Pediatric Magnet Ingestions Continue to Rise

Dr. Jonathan Silverman, MD Department of Pediatrics University of Washington in Seattle, WashingtonMedicalResearch.com Interview with:
Dr. Jonathan Silverman, MD
Department of Pediatrics
University of Washington in Seattle, Washington

MedicalResearch.com: What are the main findings of the study?

Dr. Silverman: We looked at the incidence of magnet foreign body injuries in children between 2002-2011, using a Consumer Products Safety Division surveillance database. We found an estimated 22, 581 cases over that period. Most strikingly, we found a rise in the incidence of magnet ingestions (in cases per 100,000 children/yr) from 0.57 (95% CI 0.22-0.92) in 2002-2003 to 3.06 (95% CI 2.16-3.96) in 2010-2011. The mean age for ingested magnets was 5, but for nasal magnets was 10. Multiple magnet ingestions and magnet injuries requiring hospital admission were much more common in the second half of the study period, corresponding with the rising popularity of small, high-powered, desktop magnet sets. However, due to limited detail from the database, we were unable to say with any certainty whether injuries were specifically due to these magnet sets.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Silverman; We were quite surprised by the magnitude of the rise in magnet ingestion over this time period. Also the older mean age for nasal foreign bodies supports anecdotal evidence and case reports that these magnets are sometimes used as faux oral piercings in pre-teens and teens, who may then accidentally swallow the magnets. Interestingly, while magnet ingestions rose dramatically over our 10 year study period, nasal magnetic foreign bodies have declined in recent years. The reason for this decline is unclear.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Silverman: It’s important that clinicians are aware of the risk of magnet ingestions—particularly multiple magnet ingestion in children. When multiple magnets or single magnets with other metallic foreign bodies are ingested, they can attract across loops of bowel resulting in fistulae, perforations, abdominal sepsis, and even death. Often these patients present with non-specific abdominal complaints, such as vague pain or vomiting which can easily be dismissed as a viral gastroenteritis or functional abdominal pain. Older children may be too embarrassed to admit that they swallowed magnets. If a clinician suspects magnet ingestion, obtain an x-ray. Metal detectors are too insensitive to exclude these tiny foreign bodies. Consult gastroenterology or surgical colleagues to aid in management decisions. There is an excellent algorithm published by Hussain and colleagues that may also be consulted: http://www.ncbi.nlm.nih.gov/pubmed/22785419. As for parents, keep these small high-powered magnet sets out of the house—it’s very easy to lose a couple magnets out of a set of 200 tiny balls, which might later be found and ingested by a curious toddler. If you suspect your child may have ingested one or more magnets, seek medical attention immediately.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Silverman: While our study demonstrated the dramatic rise in magnet ingestions, we weren’t able to comment on the circumstances of injury, most specifically, which types of magnets were most involved in these injuries. More work can be done to try and clarify this. Recently there has been more regulatory action taken by the Consumer Products Safety Commission (CPSC) to reduce the availability of high-powered magnet sets. It is imperative that follow up studies are undertaken to assess the effectiveness of these interventions.

This is an informational video for teens:

http://www.cpsc.gov/Newsroom/Multimedia/?vid=61829

Here is an informational video for parents:

http://www.youtube.com/watch?v=rGYR_GaOfvA&feature=youtu.be

This is the  public link to the NASPGHAN guidelines.

http://www.naspghan.org/user-assets/Documents/pdf/NASPGHAN%20magnet%20ingestion%20algorithm%20AB%20edits%20May%2029%202012.pdf

Citation:

Increase in Pediatric Magnet-Related Foreign Bodies Requiring Emergency Care.

Silverman JA, Brown JC, Willis MM, Ebel BE.

Department of Pediatrics, University of Washington, Seattle, WA.

Ann Emerg Med. 2013 Jul 19. pii: S0196-0644(13)00603-3. doi: 10.1016/j.annemergmed.2013.06.019. [Epub ahead of print]