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Battery swallowing: a growing childhood health hazard

Robin Wulffson MD's picture
battery swallowing, fatalities, button batteries, lithium batteries

According to a new study, the number of battery-related emergency department visits is on the rise. The researchers note that the number and rate of battery-related emergency department visits has nearly doubled between 1990 and 2009 (1990: 1,301; 2009:2,785). Most of the incidents involved small button-sized batteries. Of interest, most of these batteries were not used to power children’s toys.

Of cases in which the battery source was noted; the intended uses for the remainder were devices such as hearing aids, watches, calculators, flashlights, and remote controls. Investigators from the Center for Injury Research and Policy, the Research Institute at Nationwide Children's Hospital in Columbus, Ohio published their results online on May 14 in Pediatrics. It will appear in the June print edition of that journal.

The study was designed to investigate the number of battery-related emergency department visits among children less than 18 years of age in the US. The researchers reviewed a nationally representative sample from the National Electronic Injury Surveillance System and located battery-related emergency department visits from 1990 to 2009. They determined four battery exposure routes: ingestion (swallowing), mouth exposure, ear canal insertion, and nasal cavity insertion.

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The study authors unearthed an estimated 65,788 battery-related cases (54,498–77, 078) of patients less than 18 years of age during the 20-year study period; the average annual rate was 3,289 battery-related annual visits were 4.6 visits per 100,000 children. The number and rate of visits increased significantly during the study period; furthermore the largest increase occurred during the last eight years of the study period. The average age was 3.9 years; 60.2% of patients were boys. Most of the cases involved ingestion (76.6%); nasal cavity insertion accounted for 10.2%; mouth exposure accounted for 7.5%; and 5.7% were ear insertions. Most of the children were treated and released from the emergency department.

The researchers stressed the need for much greater preventive efforts by parents or other caregivers; they also recommended better childproof designs for battery compartments by manufacturers.

Take home message:
Although the authors recommended child-proof battery cases, children can be quite clever in opening these cases. The safest solution is to place all devices, such as remote controls, out of reach of children. Button batteries are particularly dangerous because they are small enough to be swallowed but large enough to lodge in the esophagus. Particularly dangerous button batteries are those that are 20 mm or more in diameter (i.e., the 3-V 20-mm lithium battery). Most batteries will pass through the gastrointestinal tract without injury; however, a battery that becomes lodged in a child's esophagus can give off electricity, which can kill nearby tissue within two hours. This can result in a perforation of the esophagus, which can be fatal. Usually, no symptoms arise just after the perforation and when they do, an appropriated diagnosis is often delayed.

A previous study published in the February 2010 issue of Pediatrics evaluated that issued. The researchers noted that the 20 mm lithium cell was implicated in most severe outcomes. They reported that severe burns occurred within 2 to 2.5 hours and most fatal (92%) or major outcome (56%) ingestions were not witnessed. They reported that at least 27% of major outcome and 54% of fatal cases were misdiagnosed, usually because of nonspecific presentations. Injuries often progressed after removal and included: unanticipated and delayed esophageal perforations, tracheoesophageal fistulas (an opening forming between the windpipe and esophagus), fistulization into major vessels, and massive hemorrhage.