How Small Batteries Can Become Dangerous to Children

Thousands of children are treated in emergency departments each year after ingesting either button batteries or lithium coin batteries. Both types of batteries are small, shiny and appealing to children. And both can cause major injury if stuck in a child's nose or ear, and possibly even death if swallowed. (See "A Nosebleed," below.)

What are button batteries & lithium coin batteries?

Button batteries and lithium coin batteries are not exactly the same, but both are small round batteries that power many electronic devices. They're found in remote controls and many other household items. Products designed for children may also contain button batteries or lithium coin batteries, such as some games and toys, and flashing shoes, clothing and jewelry.

How can these batteries injure children?

When it comes into contact with body fluids, the battery generates a current. That current produces small amounts of sodium hydroxide, a harsh corrosive similar to lye. If the battery gets stuck somewhere in the body, the lye burns a hole at that spot. Infection usually follows. The result can be serious injury and illness, long-term disability or even death.

A Nosebleed By Jackie Huff, PA-C My son Johnathan's daycare teacher called, asking me if he ever had a history of nosebleeds. He laid down for a nap 10 minutes ago, she explains, and they just noticed a large puddle of blood around his face and head. Being a physician assistant, trained in the emergency department, I'm not too concerned yet. Moments later, I hear that he's vomiting blood. Within minutes, the paramedics, my husband (also a paramedic) and I arrive. Johnathan sees us and the sweetest little smile spreads across his face. His vital signs are all within normal limits, and there's no signs of active bleeding. We examine the vomit and see his half-chewed lunch of peaches, some kind of noodle, and one penny-size blood clot. Nose bleeds can make you nauseated and cause you to vomit. The pediatrician examining Johnathon later that day says the nosebleed likely was caused by nose picking or dry nasal membranes. At daycare the next day, Johnathan plays all day. I get picture updates from his teachers. He had given everyone a scare, but we were back to normal. Fifteen minutes before pick-up time, they said he laid his head down on the desk. Not normal. Within an hour, he has a slight fever. We decide to go back to the pediatrician in the morning. As the doctor swabs him for a COVID-19 test, I request a chest X-ray to rule out pneumonia from possibly aspirating his lunch when he vomited. Although very unlikely, our pediatrician agrees. The X-rays shows bronchiolitis, a viral infection. Saturday, three days after the nosebleed started, Johnathan seems to be getting better. On Sunday, we wake up in the early morning hours to him coughing. He coughs very hard one time and a half dollar size blood clot hits our bed cover. I wonder if Johnathan might have a nasal aneurysm that will need to be cauterized. Then I worry he may have some sort of clotting disorder. We will go back to the pediatrician in the morning for blood work. Jonathan sleeps for two hours. Then, he coughs. He coughs hard. A large volume of frothy blood covers my shirt. Two minutes later, he becomes rigid. Possibly a febrile seizure? We call 911. He is breathing. He has a pulse. Then it starts to slow down. It stops. We begin CPR. There is blood in his airway. Or is it in the stomach? Air goes in and out, blood goes round and round. He's young. He's a fighter. He will pull through this. He didn't. My husband and I left the ER that evening without our son. The next day, the medical examiner told us they found a hole found between his esophagus and aorta surrounded by burned and necrotic tissue. There was also massive gastrointestinal bleeding. In his intestines, they found a button battery. Johnathan died five days before Christmas, two weeks shy of his second birthday. I grieve his death every moment of every day. Read more of Johnathan's story at Remember Nugget: Battery Danger Awareness. Learn about Jackie Huff's grassroots efforts to raise awareness of these injuries at Button Battery Awareness – Protecting Our Children or Change.org.

What should parents do?

Parents and caregivers should not assume that every battery-powered product that enters their home is safe for use by children. In many products, for example, the battery is easily accessible or can fall out when the product is dropped. Make sure that the battery compartments of all electronic items are secure and taped shut.

When replacing a button battery or lithium coin battery, keep in mind that it stops powering a device way before it runs out of a charge. So, what we think of as a "dead" battery still has the charge to harm a child should it get caught in their ear, nose, and throat or swallowing passage. The higher the voltage of the battery (3V vs. 1.5V), the faster the injury. To safely dispose of button batteries and lithium coin batteries, wrap them in tape and promptly recycle or put them in an outside garbage can.

Symptoms When a child ingests a button battery or lithium coin battery, symptoms could be virtually absent or similar to those of a common infection. This can make it challenging for health care professionals who are evaluating the child.

• When a button battery or lithium coin battery is placed in the nose or ear, there may be noticeable drainage or pain. Since these symptoms are not unique to button battery injuries, and caregivers may not see the child get ahold of the battery, there can be delayed diagnosis and even greater injury. Batteries lodged in the nose or ear can cause extensive damage to structures such as the eardrum and nasal septum. The lye burns can lead to infections and, in some cases, permanent breathing, smell and hearing disability.
  

• When lodged in the esophagus, the lye produced by the electric current rapidly produces burns at that site. The esophagus and nearby structures in the chest can be damaged, including the windpipe, lungs and large blood vessels. Serious infections usually follow, and bleeding caused by blood vessel damage can create an immediate, life-threatening emergency. Survivors may have lifelong disability.
  
  

_{Figure 2 (right): Rigid esophagoscopy showing button battery injury extending into the muscular layer of esophagus in a child.}

Diagnosis & treatment

Once an x-ray confirms that a button battery is stuck within the body, treatment is urgent removal. The goal is to limit damage to surrounding tissue, and to treat injury that has occurred. A child who has ingested a button battery or lithium coin battery also needs follow-up care to identify long-term and delayed complications.

Awareness is key to prevention

Parents and caregivers need to be aware of the risk posed by button batteries and lithium coin batteries in their home. Keep loose and spare batteries locked away, store any product that uses button batteries or lithium coin batteries out of reach of curious children, and know what to do if they do manage to ingest one. Talk with you pediatrician if you have any questions about your child's safety.

More information

• What Parents Need to Know About Button and Lithium Coin Batteries
• Lithium Coin Batteries: A Home Safety Walkthrough
• Button Batteries: Damaging if Swallowed, Put in Ears or Nose (Video)
  
• Tiny Batteries Pose Sizable Risks (National Safety Council)