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Children's Health & Safety Association

Issue 43: July 2018

Wednesday, 30 October 2013 11:11

Increased Emergency Hospital Visits Due to Button Batteries

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October 12, 2013 - Toddlers are not only curious but very determined and extremely smart. It would be a mistake to underestimate the eager and tenacious intent of those eight little fingers and two strong thumbs.

A 2012 U.S. study published in 'Pediatrics' stated that children aged five and under account for more than 75% of all battery related hospital visits. These coin-sized button batteries that can be found in watches, cameras, TV remotes, games, digital thermometers, calculators, greeting cards, hearing aids, toys, flashlights, car keys and other remote control devices, can cause a considerable amount of damage in less than two hours if they are lodged in a child's aesophagus.

Coin-sized lithium batteries were the leading cause for children in emergency departments across Australia last summer according to the latest statistics from the Australian Competition and Consumer Commission.

The Hospital for Sick Children removed four button batteries from children between 2001 and 2006, but the US statistics are another story altogether. There were nearly 66,000 battery related hospital visits by children under the age of 18 between 1990 and 2009, and the annual number just doubled from 2,591 to 5,525.

The toddler's symptoms were 'very nondescript'.   

"She was drooling a little and had a bit of a cough but the next day and the day after that, the child was having more and more difficulty swallowing, and in fact she wasn't swallowing anything, not drinking and not eating," said Dr. Campisi.

Dr. Gary Smith, Director of the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio stated that some of the newer batteries like a 3-Volt 20 mm lithium battery can spark a microcurrent, which will lead to cell death and eventually burn a hole right through the esophagus which will lead to long term scarring and stricture, and in some cases, where it eroded right into the aorta, the child bled to death. "These are horrific, horrific outcomes that need to be prevented," Dr. Gary Smith added.

If ingestion is suspected it is vitally important to have an x-ray taken immediately. If left undetected, the button battery can cause death. Dr. Paolo Campisi, an Ear, Nose and Throat Surgeon at Sick Children's Hospital in Toronto, stated, "Even if they're spent, even if they're used up, they are still dangerous." "The problem is that they leak an alkaline solution, which is kind of the opposite of acid, but it's more dangerous than acid because what it does, is it starts to erode and it keeps going. It doesn't stop."

Dr. Campisi earlier this year had to perform emergency surgery on a two-year old Ontario toddler who swallowed a nickel-sized button battery that stuck to the wall of her aesophagus and began eating away tissue. The toddler's symptoms were 'very nondescript'. "She was drooling a little and had a bit of a cough," said Dr. Campisi. Thinking the child was developing a cold, the doctor advised the family to give her acetaminophen and bed rest. "But the next day and the day after that, the child was having more and more difficulty swallowing, and in fact she wasn't swallowing anything, not drinking and not eating."

emergency-image006If the button battery is not detected and removed, a hole will eventually develop through the aesophagus, which is in the middle of the chest where the heart, lungs, and all the major blood vessels are located. Dr. Campisi adds that it's not just the swallowing of the battery that can cause such damage because toddlers have been known to place them in their ears and nose as well - places where warm, moist conditions encourage corrosion. What adds to the complication of these small button batteries is that not all doctors are trained to recognize a button battery on an x-ray even though it is detectable because it is surrounded by a telltale 'halo' (to view image click on halo and scroll down to page 5). Too often, the button battery is misdiagnosed for a coin that they assume will eventually pass harmlessly through the child's digestive system.

Dr. Alok Sharma, a clinical fellow in otolaryngology at Sick Children's Hospital performed a simple test to determine how quickly button batteries corrode. He placed a battery in a small amount of water and then measured the pH level of the solution. "There was an exponential increase," Dr. Sharma said, "so that within a half an hour it was already at dangerous pH levels…what you would determine as industrial alkali – the ones that carry all the safety and health precautions." Dr. Sharma suggested that manufacturers should etch a 'skull and crossbones' (the universal symbol for poison) on the button batteries so that they are more easily recognizable on an x-ray.

According to the September 2013, issue of International Journal of Pediatric Otorhinolaryngology there has been a dramatic increase of button battery ingestions in the last ten years. To reduce the continual rise in life threatening injuries, a national Button Battery Task Force was assembled to pursue a multi-faceted approach to injury prevention, which includes representatives from medicine, public health, industry, poison control and government.

If you have a suspicion that your child has swallowed a button battery – even if you're not sure – take your child immediately to the emergency room to get an x-ray to see if the button battery is stuck in your child's aesophagus.

The Canadian Paediatric Society states:

  • Choking and suffocation are responsible for almost 40% of unintentional injuries in infants under the age of one in Canada.
  • For every choking-related death, there are an estimated 110 children treated in hospital emergency departments.
  • Morbidity associated with these injuries can be significant, including anoxic brain injury and esophageal perforation.
  • Virtually all choking and suffocation deaths and injuries can be prevented.

Helpful Hints

  • Do not let your children see you change the batteries on any of your small devices.
  • Do not allow your children to have access to your remote control devices and as an added precaution, tape the battery compartments shut.
  • Keep loose batteries and all other small items locked away - out of reach and out of sight.
  • Share these tips with caregivers, friends, family members and sitters.

    emergency-image008

Canada and U.S. Hotline

Manufacturers know that the ingestion of batteries is a very serious issue. There is a 24-hour National Button Battery Ingestion Hotline -- 1-202-625-3333 -- that accepts collect calls from both U.S. and Canadian citizens.

Resources

International Journal of Pediatric Otorhinolaryngology

www.poison.org/battery

Canadian Paediatric Society – battery ingestions

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