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Button batteries: A hidden danger

Posted on December 8, 2021 by the Canadian Paediatric Society | Permalink

Topic(s): Public education

By Dr. Daniel Rosenfield and Dr. Suzanne Beno


This adage often refers to holiday gift preparation, but it is relevant all year round. As paediatricians, emergency physicians, and parents ourselves, we want to draw your attention to a threat that has been increasing in severity of injury and death in recent years – the ingestion of button batteries.

Over the past decade, button batteries have become ubiquitous. Initially expensive and only in high-end electronics, these coin-like batteries are now cheap, plentiful, and in countless devices used by adults and children alike. They’re in common household items such as remote controls, hearing aids, flashlights, watches, computer games, greeting cards, car key fobs, various children’s toys, and more. While some are properly encased (i.e., behind a screwed-down cover), many can easily be removed by toddlers.

Newer lithium-ion button batteries now have higher voltages and are larger. If ingested, they can become lodged in the esophagus where they immediately cause injury by breaking down tissues, potentially leading to catastrophic results. Button batteries have also been known to get lodged into little noses and ears, and are equally dangerous in these locations. 

Along with our ear nose and throat (ENT) colleagues, we have had to manage these children acutely, and even weeks or months after ingestion. Unlike traditional coin ingestions, many providers are not aware that these events need to be treated like a red-alarm, “lights and sirens” emergency. The time window for severe damage is narrow, believed to be less than two hours, so the batteries should be removed within this timeframe.

Awareness and teamwork on every level – parents, system, and healthcare provider – is needed to make this possible. These batteries must be removed by the fastest and safest means possible, either via local or referral centre ENT. While awaiting definitive management (i.e., removal), new evidence has guided recommendations to give honey (10 mL = 2 teaspoons) every 10 minutes for up to six doses—if the suspected or known ingestion occurred within 12 hours—can help mitigate tissue damage. This is the only “indication” for honey to be given in children <1 year-old, as the risk of infant botulism is significantly less than the almost inevitable risk of esophageal injury. Emergency departments might also consider stocking sucralfate, which should then be given 1g/10mL every 10 minutes, up to three doses.  

We have been working with community partners around the country to inform them of the standardized pathways and triage protocols to quickly image and interpret X-rays for children who may have ingested a battery, and to confirm location if unsure. The pathognomonic “‘halo” and/or “step-off” signs are seen on X-ray, and should prompt immediate transfer to a centre capable of removing it.  

Unfortunately, even after battery removal, children must be closely monitored at home for up to two months for delayed complications, which can be lethal (i.e., esophageal perforation, tracheo-esophageal fistula, major vessel injury, such as aorto-esophageal fistula with catastrophic hemorrhage, vocal cord paralysis, and spondylodiscitis). Guidance to parents and healthcare workers should emphasize ongoing vigilance for pain, vomiting, blood in the stool or any breathing difficulty. 

As the holiday season approaches, a combined approach from healthcare providers, parents and industry must highlight the dangers to prevent these injuries from occurring in the first place. Industry is working to improve packaging, putting stickers on one pole of the batteries (which, if an adult is unaware, can result in them thinking the batteries are dead), difficult packaging for children to open and more. 

As prevention specialists and healthcare providers, we are advocating for more attention to this issue and stronger safeguards to prevent it from occurring. Additionally, we are working on education campaigns to target primary care, emergency and paediatric providers. Engaging parents and caregivers about these dangers can help bring attention to this rare, but increasing danger. 

Both the Canadian Paediatric Society and Parachute have more information on button batteries as well as other home safety tips.

We hope everyone has a safe and happy holiday season, but don’t forget the batteries.

Dr. Suzanne Beno and Dr. Daniel Rosenfield are members of the Canadian Paediatric Society’s Injury Prevention Committee and Emergency Department paediatricians at The Hospital for Sick Children in Toronto. 


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Last updated: Dec 14, 2021