Prevention and quick action: When your child swallows something dangerous

Bharath D. Nath, MD, is a pediatric surgeon at Inova Health System who is board certified in general surgery and pediatric surgery. He specializes in pediatric general and thoracic surgery, treating premature infants to adolescents.

Every year, thousands of children are treated in United States emergency rooms (ERs) because they swallowed objects such as a coin, button, toy or anything small enough to make it into the esophagus (throat).

In recent years, cases like these have accelerated sharply. The number of children treated in ERs for swallowing objects has nearly doubled in the last 20 years.

Some common, everyday objects can cause serious illness or death if a child swallows them. Doctors refer to these incidents as critical ingestions. The two biggest hazards are button batteries and rare earth magnets.

Why Button Batteries Are Dangerous

Button batteries are so small, even toddlers can easily grab one and swallow it within seconds.  The battery can then become trapped in the esophagus.

When you’re not eating or drinking, the walls of the esophagus are floppy, like an empty sock. This makes it easy for the battery to get stuck, leading to a dangerous chain of events:

1. The soft walls of the esophagus touch the positive and negative sides of the battery.
2. Salt in saliva causes a conductive environment in the throat. This completes a circuit in the battery, so it can start working.
3. The battery discharges its voltage (power).
4. As the battery discharges, it burns the tissue in the esophagus.
5. The burns can spread to nearby organs, tissues and major blood vessels.

Burns from button batteries can cause severe scarring of the esophagus. In some cases, children need extensive reconstructive surgery to repair the damage. The burns can be so severe that they cause life-threatening infections and bleeding.

The Problem With Swallowing Rare Earth Magnets

Rare earth magnets are powerful magnets found in toys, electronics and other objects. They are often sold in building toy sets with hundreds of tiny magnetic balls – each smaller than a pea. These magnets are small enough to slip down a child’s throat and into the stomach and then into the intestines.

The magnets are so strong that if a child swallows more than one, they stick together in the digestive tract. The magnetic force of two or more magnets can tear a hole (perforation) in the intestines. This can lead to life-threatening bleeding and infections. Treatment involves major surgery, and the damage can cause long-term health complications.

Checking for Battery Hazards in the Home

Keep devices that contain button batteries away from children since they are often quite easy for children to open and then access the battery. Devices that often use button batteries include:

• Bathroom scales
• Calculators
• Electric or flameless candles
• Holiday decorations or ornaments
• Key fobs
• Musical greeting cards
• Remote controls
• Thermometers
• Toys or games
• Watches

Everyday Objects with Magnets Inside

Parents and caregivers should keep all items with rare earth magnets out of the home or out of reach of small children. The following household objects may contain rare earth magnets:

• Magnet ball sets
• Clothing or purse clasps
• Desk toys for adults
• Games
• Magnetic dart boards
• Upholstery coverings on furniture

What to Do If Your Child Has a Critical Ingestion

If you think your child may have swallowed a button battery, get them to the ER immediately. If you have honey in the house, feed your child a tablespoon of honey before you go. Honey can coat the battery and delay some of the damage to the esophagus.

If your child may have swallowed rare earth magnets, you should also go to the ER as quickly as possible. Magnets take longer to cause problems, but prompt medical care could prevent serious damage to the intestines.

Do not induce vomiting, and don’t wait to see if your child gets sick. A child who swallowed a battery or several magnets can look well for some time before the damage makes them sick.

Emergency Treatment for Critical Ingestions

Treatment for critical ingestions needs to happen quickly. A correct diagnosis and a hospital equipped to handle these situations are vital for efficient care.

Children who may have swallowed a dangerous object usually get X-rays first. Button batteries and magnets show up easily on X-rays, and doctors can pinpoint their location. However, it’s important that doctors have experience getting the most accurate picture. Button batteries and coins look very similar – and batteries are usually far more dangerous.

Button batteries require immediate removal to prevent burning of the esophagus and nearby tissues. Rare earth magnets require immediate surgical removal if:

• The child or parents can confirm that the child swallowed more than one magnet at separate times.
• Doctors find evidence of a tear in the intestines on an X-ray.
• An X-ray shows magnets that appear to be in different loops of the intestines.

Leading the Way in Better Care for Critical Ingestions

In recent months, the tragic results of swallowed button batteries and rare earth magnets have made national news. But in 2020 – before many of these stories made headlines – Inova’s Pediatric Quality Improvement and Patient Safety (PIPS) group was seeing more of these cases and decided to take action.

The PIPS group formed a critical ingestions subcommittee that included anesthesiologists, emergency medical service directors, emergency physicians, gastroenterologists, intensive care physicians, nurses, otolaryngologists, pediatric hospitalists, pediatric surgeons, and radiologists.

These experts seized the opportunity to collaborate and share best methods as well as ways to streamline care when every minute counts. They created a set of guidelines and best practices for critical ingestions care based on the latest research and advancements.

Many children who swallow batteries or magnets are transferred to Inova L. J. Murphy Children’s Hospital on the Inova Fairfax Medical Campus.  All Inova emergency physicians have access to the new guidelines, and the group plans to share them with other hospitals in the area.

Better Care Through Innovation at Inova

Thanks to the work of the critical ingestions subcommittee, Inova is equipped with best practices for critical ingestions care. We’re proud to be providing care that exceeds the standard baseline – care that can help save lives.

Learn more about our leading-edge children’s emergency services at Inova.