Young children explore the world using all of their senses. As a pediatric otolaryngologist, I see children who inhale or swallow all kinds of things, including coins, peanuts and small plastic toys. Add button batteries to the list, and seek help immediately if a child swallows one.
Button batteries are small, flat and round, and typically 5 to 25 millimeters in diameter. They have become ubiquitous due to their usefulness in powering small devices—everything from remote controls to toys and greeting cards. In the last 15 years, the number of injuries from ingested button batteries has increased ninefold.
Some of these batteries are small enough to fit in and damage little noses and ears. Children under 6 are at the highest risk, with most major injuries reported in children under 4. In all cases, button battery inhalation and ingestion are medical emergencies that require immediate attention.
Button batteries that are smaller than 15 millimeters in size often pass through the digestive tract with little to no injury. There are several types of button batteries, including alkaline and lithium.
The most dangerous button batteries are lithium and more than 20 millimeters—between a penny and a nickel—in diameter. Lithium batteries can be identified on an X-ray by the characteristic “double ring” that shows the small beveled indentation around the edge of the battery.
This means that ingested lithium button batteries cause a high voltage electrochemical “burn” wherever they are lodged. The areas that are affected can disintegrate or scar, depending on the charge of the battery and the length of exposure. Time is of the essence.
Recognize the symptoms
A child may swallow a button battery without anyone witnessing the event. Seek medical attention immediately if you notice acute onset of the following:
- Airway obstruction or wheezing
- Chest discomfort
- Difficulty swallowing, decreased appetite, refusal to eat
- Coughing, choking or gagging with eating or drinking
Extracting a button battery
Call 911 if you suspect a child has swallowed a button battery or placed one in another orifice, such as the nose or ear. The emergency responders will divert you to a hospital nearby and alert the appropriate physicians.
The first step is usually an X-ray to assess the location of the battery. If the battery is in the child’s stomach or beyond, it may be left to pass. Otherwise, the sooner the battery is removed, the better.
The window of opportunity for injury-free removal of a fully charged, new lithium battery is under two hours. This procedure should be performed under general anesthesia by a skilled endoscopist. The endoscopist will assess any damage and stabilize the child’s airway. The child may need a temporary feeding tube while the esophagus heals.
Recovery can be complicated
The full extent of injury may not be apparent for one to three weeks. When damage is seen during the initial endoscopy, the child has a high risk for stricture, or narrowing, of the esophagus. Multiple endoscopies and/or dilations may be required. Severe complications have been reported as late as 18 days after removal of a button battery.
If a child swallows a lithium button battery and it goes undetected, the battery could cause a perforation or hole in the esophagus, create a scar tract that connects the esophagus to the trachea, and/or injure nerves that power the vocal cords. The most severe injuries may cause part of the esophagus to disintegrate, posing the risk of significant bleeding and death. When a button battery ingestion causes injury, a physician will need to closely monitor the child during healing.
Keep children safe
Adults can take these steps to prevent children from being hurt by button batteries:
- Check your toys and devices. Know which ones have button batteries.
- Keep devices that have button batteries in safe locations and/or make sure the battery cases are closed and not easily opened by little fingers.
- Dispose of used batteries properly. While depleted batteries pose less of a risk, a residual charge may still cause harm.
- Act quickly if a child does swallow a battery. Call 911 immediately or get the child to an emergency room as quickly as possible.
My rabbi was rewarding children for good performance at synagogue with light-up toy dentures powered by button batteries! Needless to say, he was mortified when he found out about the danger these batteries pose.
The bottom line is that most people are unaware of the harm that can be caused by swallowing a button battery. I encourage parents to tactfully educate others and spread the word!
Working toward prevention
The Button Battery Task Force is a collaborative effort of representatives from industry, medicine, public health and government working to develop and implement strategies to reduce button battery ingestion injuries in children.
Researchers at MIT have developed a protective coating for button batteries that insulates at low pressures such as the pressure inside the esophagus, but will conduct electricity at the higher pressures found inside the devices they are intended to power. This was effective at protecting the esophagus from harm when tested on animals.
About the author
Jonathan Kopelovich is a fellowship-trained pediatric otolaryngologist, former preschool teacher, father of three and big fan of MIT research.
Emerging battery-ingestion hazard: clinical implications. Litovitz T et al. Pediatrics. 2010 Jun