Button Batteries and Children - What Parents Need to Know

Research has shown that swallowing coin-sized lithium "button batteries" found in many common household products is a growing threat to children. The data from two new studies reveal that between 1985 and 2009, the risk that children will experience a serious health complication after swallowing a button-battery increased nearly seven-fold.
According to Dr. Toby Litovitz, Director of the National Capital Poison Center in Washington D.C. and lead author for both studies,  "We're talking about a really profoundly devastating injury, and sometimes fatalities. It's also clearly a worsening situation. From the late 1970s until now there have been 14 fatalities in the U.S. that we're aware of, and of those 10 were just in the last six years. So that should send a signal of warning."
About 3,500 cases of button cell battery ingestion are reported annually to poison control centers. While swallowing batteries has occurred for years, the problem is escalating as a result of the 20-mm lithium coin cell becoming a popular household battery. Button batteries have become more common with the emergence of items such as remote controls, thermometers and even singing greeting cards and talking books - objects that are readily accessible to children.

Standard 20 millimeter lithium button batteries are thicker than a nickel and somewhere between a penny and a nickel in diameter. The batteries that pose the greatest risk are those that begin with the number 20, which stands for 20 millimeters. Batteries numbered
2032, 2025 and 2016 are responsible for more than 90 percent of serious injuries.

In 1990 only about one percent of all small 20 millimeter-sized batteries were lithium coin cells. That figure has now risen to about 18-20 percent. The batteries are popular with consumers because they have a long shelf life and have more cold tolerance, making them convenient for outdoor use.

Young children under the age of four account for 85 percent of button battery ingestions. When children swallow this type of battery, it may get lodged in the esophagus rather than the air passage. This means that the primary risk from swallowing a button battery is not choking but rather potentially fatal alkaline burns. These burns are not caused by battery leakage but by the exposure of body tissues to the battery's external current, which results in hydroxide that can burn through the throat or esophagus. Dr. Litovitz and her colleagues have determined that to prevent all possible injury, including serious injury or death, a swallowed battery needs to be removed from a child's esophagus within two hours of being swallowed.

Unfortunately, unless a child is showing signs of choking after swallowing a battery, parents and caregivers may not even be aware that the child has actually swallowed a battery. To make matters more complicated, symptoms resulting from swallowing a battery such as vomiting, fever, cough and lack of appetite may be mistaken for flu symptoms.

Data compiled by the National Poison Data System and the National Battery Ingestion Hotline, as well as a review of more than 8,600 swallowing cases and an analysis of recent medical literature shows that in nearly 62 percent of cases, children under 6 are swallowing batteries they obtained directly from a consumer product. Nearly 30 percent find the batteries loose, while just over 8 percent get them from battery packaging.

To prevent the risk of button battery ingestion, Dr. Litovitz suggests that the consumer electronics industry needs to produce items that use a compartment secured with a screw, requiring a screwdriver to open them. This would create a barrier between a young child and button batteries, making access more difficult. Federal safety rules require toys that use the batteries to have battery compartments that are locked with screws. At the same time, devices intended for adults — like bathroom scales and remote controls — often hold the batteries in with a simple plastic cover that can fall off or be easily removed.

What can parents do to keep young children safe from button batteries?
Store batteries in a secure place away from children.
Check your home for products that contain button batteries and make sure that compartments holding the batteries are secured. If not, use tape to secure the compartment and to be safe, put the product out of reach of children.
Check toys for button batteries before allowing your child to play with them.
Choose button battery free toys for younger children under the age of 6.

To read the full report of these studies check out the June issue of Pediatrics:
Emerging Battery-Ingestion Hazard: Clinical Implications
Toby Litovitz, Nicole Whitaker, Lynn Clark, Nicole C. White and Melinda Marsolek