When such batteries lodge in the esophagus, the tube that connects the throat to the stomach, they can cause serious damage in as little as two hours. While larger lithium cells are of more concern because they are more likely to be caught in a child’s esophagus, smaller non-lithium button batteries can cause severe injury as well, the team said, especially in children younger than 1.
Using data from the Consumer Product Safety Commission’s National Electronic Injury Surveillance System, the researchers estimated there were 70,322 battery-related emergency room visits among children between 2010 and 2019. Ninety percent of the visits involved children who had swallowed batteries (other injuries involved insertions into the nose, ear and mouth). Most of the cases were among children ages 5 and younger, with the highest number involving 1-year-olds.
The increase in battery-related emergency room visits can likely be attributed to the greater prevalence of button batteries in homes, according to Mark Chandler, senior research associate at Safe Kids Worldwide, which conducted the study in cooperation with Nationwide Children’s Hospital and the Global Injury Research Collaborative, both located in Columbus, Ohio.
“In recent years, particularly in the last decade … devices that are commonly found around the home just continue to get smaller and smaller, and that means that the types of products that are powered by button batteries have become more plentiful,” he said.
Chandler said parents often aren’t aware of how many devices in their home are powered by button batteries and the significant risk that the batteries can pose to children. The researchers concluded that existing prevention efforts are not doing enough to cut down on battery-related emergency room visits, and they called for “regulatory efforts and adoption of safer designs by industry to reduce or eliminate ingestion injuries in children.”
On Aug. 16, President Biden signed a bill, Reese’s Law (named after a child who died after ingesting a button battery), that will set those regulatory efforts into motion. The legislation directs the CPSC to develop new safety standards regarding button or coin batteries that will require safer packaging, more visible warning labels — including on the batteries themselves — and more secure compartments on devices that hold the batteries, to prevent access by children 6 or younger. The agency has a year to issue the standards.
In the Pediatrics study, 12 percent of all swallowed-battery cases resulted in hospitalization; ingestions involving specifically button batteries were twice as likely to result in hospitalization. The data did not include outcomes beyond hospitalization. According to the National Poison Data System, 3,467 button battery ingestions by children and adults were reported in 2019; of those, 207 resulted in moderate effects, 51 in major effects and 3 in death. More than half the cases involved children 6 or younger.
Varun Vohra, clinical toxicologist and director of the Michigan Poison & Drug Information Center at Wayne State University School of Medicine, said that through 2017, Michigan had actually seen a drop in cases of button battery ingestions. There were 562 reported to the center from 2010 through 2017, compared with 723 from 2002 through 2009. But button batteries “are always a concern because they’re so small, and they’re in so many different products,” he said.
Most cases don’t result in severe harm, Vohra said, and button batteries can pass through a child’s gastrointestinal system. But when a button battery becomes lodged in a child’s esophagus, the consequences can be severe. Moisture in the mucus membranes can trigger an electric current that causes a chemical reaction, injuring the adjacent tissue (the current creates hydroxide, which causes alkaline burns).
“This can lead to severe injury, including esophageal perforation, which can result in significant downstream complications,” Vohra said. If X-ray imaging reveals a battery in the esophagus, it will need to be promptly removed, either endoscopically or surgically, since severe injury to the esophagus can occur in as little as two hours. But the injury can progress even after the battery is removed, resulting in relatively rare complications such as vocal cord paralysis or tracheoesophageal fistula, an abnormal connection between the trachea and esophagus.
The latter is what happened to the child that Reese’s Law is named for. Reese Hamsmith, an 18-month-old child from Texas, was having breathing difficulties in October 2020 that were initially diagnosed as croup. After the family realized that a button battery was missing from a broken remote control and that Reese had ingested it, she underwent surgery to remove the battery but developed a difficult-to-treat fistula between her esophagus and trachea. After weeks of hospitalization and complications, she died on Dec. 17, 2020.
While thankful that the bill has passed, Trista Hamsmith, Reese’s mother, said that truly protecting children will require more. “We ultimately need a safer battery,” she said.
Hamsmith, who founded the organization Reese’s Purpose to advocate for protections for children from dangers such as button batteries, urges parents “to be very diligent and very aware of where these are in their homes — if they choose to have them in their homes.” She and Chandler offered some safety tips for parents.
- Make a sweep of your home; you may find button batteries in surprising places, including some children’s electric toothbrushes. “They’re literally designed to go in our children’s mouths, and they’re powered by button batteries,” Hamsmith said.
- Keep any devices powered by button batteries and any loose batteries out of reach and out of sight of children.
- Purchase button batteries packaged in ways that aim to reduce the chance of a child getting into the package and ingesting them. For example, Hamsmith said, some battery packages need to be cut open. She also noted that Duracell sells button batteries with a bitter coating designed to discourage kids from swallowing them.
- Examine your button-battery-powered devices to make sure the battery compartment is as safely secured as possible. Devices that secure the cover with a screw are generally considered safer to have around children, Chandler said.
If your child does swallow a battery or is found near an open electronic device that is missing a battery, Vohra offers this guidance.
- Call the Poison Help Line (800-222-2222), which will connect you to a local poison control center. They will ask for and document important information regarding the battery (including size and imprint code) and may tell you to head for the nearest emergency room for further evaluation. They will also want to know how old your child is, how long it has been since the battery was swallowed and what symptoms the child is experiencing, in order to help establish a treatment plan.
- Do not try to make your child vomit.
- Make note of symptoms such as wheezing, drooling, vomiting, bleeding, abdominal pain, difficulty swallowing, chest discomfort, coughing, choking or gagging, decreased appetite or refusal to eat, or fever.
- Do not give your child anything to eat or drink.
- If a magnet is swallowed along with the battery, this can potentially lead to more severe injury. Call poison control and head to your nearest emergency department.
- If it’s been less than 12 hours since the battery was swallowed and your child is older than 12 months, you can give them commercial honey — two teaspoons every 10 minutes for up to six doses — on the way to the ER. This will coat the battery and prevent the generation of hydroxide, delaying burns to adjacent tissue. However, it is not a substitute for removing the battery, because this helps slow but does not eliminate the risk of tissue damage.
- In cases where a child has a battery lodged in their nose or ear — which can also damage tissue — look for pain or discharge. Do not administer nose or ear drops before a complete examination by a physician; these fluids can potentially lead to worsening damage.