BUTTON BATTERY INGESTIONS IN CHILDREN
There has been a rise in severe and even fatal injuries caused by button battery ingestion. Not only has the severity of injury evolved with time, but the frequency of button battery ingestions by children has also increased.
So far in 2021, we have had 10 admissions to the Alberta Children's Hospital for button battery ingestion.
Button batteries are small and shiny ranging in size from a pill to a quarter. A button battery or any battery in the body can cause life-threatening injury. Serious injury can occur when batteries are swallowed and become stuck in the esophagus (the food pipe or tube that connects the throat to the stomach) - damage to tissue inside the body begins to occur in as little as 15 minutes. The battery reacts with saliva and lets off an electrical current that burns tissue due to the production of hydrogen radicals and acidity. Even expired or "dead" batteries can cause caustic burning when ingested. Injury may be ongoing, even after removal of the button battery. Fatal hemorrhage has been reported up to 18 days after initial ingestion.
What to look for:
Battery ingestions are often not witnessed. Always consider the possibility of a battery ingestion in children where any airway obstruction occurs causing wheezing or other noisy breathing, drooling, vomiting, chest pain, throat pain, abdominal pain, difficulty swallowing, coughing, choking or gagging.
If battery ingestion is suspected:
If you suspect your child has swallowed a button battery, go to the nearest emergency department right away. Every minute counts.
Administer honey immediately and continue to do so while on route to the ER
Honey dosing: give 10mL (2 teaspoons) every 10 minutes (up to 6 doses)
Note: Although honey is not recommended to be given to children under 12 months of age, it is still encouraged as treatment for a suspected battery ingestion as the benefit outweighs any potential risk of botulism.
Do not delay going to the hospital to obtain honey. Honey is NOT a substitute for immediate removal of a battery lodged in the esophagus but can slow the development of battery injury from occurring.
Why give honey?
Honey is administered to coat the battery and prevent local generation of hydroxide, thereby delaying burns to adjacent tissues.
- Do NOT make the child vomit
- Do NOT let them eat or drink (other than honey)
- Do NOT give Ipecac (used to induce vomiting)
- Do NOT give laxatives
Once in the ER, battery position will be ruled out by x-ray. The physician may decide to allow batteries to pass spontaneously if they have already moved beyond the esophagus and into the stomach as long as there is no clinical indication of any gastrointestinal injury. In this case, the child may be sent home to manage on a regular diet. It is important for caregivers to continually re-evaluate for any signs or symptoms possibly related to the battery. Endoscopic removal of batteries still in the stomach should be pursued if/when any symptoms occur. For batteries beyond the reach of the endoscope, surgical battery removal may be required if there is any visible bleeding in stool, abdominal pain, profoundly decreased appetite, vomiting, and/or fever. Confirm battery passage by inspecting stools.
Insertion into the ear or nose also require immediate medical attention.
Common household items containing button batteries
• key fobs • flashing shoes, clothing • hearing aids • remote controls • musical greeting cards • thermometers • toys, games, talking books • candles, tea light candles • bathroom scales • watches • decorations, ornaments • calculators • flashing jewelry • medical equipment, meters • cameras
Staying safe
Check every battery-powered device in and around your home and anywhere your children stay or play. Make sure that the battery cases are shut tight and secured. It is best to use devices that can only be opened using a tool, such as a screwdriver. Re-check all battery cases to be sure they stay secure over time. Do not let small children play with things that might use button batteries. If that is not possible, watch them carefully while they are playing with things that use batteries. Store all loose batteries in a locked cabinet or box, out of reach or sight of children.
Thanks for taking a moment to check out the blog. As always, we hope you found the content to be informative.
Cochrane Emergency Training Services,
Chelsea & Alex
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The content in the blog is based on up to date research, however it should be considered a matter of opinion . Views expressed should not be taken as medical advice or deter you from seeking medical care for acute and/or chronic injuries.
@cets.firstaid
Call the National Battery Ingestion Hotline at 800-498-8666 with any questions.
References:
Emerging battery-ingestion hazard: Clinical implications. Marsolek M. Pediatrics. 2010;125(6):1168-1177
Foreign-body ingestions of young children treated in US emergency departments: 1995–2015. OrsaghYentis D, McAdams RJ, Roberts KJ, McKenzie LB. Pediatrics. 2019;143(5)
Management of ingested foreign bodies in children: A clinical report of the NASPGHAN endoscopy committee. Kramer RE, Lerner DG, Lin T, et al. J Pediatr Gastroenterol Nutr. 2015;60(4):562-574
Management of button battery-induced hemorrhage in children. Brumbaugh DE, Colson SB, Sandoval JA, et al. J Pediatr Gastroenterol Nutr. 2011;52(5):585-589
Children’s Hospital Colorado Treatment of Button Battery Ingestion. Published 2018. Accessed May 18, 2020.
Pediatric button battery injuries: 2013 task force update. Jatana KR, Litovitz T, Reilly JS, Koltai PJ, Rider G, Jacobs IN. Int J Pediatr Otorhinolaryngol. 2013;77(9):1392-1399
Emergent treatment of button batteries in the esophagus: Evolution of management and need for close second-look esophagoscopy. Ruhl DS, Cable BB, Rieth KKS. Ann Otol Rhinol Laryngol. 2014;123(3):206-213
Litovitz T, Whitaker N, Clark L, White NC, Marsolek M: Emerging battery ingestion hazard: Clinical implications. Pediatrics 2010;125(6): 1168-1177. epub 24 May 2010.
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):1276-1282.
Anfang RR, Jatana KR, Linn RL, Roades K, Fry J, Jacobs IN: pH-neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury. Laryngoscope. 2018 Jun 11; Epub ahead of print.