With the increasing production of electronic products in the consumer market, more button batteries are found in the home setting. From remote controls and watches to musical greeting cards and toys, these small, shiny objects are the perfect size for a curious child to swallow or even push into their nasal cavity or ear canal. It is important for parents to be aware of the dangers that button batteries pose to young children and the damage they can cause.
The incidence of button battery ingestion is rising. Between 2007 and 2009, more than 3,400 cases were reported annually to U.S. poison centers. The clinical challenge for physicians who may evaluate children who ingest button batteries is that they can be asymptomatic or present with non-specific symptoms such as irritability, fever, cough, poor oral intake and/or vomiting similar to those of a common viral infection. This can lead to a delayed diagnosis and more severe injury.
"The clock is ticking when a button battery is placed in the body," said Kris Jatana, MD, a pediatric head and neck surgeon at Nationwide Children's Hospital. "In as little as two hours, button batteries can cause severe injury."
Button batteries are dangerous in the hands of a child. The smaller batteries, such as those found in hearing aids, typically will pass through the gastrointestinal system; but the larger batteries can get stuck, causing the most significant injury when swallowed by young children. Complications from ingestion may include erosion through the esophageal wall or into the adjacent airway, damage to the nearby nerves that supply the vocal cords, or erosion into a major blood vessel, such as the aorta, which is always fatal.
"I have seen many otherwise healthy children suffer serious injury from button batteries," said Dr. Jatana, assistant professor of otolaryngology-head and neck surgery at the Ohio State University College of Medicine. "While educating parents about the dangers of these batteries is important, it is equally important for physicians to be aware of the increasing frequency of button battery ingestions when evaluating children in the primary care or emergency room setting. An X-ray can be done to confirm the diagnosis."
If a child is suspected of swallowing or pushing a button battery into their nasal cavity or ear canal, the child needs to be taken to an emergency room immediately. The diagnosis can be confirmed by a two-view X-ray, which from a distance may be mistaken for a commonly ingested foreign body in children - a coin. The key to differentiating a button battery from a coin is to magnify or zoom into the image to look for the double ring or halo seen around the battery. In addition, the side-view X-ray often can reveal a small step-off or notch with most batteries.
"Identifying a metallic foreign body as a button battery is critical, as the battery creates an electrical current around the outside of the battery generating hydroxide, an alkaline chemical, causing the rapid tissue injury," said Dr. Jatana.
The treatment for a button battery lodged within the body is emergent removal. When swallowed, these batteries can get lodged in the esophagus, which requires general anesthesia for removal in an operating room. When pushed into the ear canal or nasal cavity, the removal usually can take place in an emergency room setting.
After Dr. Jatana and a panel of experts from across the country made a presentation on the hazards of button batteries to the U.S. Consumer Product Safety Commission (CPSC) earlier this year, the commission released a public warning statement emphasizing their dangers to consumers. U.S. Sens. John Rockefeller and Mark Pryor have introduced legislation called the Button Cell Battery Safety Act of 2011. If the legislation passes through Congress, the CPSC would be able to regulate electronic devices that contain these batteries to make them safer for children.
"The initiation of this legislative process shows the true commitment of members of U.S. Congress and the CPSC to the safety of children," said Dr. Jatana. "Parents need to be aware of this potential household risk to ensure that button batteries and any electronic devices that do not contain them in a properly secured compartment are kept out of the reach of young children."