This article explores the history of button batteries and how clinicians and industries alike could reduce the harm to children following ingestion. Following ingestion, if lodged, button batteries cause an alkaline reaction leading to necrosis of mucosa. Significant oesophageal injury can occur within two hours, necessitating urgent removal regardless of nil by mouth status. Interestingly, the authors found evidence that giving children two teaspoons of honey every 10 minutes, up to six doses, early on following ingestion reduces the rate of injury. However, it is important to remember that giving honey does not substitute for early removal and that the authors did not specify how the injury was measured after using honey. Honey should generally be avoided in children under the age of one year old. Following removal of the battery, the authors also found 50-100ml wash out with 0.25% sterile acetic acid helps to neutralise the pH and stops any progressive tissue injury (in cases where there is no oesophageal perforation). Concurrent bronchoscopy may be useful as well to assess for tracheoesophageal fistula. In cases where significant injury is found, subsequent follow-up is important to rule out laryngeal injury such as vocal cord paralysis or oesophageal stricture. There have been some industry efforts to reduce the incidence of button battery ingestion. There are improved warning labels on the packaging and also more secure packaging for some brands where scissors are needed to access the battery. Safer button batteries are being designed, where the battery would be non-conductive if in a relatively low-pressure gastrointestinal tract. As a matter of interest, the top three sources of batteries ingested were from remote controls, lights and electric candles.

Button battery safety: Industry and academic partnerships to drive change.
K Jatana, S Chao, I Jacobs, T Litovitz.
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Wai Sum Cho

Queens Medical Centre, Nottingham, UK.

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