Injuries related to button batteries in children have been a significant problem in the past two decades but a dramatic rise in severe outcomes is now a growing risk and a child may be seen in the ER for a battery-related issue as frequently as every 3 hours. In the U.S alone, more than 2,500 button batteries are ingested every year. Button batteries are small round batteries that have become ubiquitous in electronics such as thermometers, calculators, remote controls, hearing aids, games and toys, key fobs, cameras, electronic jewelry, holiday ornaments, bathroom scales, and more. As more consumer battery-powered electronics and more homes use small electronics like these ones, the risk of these shiny and appealing objects getting into hands of crawling and curious infants and kids increases.
Many of these batteries contain 3 V and are 20mm in diameter. This makes them large enough to get stuck and more powerful than older-model batteries. In fact, studies show that 12.6% of children who ingested such batteries suffered severe or fatal injuries.
When a child ingests a battery, their symptoms may not be immediately apparent or may be similar to those of a common infection. Not every child with the symptoms will have an x-ray performed to track a foreign body. The challenge with this situation is that the clock is ticking and even if the battery doesn’t entirely block the throat, they can trigger a chemical process, which can severely burn through tissues in as little as 2 hours. Even when the battery ingestion was witnessed, it can be difficult to take the child to an ER and have surgery done to remove the device in less than 2 hours. The batteries carry extra risks because they can send an electrical current through tissues in the esophagus, which can result in a hole in the trachea or esophagus. It can leak acid if the casing is eroded or can wedge or lodge in the esophagus and push on its wall. But even if they do not have enough juice to power a calculator, the most common fear is their ability to create an electrical current flowing through tissue.
When the battery is lodged in the body, the electric current rapidly increases the pH of the tissue next to the battery, resulting in significant injury. Battery injuries can include tracheoesophageal fistula, vocal cord paralysis, esophageal stricture, mediastinitis, esophageal perforation, or death caused by a significant hemorrhage or busting. Conversely, when a button battery is placed in the ear canal or nasal cavity, pain or drainage may be noted, which is not something unique to batteries. Unwitnessed placement combined with non-specific symptoms can lead to a delay in diagnosis and even greater injury. Batteries lodged in the ear canal can cause hearing loss, facial nerve paralysis, and tympanic membrane perforation. Injuries in the nasal cavity include scar tissue formation, nasal mucosal injury, nasal septal perforation, and periorbital cellulitis.
When surrounded by moist tissue, the electrical current can combine with body fluids to form a caustic lye-like substance. Another significant mechanism is the production of hydrogen ions at the battery’s negative pole as a result of the current created through the nearby tissue. The tissue tends to act as the connecting circuit around the two poles. The resulting hydroxide accumulation is similar to an alkaline caustic injury causing necrosis and tissue liquefaction. In one case, for instance, an infant boy died when a dime-sized battery burned through his esophagus and since no one saw him swallow the battery, doctors suspected a stomach issue. An x-ray was performed several days and revealed the battery in his throat. The battery was surgically removed and the boy was sent home. But then he passed on a few days later when his aorta burst out of the burn.
What Parents Should Do
Parents and caregivers should be careful to ensure that every battery-powered product in their home is safe for use by and around kids. The battery can be easily accessible or may fall out when the device is opened. The battery compartments should always be taped shut and lose batteries stored out of children’s reach. Loose and spare batteries and products that use small batteries should also be stored away. A battery often stops powering a device even before it runs out of charge and what might be thought of as a “dead” battery is still charged and has the power to harm a child should it get caught in their swallowing passage, throat, nose, and ear. The higher the voltage of the battery the faster and more severe the injury.