foods more accessible for children with chronic medical conditions, but did not have any other “high priority” issues. In April 2012, Dr Adam Noel, a pediatric gastroenterologist in New Orleans, was caring for a 2-yearold child in the intensive care unit who had swallowed a group of high powered neodynium magnets. These magnets pinched several loops of bowel together, causing bowel ischemia, necrosis, and resulted in the development of short bowel syndrome. Noel had heard of similar magnet ingestion cases elsewhere, including a case publicized in the Washington Post, 1 but he did not know how common this problem was. Noel posted a query about magnet ingestions on NASPGHAN's pediatric gastroenterology e-mail listserver (a bulletin board subscribed to by more than 2000 pediatric gastroenterologists worldwide). Within a few days, more than 50 pediatric gastroenterologists reported cases from across the country, with many children needing surgery. The vast majority of cases had occurred within the last year. We had identified a major ingestion hazard that was increasing with alarming speed. Why do these magnets pose such a unique risk to children? First, these magnets are quite innocent-appearing. They are small, round, shiny, 2-3 mm in size, and about the size of a ball bearing. Second, neodymium magnets are incredibly powerful, and if 2 or more such magnets are ingested, they can attract 2 different bowel loops within the abdomen from centimeters away. Lastly, the injury caused by such magnets is difficult to detect. If two magnets attract through the intestine, a child can be completely asymptomatic until the intestinal wall ulcerates and perforates, leading to peritonitis. Thus, even though a known ingestion is amenable to endoscopic magnet retrieval by the gastroenterologist, an unknown ingestion (as is the case with many toddlers) will present with peritonitis and require a surgical approach. Why did these magnet ingestions have such a dramatic rise in prevalence in the past year? Simply put, these magnets were quite popular, marketed aggressively, and were for sale in many major retailers across North America. Although the US Consumer Product Safety