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Button Batteries Pose Serious Danger for Children, Elderly


There has been an increase in the use of “button” style lithium cell batteries in recent years, which are used in many household productions including remote controls, flashlights, watches, hearing aids, cameras, children’s toys and books, and musical greeting cards. There has also been a significant increase in the number of battery ingestions, particularly among children.

New research published in the June issue of the journal Pediatrics has found that between 1985 and 2009, there has been a 6.7-fold increase in the percentage of battery ingestions, including 13 deaths involving button batteries that become lodged in the esophagus. Certain battery types, especially the 20-millimeter lithium cell battery, can also cause serious injury if not promptly removed, such as tissue tears, burning, and internal bleeding, because they continue to generate an external current, even when weakened.

Toby Litovitz, MD, from the National Capital Poison Center and department of emergency medicine at Georgetown University School of Medicine, analyzed data from three sources: The National Poison Data System, the National Battery Ingestion Hotline, and the medical literature. Age was a significant predictor of severity of complications. Children younger than 6 years old were involved in 62.5% of the button cell ingestions and 85% of the major effects occurred in children younger than 4.

Litovitz also looked at how children and adults obtained the batteries and found that ingested batteries were removed directly from the household products about 62% of the time. The batteries were loose 29% of the time. More than 37% of the 20-millimeter lithium batteries ingested came from remote controls.

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Children are not the only ones affected. About 36% of the ingested batteries were from hearing aids. In older adults, the batteries were mistaken for pills.

Health care providers missed diagnosis in seven of the 13 deaths because of non-specific symptoms, including vomiting, fever, lethargy, poor appetite, irritability, cough, wheezing, and/or dehydration. (In the majority of cases, no one has seen the person swallow the battery.) The batteries were in the esophagus for 10 hours to two weeks before removal or death. The researchers propose guidelines for physicians that will state the critical period for removing batteries is within two hours of ingestion.

"We're talking about a really profoundly devastating injury, and sometimes fatalities," said Dr. Litovitz. "But I think people are not aware of the problem, which is very, very much worse than swallowing a coin. And of course it's hard for parents to protect their kids when they don't realize that something is a problem."

The researchers are asking manufacturers to create better design and child-resistant measures to secure the battery compartment on everyday household products. They also request improved industry standards that would require warning labels to help reduce the incidence of battery ingestion and better guidelines for physicians.

Parents and care givers are strongly encouraged to use extra caution with all batteries, but particularly the small 20-mm lithium cell batteries, which can be recognized by their imprint codes – usually CR2032, CR2025 or CR2016. Store the batteries out of reach and discard them safely when they are used. Place tape around non-secured battery compartments or place the object out of reach.