Australian researchers have found that button batteries, which are used in some hearing aids, can cause devastating injuries by their ingestion or insertion into the nose or ear.
The tiny batteries power an increasing number of common household items including remote controls, watches, toys and hearing aids.
The study examined injuries from ingestion in children and found a combination of young age, button battery size and delayed diagnosis created a ‘perfect storm’ that increased the chance of severe injuries and death.
The researchers were from the Australian Paediatric Surveillance Unit (APSU) at the University of Sydney and Sydney Children’s Hospital Network, and Queensland Injury Surveillance Unit at Royal Brisbane Women’s and Children’s Hospital.
Their review of 217 studies included 439 children worldwide who had swallowed or inserted the batteries into the nose or ear and was published in the World Journal of Paediatrics on 22 August 2024.
The review found:
- It can take less than six hours after a child has swallowed a button battery for severe injuries and complications to occur; severe injury can occur in as little as two hours.
- The group most at risk for severe injury or death were children younger than two who had swallowed a battery 20mm (2cm) in diameter or more. These are the most dangerous as they are small enough to be easily swallowed but not small enough to reliably pass through a child’s oesophagus. Smaller batteries can also cause injury and long-term complications.
- More than one-quarter (26 percent) of injuries from swallowing button batteries were burns to the child’s oesophagus.
- Almost one-quarter (23 percent) were extremely severe injuries which included the battery burning a hole through the oesophagus into the trachea.
- Nearly nine percent of all the complication cases of ingestion resulted in death and the most common factor was bleeding. In severe cases, burning can create a hole in a major vein or artery, causing a fatal loss of blood.
- Delay in removal can be fatal. Children who did not have the button battery removed within six hours were almost eight times more likely to die.
Despite Australia introducing world-first, mandatory safety standards for child-resistant packaging of button batteries, the researchers said that to protect children, the industry must redesign button batteries as current standards only focus on child resistant packaging and product compartments.
Additionally, parents need to be made aware of the potential danger of button batteries and the need for safe storage of batteries and appropriate disposal. Curious children can accidentally swallow button batteries or insert them in their ears, nose or mouth but are unable to communicate clearly what has happened, they said.
“Once a child has swallowed a button battery, it becomes a race against time since injury can occur within a couple of hours,” said co-lead author Dr Carlos Nunez from APSU.
“Often battery ingestion or insertion is not witnessed by adults. We need primary and secondary preventative strategies to restrict unintended button battery access and the development of evidence-based guidelines to accelerate diagnosis and optimal management.”
The most common initial symptoms of button battery swallowing in a child were choking, difficulty feeding and coughing. Over time these changed to vomiting and drooling and may be mistaken for other health issues such as gastroenteritis or a respiratory infection, reviewers said.
Co-lead author, Mr Christopher Tran from APSU said: “It is imperative that a potential button battery ingestion always remains in the back of clinicians’ minds when dealing with acute onset respiratory or gastrointestinal symptoms in young children.” When a child swallows a button battery, it can cause a chemical reaction in the oesophagus that creates a solution that burns and dissolves the tissue inside the child’s throat, he added.
“We need global regulations to implement the same regulatory requirements that Australia and more recently the US have implemented because this is a global issue,” said another author, Professor of paediatrics and child health, Prof Elizabeth Elliott from APSU, Sydney Medical School and the University of Sydney. “Parent’s education about safe battery storage and disposal and health professional education about the need for timely diagnosis are also critical.”
Other reviewers were epidemiologist Dr Guy Eslick from APSU and Queensland Injury Surveillance Unit director Dr Ruth Barker from Royal Brisbane Women’s and Children’s Hospital.
