The holidays are just around the corner and growing up as a kid the best toys were always the ones requiring batteries. Batteries can be a significant hazard as they are found in every household and the caustic material inside of the battery can lead to burns. But not all batteries are created equally, and there is a subset of batteries that frightens every specialist here at the Illinois Poison Center (IPC), button batteries.

Button batteries can be found in a variety of products including toys, hearing aids and musical greeting cards. Their small size, ranging from less than 12 mm to larger than 20 mm, makes them easy for children to ingest. These batteries can become lodged in the esophagus, causing a life-threatening medical emergency. When stuck in the esophagus, the results aren’t pretty, here’s just a taste of what damage they can cause:

A demonstration by Dr. Brent Furbee (above image – using a hot dog to resemble a human esophagus) shows how rapid and extensive the burns from a button battery can be. The damage to living tissue could be much worse than the damage to a dense meat product.

Burns from button batteries can develop within 2 hours of exposure and are thought to be caused by:

• Electrical current from the battery;
• Leakage of corrosive contents; or
• Physical pressure against the esophagus.

Signs and Symptoms

While the symptoms of a button battery lodged in the esophagus can present as the classic choking symptoms (gagging, wheezing, and/or difficulty breathing), symptoms can also be more general such as vomiting, coughing, refusal to eat or drink, drooling, difficulty swallowing, and poor appetite. If a button battery is unknowingly swallowed by a toddler, the symptoms may be mistaken for a simple cold.

While not as common, button batteries can still cause damage if a child sticks one up their nose, in their ear, of if a battery becomes stuck in their clothing and presses against the skin. The IPC also receives calls on adults ingesting button batteries; typically it’s an elderly patient ingesting a hearing aid battery when either confused or distracted.

What to do

Any person with symptoms after a suspected button battery ingestion needs immediate medical attention and should go to their local hospital emergency department for evaluation.  Patients who are choking or in respiratory distress require immediate medical assistance and 911 must be called. Depending on the location, a button battery may need to be removed by a gastrointestinal specialist. Close monitoring is necessary for the development of further complications. Children under the age of 12 who do not have any symptoms still need an x-ray, as soon as possible to verify the location of the button battery. Patients who have the button battery in their stomach or intestine and are symptom free can be discharged home with instructions to monitor for symptoms and to check the stool to confirm the passage of the battery.

Honey Helps

A recent study performed in piglets suggests honey administered in button battery ingestions prevented or delayed the development of esophageal burns. Based on this study, the new guidelines recommend 2 teaspoons of honey to be given every 10 minutes in patients 12 months of age and older, up to six doses as long as honey administration does not delay transportation to an emergency department. Honey should not be given to children under 12 months of age due to the risk of developing botulism.

Button battery exposures are complex cases and the number of fatal outcomes is rising. If you have a suspected exposure please contact your local poison center immediately for management guidance at 1-800-222-1222. You can also reach out to our good friends at National Battery Ingestion Hotline at 1-800-498-8666.

Until next time

Matt