American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Harmful if Swallowed: The Persistent Danger of Button Batteries and Small Magnets

OCTOBER 29, 2019
Clinical Congress Daily Highlights, Tuesday First Edition


People, especially children, are known to swallow all sorts of foreign objects. In most cases the toys, toy parts and coins they typically ingest present no real threat to their health.

But there are two types of objects that present a special danger to those who swallow them – magnets and button batteries, according to the panelists on “Button Batteries and Magnets: Ingestion of Foreign Bodies.” These particular foreign objects can do significant damage to internal organs and may lead to death. Deborah Billmire, MD, FACS from Riley Children’s Hospital, and Ian Jacobs, MD, FACS from Children’s Hospital of Philadelphia moderated this specialty panel session.

Small powerful magnets are sold as toys, stress relievers, healing devices, weight loss devices, and jewelry, said Elizabeth A. Beierle, MD, FACS, University of Alabama, Birmingham. They are sometimes sold in sets and used in puzzles or to create sculptures. If one magnet is swallowed, the typical approach is to let it pass through the digestive system. But if two or more magnets are swallowed, they attract each other internally, even though they may be in different parts of the anatomy. This property can cause real damage to a child’s stomach and intestines. Two or more swallowed magnets must be surgically removed, preferably the sooner the better.

“If there is a high suspicion that it is not a single magnet that has been swallowed, there should be prompt attention to remove it,” she said.

Although the U.S. Consumer Product Safety Commission has restricted sales of these types of magnets, they are still readily available through the internet, Dr. Beierle noted.

Meanwhile, button batteries, especially lithium batteries, can quickly have a toxic effect on surrounding tissue. This is especially the case if they are swallowed by children, who are more likely to get small objects lodged in the upper esophagus. The batteries react quickly with saliva, discharging a current that hydrolyzes water and generates hydroxide, creating caustic injury. Damage can begin after just 20 minutes, and significant damage can develop within two hours, said Kris R. Jatana, MD, FACS, Nationwide Children’s Hospital, Columbus, OH. There are an estimated 3,000 button battery ingestions per year, according to Dr. Jatana.

If it is not known whether or not a child swallowed a button battery, diagnosis can be challenging. The initial symptoms present as respiratory issues. On X-ray, button batteries often look very much like coins, which are a far lesser threat to a child’s health, said Robert T. Russell, MD, MPH, FACS, Children’s of Alabama, Birmingham. Typically, however, a close examination of the X ray can reveal whether or not it is a battery, he said. For example, batteries typically appear with a double side or a halo.

Complications from button batteries that become lodged in the esophagus can quickly escalate to include strictures, perforations, vocal cord paralysis, spondylodiscitis, tracheoesophageal fistulas, and aortoesophageal fistulas, Dr. Jatana said.

Since it is critical to respond quickly to a button battery ingestion, new protocols have been developed to triage these cases to Level I pediatric trauma centers, where a surgical team is expected to be ready to respond within 15 minutes of learning about an incident, Dr. Russell said.

There are ways to mitigate the damage until surgery is available. One way to reduce the battery injury rate is to have the patient ingest honey or sucralfate, Dr. Jatana said.

“We tested about 30 substances, and honey worked the best,” he said. Honey has the additional advantage of being readily available in most households.

Even after the battery or batteries have been removed, damage can continue to occur. That damage can be minimized by irrigating the injured esophagus with a solution of 0.25 percent acetic acid, according to a 2019 study led by Dr. Jatana.

What can be done to reduce or prevent button battery ingestion?

One small company has come up with a way to make batteries that deactivate when immersed in water (such as when they are swallowed).

“It deactivates within 10 minutes,” said Melissa Fensterstock, MBA, MPhil, co-founder and chief executive of Landsdowne Labs. The product, called ChildLok, would cost battery companies less than a penny per battery to add to their production processes.

The product is going through some final testing, and it could be introduced – either on its own or through a partnership with a battery company – in a year or two, Ms. Fensterstock said.

Dr. Jacobs noted that the introduction of the product could result in a dramatic reduction in injuries from ingested button batteries.

In addition, a new non-profit organization called the Global Injury Research Collaborative (GIRC, www.globalirc.org), has developed a free smartphone app that surgeons can use to anonymously and efficiently report incidents when children aspirate or swallow foreign objects to a central data source. This new resource of worldwide data can help drive injury prevention efforts.

“When we go to industry about a hazard, we have been met with some resistance about the currently available data,” said Keith Rhoades of GIRC. “Based on a recent survey among nearly 400 pediatric surgeons, otolaryngologists, and gastroenterologists, foreign body injuries are infrequently reported. The GIRC has created an app based platform for medical professionals to quickly report relevant injury data.”


Additional Information:
The Panel Session, Button Batteries and Magnets: Ingestion of Foreign Bodies, was held Tuesday, October 29 at the American College of Surgeons Clinical Congress 2019 in San Francisco (program, webcast and audio information).