Not a Happy Meal - Why kids keep trying to eat batteries
By Kush Sutaria and Dr. Puja Shah
Kids have a habit of attempting to eat whatever they can get their hands on. We all know the choking hazard of small objects, but an equally deadly danger comes from the ingestion of batteries and the toxic mix of substances they contain. Our regular contributor Kush has teamed up with Dr. Puja Shah to take a look at this hazardous snack, highlighting what happens in the body, how it’s treated, and how legislators are attempting to solve the issue.
National Capital Poison Center data shows that in 2019, there were 3,467 ingestions of batteries in the US, with 1,843 of these in kids below the age of 6. 51 of the outcomes were considered ‘Major’ with 3 deaths recorded.
Data collected from July 2016 to June 2018 gives us some insight into the intended use of these batteries, with the 3 main categories being for hearing aids (26.4%), Games/toys (16%), and lights (11.9%).
What is clear is that this appears to be a problem that isn’t going away.
So what happens when a battery is swallowed?
Dr Puja Shah is a Pediatric resident at Children’s Hospital Los Angeles. She is on the front line when dealing with the effects of battery ingestion and takes us through what actually happens when you swallow a battery, and what has to happen to fix it.
Button batteries pose a significant danger when ingested, especially in young children. Once lodged in the esophagus, the pressure with moist tissue forms a circuit with the battery, generating an electrical current that triggers the hydrolysis of water. This reaction releases hydroxide (OH⁻) ions, rapidly increasing the local pH and causing liquefactive necrosis—a destructive breakdown of tissue. This reaction starts immediately and the devastating damage can occur in as little as two hours.
The situation becomes particularly life-threatening when the battery erodes through the esophageal wall, as the esophagus lies next to the aorta—the body's largest blood vessel. In severe cases, the battery can penetrate into the aorta, causing catastrophic bleeding.
How is Button Battery Ingestion Treated?
If a button battery is ingested, immediate medical attention is critical. An X-ray is required to determine the location of the battery and the NASPGHAN guidelines are used to guide management of button battery ingestions. If the battery is lodged in the esophagus or stomach, an emergent endoscopic esophagogastroduodenoscopy (EGD) under general anesthesia is performed to locate and remove the battery. This involves placing a camera down the throat and using a tool to retrieve the battery. If the battery is found to have passed through the stomach, is less than 20 mm in size, and the patient is older than 5 years of age, the medical team may decide to observe the patient and conduct serial X-rays to see if the battery is passed in stool.
Depending on how long the battery has been in place, some children may suffer severe esophageal injuries that necessitate multiple surgeries for repair. Recovery can be lengthy, as the tissue in the esophagus remains fragile even after the battery is removed. During this time, patients are often placed on a nasogastric feeding tube (a tube that runs from the nose to the stomach) to allow the esophagus to rest and heal without the additional strain of swallowing.
Esophageal injuries can lead to lifelong complications, including difficulty swallowing and eating. Additionally, if the battery becomes lodged higher in the throat, it can affect speech and voice, depending on the extent of the injury.
Which batteries do the most damage?
Button batteries (aka coin cells) carry the greatest danger due to their small size and widespread use. Even when you may think the battery may be dead, it still carries enough energy to seriously injure. Lithium (LiMnO2) coin cells are the most common type of coin cells and have a nominal voltage of 3V, but can operate down to around 2V. 2V may be too low to power a device, but it’s still plenty enough to cause damage in a human body. Larger batteries, such as AAA form factors also carry a danger of ingestion.
What are manufacturers doing about it?
Several medical societies and organizations such as the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) have called on battery manufacturers to release a safe battery to the consumer market. No battery manufacturer currently makes a ‘safe to consume’ battery, but by nature this is quite tricky. Batteries generate a current when a conductive surface is between the terminals, this is what allows devices to be powered.
Duracell and Energizer use a bitter coating on their CR2032 battery which causes children to instinctively spit out a battery if it makes contact with their tongue. Energizer’s battery also has a dye which turns blue when in contact with saliva. The idea is to dye the mouth blue so caregivers can be alerted and get help faster.
A novel solution was proposed by researchers at MIT, Brigham and Women’s Hospital, and Massachusetts General Hospital which uses a pressure sensitive QTC (Quantum tunneling composite) coating on batteries that only conducts when the battery is under pressure.The idea is that in devices, a slight mechanical pressure is applied to the battery, which allows the coating to conduct electricity and the battery to generate current. However, when in the body and minimal pressure is applied, the coating acts as an insulator to stop the flow of electricity. QTC is a silicone embedded with metal particles which are normally too far apart to conduct, however when squeezed, the particles come closer together and start conducting. This article from 2014 states that they are developing this solution and MIT’s website states this technology is available to license.
Reese’s Law
In August 2022, President Biden signed Reese’s law which mandated stricter standards to minimize the risk to children from ingested batteries. Reese’s Law was named after Reese Hamsmith, an 18-month-old child who passed away after ingesting a button battery. Specifics of the law and action dates can be found here, but the main points are:
Battery compartments with a replaceable button cell must be secured that they require the use of a tool or two hand movements to open
Batteries must not be liberated in abuse testing
The packaging and where possible product must bear a warning, as well as the instructions.
Reese’s Law also requires manufactured or imported button or coin cells to utilize packaging that meets the requirements of 16 CFR § 1700.15, making them harder for kids to open.
Time will tell how effective these measures are.
How to keep safe at home
Keep button batteries out of reach of children, especially crawling infants and toddlers who are more likely to put small, shiny objects in their mouths.
Secure battery compartments on devices such as remote controls, toys, and hearing aids with tape or screws.
Dispose of used batteries safely to avoid accidental access.
Educate caregivers and older children about the dangers of button batteries and the importance of immediate medical care if ingestion is suspected.
If you suspect a child has swallowed a button battery, take immediate action. Do not attempt to induce vomiting or wait for symptoms to develop. Seek emergency medical care at the nearest children’s hospital, and inform the medical team that a lithium button battery may have been ingested.
For infants under 12 months of age, do not give anything to eat or drink, including water, as this may accelerate tissue damage. For children older than 12 months, you can administer 10 mL (2 teaspoons) of honey by mouth every 10 minutes, up to six doses, while on the way to the hospital. Honey may help coat the battery and delay some of the battery’s harmful effects, but it is not a substitute for immediate medical care. For more information, visit National Poison Control’s website. Prompt intervention is crucial to saving lives and preventing severe complications, so act quickly.
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