In Conversation with Doctors

 

Danger of button batteries & Children

by Dr Jeyanthi Kulasegarah ,Consultant Otorhinolaryngology, Head & Neck Surgery,Interest in Otology and Paediatric Otorhinolaryngology

 

  1. What is button batteries ingestion?

Young children especially between 2 and 4 years old have a tendency to put things that are lying around the house into their mouths. Button batteries are the small, shiny, flat, batteries that are found in many household things, such as remote controls, thermometers, toys, key fobs, hearing aids, musical greeting cards, bathroom scales, calculators, ornaments, watches, and many more household electronic devices.  In the last 2 decades, the number of button batteries ingestion cases has risen almost 7 folds, as it is easily found in the home and also because the lithium button batteries are much larger, 20 to 25mm, making it easier to get logded in the throat, oesophagus or stomach. It is also more powerfully charged leading to more destruction to tissues.

If swallowed, the button battery may travel through the oesophagus, stomach and intestines with no problems BUT if it becomes lodged it can cause serious burn injuries and can be lethal.

   2. When should button batteries ingestion be suspected?

Button battery can get lodged in the throat, eosophagus or the stomach. If it gets lodged, it can cause choking, sore throat, trouble swallowing, drooling, cough and your child might refuse to eat. As it remains stuck for longer it can cause changes in voice, difficulty breathing, abdominal pain, chest pain, vomiting and shock as it continues to cause more destruction. In some cases it can cause catastropic bleeding. The smaller alkaline button batteries can be easily placed into the nose or the ear canal causing pain, ulceration, swelling or discharge. Non-specific symptoms combined with an unwitnessed placement can lead to a delay in seeking treatment and even serious injury.

   3. Why are button batteries so dangerous?

When lodged in the oesophagus, the button battery can cause significant tissue burns, which  can extend beyond the esophagus to the trachea (wind pipe), voice box or aorta (main blood vessel in the chest supplying blood to the body). The three natural constriction of the oesophagus where it can get lodged is at the level of the throat where the oesophagus begins, at the level of chest where the aorta crosses over the oesophagus or at the junction between the oesophagus and stomach. Batteries that are lodged in the nose can cause swelling, pain and discharge due ulceration and/or infection leading to the cartilage destruction. Injuries in the ear canal can cause hearing loss, a hole in the ear drum, and weakness of the face due to inflammation of the facial nerve.

  4. How do button batteries cause tissue damage?

There are different types of button batteries but the most common ones are the alkaline and lithium button batteries. Button batteries contain an anode part (negative battery pole); a cathode part (positive battery pole); and an electrolyte-soaked separator such as sodium hydroxide or potassium hydroxide to facilitate electrochemical reaction.

Button batteries can cause tissue burns in 3 ways:

  1. It can create electrical current when battery is in contact with mucosa and discharges current through surrounding tissue.
  2. It can put pressure on sensitive tissues causing ulceration.
  3. It can cause leakage of battery content leading to chemical reactions.

  5. What advice would you give to parents with a child with suspected button battery ingestion?

If you ever suspect your child swallowed a button battery, go IMMEDIATELY to an emergency department. Serious damage can occur within 2 hours.

DO NOT induce vomiting in your child.

There is new evidence to suggest that honey could be beneficial in these circumstances. Giving your child 2 teaspoon of honey every 10 minutes up to 6 doses, while getting to the hospital could provide a protective barrier until the battery is removed. However, honey is NOT recommended for:

  1. Under 1 year old.
  2. If the swallowed battery incident has been more than 12 hours.

DO NOT delay getting to the hospital if there is no honey at home.

 

  6. What is the treatment for button batteries?

 Ingested button battery needs URGENT removal in order to minimize local tissue damage. Prior to removal, the diagnosis is confirmed on x-ray that should include the neck, chest and abdomen. On x-ray, a button battery can sometimes be mistaken for a coin. But the button battery has a double ring, or halo sign, as opposed to a single ring of the coin and on lateral view, there is step-off effect. The step-off is on the negative side of the battery and this is the side that can cause more damage to adjacent tissue.

Endoscopic removal is the treatment of choice for button batteries in the throat, oesophagus, stomach, ear and nose as it also allows direct visulalization of tissue injury.

If tissue injury was present in the oesophagus, the child will be observed for delayed complications and the oesophagus is rested.

For button batteries beyond the oesophagus, it is allowed to pass spontaneously except in the following circumstances where retrieval is required:

  1. A child younger than 6 years who ingested a large button battery >15mm diameter and remains in the stomach for 4 days or longer.
  2. A child younger than 5 years who ingested a large button battery >20mm diameter and based on history , it might have lodged in the oesophagus for > 2 hours before passing to the stomach.

 

  7. What are the long-term sequelae of button battery ingestion?

Esophageal narrowing (strictures) and spondylodiscitis (inflammation of vertebrae and/or disc space) may not manifest for weeks to months after button battery ingestion. Recurrent laryngeal nerve injury causing hoarseness or weak voice may also be diagnosed weeks after button battery removal.

  8.  What steps can be taken to protect children from button batteries?

Firstly, if possible avoid buying electronic devices, especially toys, with button batteries. Otherwise, ensure the button batteries are in child resistant safety packaging. Secondly, identify all devices at home that use button batteries and make sure these are out of sight and out of reach of children. Thirdly, dispose button batteries safely.

Finally, apply duct tape to battery compartments of devices that are NOT child resistant safe. Please share this information to family members, friends and caregivers to bring awareness of the dangers of button batteries.