Deadly Batteries: Number of Serious Button Battery Incidents Still Not Decreasing Interview with:
Toby Litovitz, MD
Executive & Medical Director, National Capital Poison Center
Professor of Emergency Medicine, Georgetown University
Clinical Professor of Emergency Medicine
The George Washington University
Washington DC What is the background for this study? What are the main findings?

Response: Over the past decade, a dramatic and persistent rise in the severity of swallowed batteries has been attributed to increased use of 20 mm diameter lithium coin cell batteries. With its larger diameter compared to traditional button cells, these cells get stuck in the esophagus of small children. There the greater voltage (3 V for lithium coin cells rather than 1.5 V for traditional button batteries), causes these cells to rapidly generate an external current that hydrolyzes tissue fluids, generating hydroxide and causing severe burns, injury and even death. Severe or fatal complications include perforations of the esophagus, tracheoesophageal fistulas, recurrent laryngeal nerve damage leading to vocal cord paralysis, spondylodiscitis, strictures and aortoesophageal fistulas – the latter nearly always fatal.

A multi-pronged effort to address this hazard has been implemented, including public education about the hazard delivered through social and traditional media. Healthcare providers have been alerted to the importance of immediate removal of batteries lodged in the esophagus. Battery manufacturers have changed packaging to increase child-resistance and limit access by children. UL has implemented standards to secure the battery compartments, first of battery-powered media devices, then later expanding the scope of the standards to cover other household electronics. And researchers and industry engineers have tried to design a still-elusive, safer battery.

This analysis was conducted to trend severe and fatal battery ingestion incidents to assess the impact of interventions deployed to decrease the frequency of serious cases. The focus is on data from the National Battery Ingestion Hotline (202-625-3333), a 24/7 hotline for the public and healthcare providers facing a battery ingestion emergency. Data from the National Poison Data System supplement the core data set.

The analysis demonstrated that fatal and serious button battery incidents are still not decreasing – despite attempts to educate, secure battery compartments on products, and make battery packaging child-resistant. In 2015, more than 3,100 people of all ages swallowed button batteries, and more than 1,900 were children. At least 20 fatal or major cases occurred in children younger than 6 years.

National Battery Ingestion Hotline data show where and how the swallowed 20 mm lithium coin cells were mainly used over the past 2 years: 25% were intended for remote controls, 15% for lights, and 14% for flameless candles. The latter is remarkable because we turn to these for a presumably safer alternative to an open flame, but data from the National Battery Ingestion Hotline for the 2-year period ending June 2016 show a rising number of button battery injuries associated with flameless candles (or tea lights). Other sources include games and toys, bathroom scales (right on your toddler’s level), watches, key fobs, digital thermometers, 3-D glasses, Christmas ornaments, and many others. In 54% of cases involving lithium coin cells swallowed by children under age 6, the child has removed the battery from the electronic device. Most parents are not even aware when it happens. What should readers take away from your report?

Response: An ingested battery lodged in the esophagus can have disastrous, tragic consequences. These batteries must be removed within just two hours to prevent terrible injuries. That timeline is especially challenging when no one witnessed the child swallow a battery, as the subsequent clinical effects mimic common viral illnesses. Affected children may require multiple surgeries and feeding or breathing tubes for months or even years. Complicating management is the delayed development of injury, with fistulas, perforations and vocal cord paralysis occurring as long as 28 days after battery removal, and strictures or spondylodiscitis delayed by weeks or months. Is there anything else you would like to add?

Response: While we wait for engineers to develop a safer battery, we must focus on prevention. Here are some tips:

  • Keep batteries out of reach. Don’t let your child near household items that have accessible batteries. Keep those products out of reach, replace them with safer products, or secure the battery compartment with strong tape. Don’t insert or change batteries in front of small children.
  • Be especially cautious with any battery or battery-powered product that contains a battery that’s the size of a penny or larger. (A penny is 19 mm in diameter.) The 20 mm or even larger diameter lithium coin cell causes the most serious problems when swallowed. These problem batteries can be recognized by their imprint that contains these numbers: 2032, 2025, or 2016.
  • Batteries are everywhere. Check remote controls, flameless candles, garage door openers, key fobs, bathroom scales, games and toys, watches, cameras, digital thermometers, hearing aids, singing or talking greeting cards or books, music players, medical equipment and meters, lights, flashing or musical accessories or shoes, bedwetting monitors, dog shock collars, keychains, guitar tuners, and more!
  • Ingestion of a battery is a medical emergency. If a child swallows a battery, don’t delay. Go to the emergency room right away to get an x-ray to make sure the battery is not stuck in the child’s esophagus. It can be stuck even if there are no symptoms. And if a battery is lodged in the esophagus, it MUST come out within 2 hours to prevent devastating, even fatal, consequences.
  • Call the National Battery Ingestion Hotline at 202-625-3333 (U.S.) for immediate and expert help if a battery is swallowed. Specially trained nurses and pharmacists are available 24/7 to assist at no charge.

For more information:

Full press release

More tips to prevent a battery ingestion

Triage and treatment guideline for battery ingestions

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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