The number of button battery ingestions resulting in severe injury or death has increased dramatically over the past thirty years. Rapid diagnosis and treatment are critical in preventing extensive injury, and close follow-up is required as delayed complications can occur weeks to months after button battery removal.
Within the pediatric population, the swallowing of foreign bodies is a commonly encountered situation, particularly in those children aged 0 – 5 years. While the ingestion of many foreign bodies can be managed on a non-emergent basis, the ingestion of button batteries results in rapid and often catastrophic injuries. From 1985 – 2009, a 6.7-fold increase in the percentage of button battery ingestion with severe and fatal outcomes has been reported, with outcomes notably worse in children younger than 4 years old. Button batteries are ubiquitous, and their ingestion has become an increasingly encountered emergency associated with the increasing use of 3V 20-mm Lithium button batteries. Recent legislation now requires that toys have a compartment with a screw to contain button batteries, however, button batteries are also found in many less secure household items. 36.2% of reported cases of 20 mm lithium battery ingestions were from remote control devices, with a significant percentage of batteries also intended for watches and stopwatches, flameless candles, bathroom and kitchen scales, key fobs, and singing greeting cards. While batteries less than 15 – 18 mm in diameter generally pass through the esophagus and rarely require removal, the large size of the 20 mm batteries results in a propensity to become lodged within the esophagus, and the increased power results in more severe injuries. In fact, 94% of severe injuries or fatalities related to battery ingestion involved batteries greater than 20 mm in diameter.
Button batteries produce injury by three mechanisms: (1) the generation of an external electrolyte current resulting in electrolysis of tissue fluids and the generation of hydroxides at the battery’s negative pole, (2) leakage of alkaline fluid, and (3) pressure necrosis. The generation of current is the primary mechanism by which button batteries cause injury. This mechanism is particularly important in the case of 20 mm lithium batteries, as these batteries do not contain an alkaline electrolyte and generate twice the current. These injuries occur rapidly, within two hours of ingestion, and are serious or fatal in up to 13% of cases.
Foreign body ingestions are often unwitnessed, and the symptoms of button battery ingestion are often nonspecific. They include cough, fever, decreased oral intake, difficulty swallowing, sore throat, and vomiting. These nonspecific complaints often result in a delayed diagnosis and further injury. X-ray imaging is essential in diagnosing button battery ingestion.
Current National Battery Ingestion Hotline (NBIH) guidelines focus on a 2-hour window during which diagnosis and removal should be performed to minimize esophageal damage. Given the nonspecific nature of presenting complaints, it is imperative that health professionals maintain a high index of suspicion for button battery ingestion. Once the diagnosis is made, rapid removal of the battery within 2 hours results in the best outcome for patients and should not be delayed for any reason. Delayed complications occur often after removal of button batteries, sometimes presenting days to weeks after the initial insult. Therefore, close observation and follow-up after removal of a button battery is recommended.
So, the question remains: what can we, as parents, do to protect our children? Be aware. Be vigilant. Try to remove unnecessary items from your child’s environment that contain button batteries. Make sure that toys with button batteries utilize the required safety measures to avoid ingestion. And hide all spare button batteries in a place you are certain your children can never find. If you have the slightest suspicion that your child has ingested a button battery, treat it as a life-threatening emergency and have your child evaluated immediately. With increased awareness and prevention, we can hope to keep our children safe and avoid the often-devastating consequences of button battery ingestion.