five facts to know about button battery ingestions in children

AUTHOR Yasmine Madan, Nikolaus E Wolter

Button batteries ingestions are a growing problem

There have been more button battery (BB) ingestions in Ontario last year than ever before. This is a world wide trend.1,2,3 BBs are found in many household electronics, including TV remotes, key fobs, and children’s toys When ingested by a child, they can cause serious injury or death. When a BB gets lodged in a child’s esophagus, the saliva triggers a current flow, leading to a chemical reaction that burns the tissue.4

Injury can continue to occur even after surgical removal of the BB

The burning process starts in 15 minutes and severe injury can occur in as little as two hours 4 Rapid removal is key to avoiding serious injury, but burning can continue to occur after surgical removal of the BB.5 Children can develop severe complications, such as swallowing problems due to scarring, and holes in the esophagus that can be deadly, even weeks after removal.5 Thus, it is important to remain vigilant for symptoms even after a child’s BB has been removed with no immediate harm.

The symptoms of a BB ingestion are vague; thus, they are a diagnostic challenge

The majority of BBs are obtained directly from the devices or found loose in the home. Most BB ingestions are unwitnessed,6 and the symptoms can resemble common viral illnesses 7 Because of this, they are a diagnostic challenge, and are often initially misdiagnosed.8 Esophageal BBs are diagnosed by a chest x-ray Thus, it is imperative to inform emergency staff about a suspected BB ingestion.

Honey should be given to a child who swallowed a BB less than 12 hours ago

Children with a suspected BB ingestion should be brought to the hospital as soon as possible If honey is available, it can be given to children over the age of one.5 Honey reduces burns by creating a physical barrier between the BB and esophageal tissue 8 The recommended dose is two teaspoons every ten minutes if the child swallowed the BB less than 12 hours ago (up to six doses) 5

A ‘dead’ BB can still cause injury

‘Dead’ or ‘spent’ BBs may still have enough energy to create a current flow in a child’s esophagus, and thus can still cause injury. The correct way to dispose of BBs is to bring them to a local battery recycling facility Recent studies show that wrapping BBs in packing tape or duct tape completely inhibits current flow and may prevent injury 9

References

1 Button Battery Ingestion Statistics Washington (DC): National Capital Poison Center Available from: www poison org/battery/ stats

2. Bucci C, Caruso F, Quitadamo P, Tipo V, Martemucci L, Marmo R Covid‐19 Lockdown led to fewer ingestion cases but a higher percentage of more serious cases needed hospitalisation Acta Paediatrica 2021;110(4):1293–4. Available from: doi:10 1111/apa 15748

3 Festa NT, Thakkar H, Hewitt R, Dhaiban M, Muthialu N, Cross K, et al. Foreign body ingestion during the COVID-19 pandemic: A retrospective single centre review BMJ Paediatrics Open 2021;5(1) Available from: doi:10 1136/bmjpo-2021-001042

4 Jatana KR, Rhoades K, Milkovich S, Jacobs IN Basic mechanism of button battery ingestion injuries and novel mitigation strategies after diagnosis and removal. Laryngoscope 2017;127(6):1276-82 Available from: doi:10 1002/lary 26362

5. Mubarak A, Benninga MA, Broekaert I, et al. Diagnosis, management, and prevention of button battery ingestion in childhood: a European Society for Paediatric Gastroenterology Hepatology and Nutrition position paper J Pediatr Gastroenterol Nutr 2021;73:129-36 Available from: doi: 10 1097/ MPG 0000000000003048

6. Litovitz T, Whitaker N, Clark L, White NC, Marsolek M Emerging battery-ingestion hazard: clinical implications Pediatrics 2010;125(6): 1168-77. Available from: doi:10 1542/peds 2009-3037

7 Buttazzoni E, Gregori D, Paoli B, Soriani N, Baldas S, Rodriguez H, et al Symptoms associated with button batteries injuries in children: an epidemiological review Int J Pediatr Otorhinolaryngol 2015;79(12):2200-07 Available from: doi:10 1016/ j.ijporl.2015.10.003.

8. Anfang RR, Jatana KR, Linn RL, Rhoades K, Fry J, Jacobs IN pH-neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury Laryngoscope 2019;129(1):49-57 Available from: doi:10 1002/ lary 27312

9 Wolter NE, Wolter JK, James AL, Ostrow O, McKinnon NK, Everett T, et al Button battery taping prevents oesophageal injury Journal of Paediatrics and Child Health 2022;58(8):1337–44. Available from: doi:10.1111/jpc.15978.