May 24, 2010 — New research shows there has been a significant increase in both button and cylindrical battery ingestions, particularly among children, and that the batteries that are lodged in the esophagus must be removed within two hours to prevent serious injuries, including tissue tears, burning, and internal bleeding.
The researchers also call on manufacturers to create child-resistant measures to secure the battery compartment on everyday household products and create industry standards that would require warning labels to help reduce battery ingestion.
These conclusions are based on two studies published in the June issue of Pediatrics. One study looked at the problem of battery ingestion among children and how to best treat them; the second study examined the incidence of battery ingestion and how manufacturers can improve best practices.
Overall, the two studies suggest that the 6.7-fold increase in the percentage of button battery ingestions between 1985 and 2009 is directly related to the widespread use of lithium cell batteries, which power many household products, including television remote controls, flashlights, hearing aids, cameras, and even children’s toys. Overall, there have been 13 deaths involving button batteries getting lodged in the airway or esophagus.
Researchers suggest that these injuries could be prevented with more secure battery compartments and that treatment guidelines should be revised so that health care providers know that when batteries are lodged in the esophagus, removal must take place within two hours to minimize complications. The study also notes that health care providers may not be aware of the signs of battery ingestion.
Battery Ingestion on the Rise
In the first study, Toby Litovitz, MD, from the National Capital Poison Center and department of emergency medicine at Georgetown University School of Medicine in Washington, D.C., analyzed data from three sources: the National Poison Data System (which had 56,535 cases); the National Battery Ingestion Hotline (8,648 cases); and the medial literature. All three data sets indicated a growing national problem:
- Ingestions of 20- to 25- millimeter diameter batteries increased from 1% to 18% between 1990 and 2008, which paralleled a rise in lithium battery cell ingestion from 1.3% to 24%.
- 20-millimeter lithium cell batteries were linked to the most severe outcomes and were associated with severe burns within two to 2.5 hours after ingestion.
- Data from the National Battery Ingestion Hotline showed that children who were younger than 6 years old were involved in 62.5% of button cell ingestions.
- Age was a significant predictor of severity; all fatalities and 85% of major effects occurred in children who were younger than 4 years old.
- 54% of fatal cases and 27% of major outcome (severe) cases were misdiagnosed.
- Among the fatalities, health care providers missed diagnosis in seven of the 13 deaths because of nonspecific symptoms, including vomiting, fever, lethargy, poor appetite, irritability, cough, wheezing, and/or dehydration. Batteries were in the esophagus for 10 hours to two weeks before removal or death.
- Children sustained injuries even after battery removal, including tears to the esophagus, tracheoesophageal fistulas or holes, fistulas in major blood vessels, and massive internal bleeding.
How Batteries Are Obtained by Kids and Adults
The second study, also conducted by Litovitz and his team, looked at how children and adults obtained the batteries and what kinds of prevention strategies could be implemented. They found that:
- Ingested batteries were removed directly from the household products nearly 62% of the time.
- Batteries were loose nearly 29% of the time.
- Batteries were obtained directly from battery packaging 8.2% of the time.
- More than 37% of the 20-millimeter lithium batteries that were ingested were for remote controls.
Battery ingestion was also a problem among teens, adults, and elderly adults, particularly those ages 60 and older, the researchers reported. Batteries intended for hearing aids were implicated in 36.3% of ingestions and were mistaken for pills in 15.5% of ingestions, many times by older adults.
“Parents and child care providers should be taught to prevent battery ingestions,” Litovitz and his team write. “Because 61.8% of batteries that were ingested by children were obtained from products, manufacturers should redesign household products to secure the battery compartment, possibly requiring a tool to open it.”