July 2, 2001: What is the evaluation and treatment for a child who has swallowed a button battery?

The most common button battery ingested comes from hearing aids and involve the 7.9-11.6 mm diameter cells.  Most ingestions (62%) occur in children less that 5 years old.  83%  of all battery ingestors remain asymptomatic.

Battery lodgement in the esophagus, nose, or ear canal  predicts potential for severe clinical outcome. If there is a question of battery ingestion, a radiograph should be obtained.  If the battery is lodged in the esophagus, endoscopic removal should be performed.  (Or as one mentor informed me, get another x-ray in 30 minutes and see if the battery has passed into the stomach).  Esophageal burns may occur within 4-6 hours of ingestion.  Two pediatric fatalities have occurred following battery lodgement in the esophagus.  Delay to diagnosis was  24-hour and 4-days respectively.

Batteries that have passed beyond the esophagus do not need to be removed unless significant injury to the GI tract is evident (based on signs and symptoms).  Do Not Administer Ipecac.  Patient may be discharged with a regular diet and normal activity.  Stools may be inspected for battery passage.  Alternatively, radiographs should be repeated in 7-14 days in asymptomatic patients who  have not passed the battery.  Passage was delayed more than 2 weeks in 1.1% of cases.  Don't get too aggressive. Mercury or other heavy metal poisoning is unlikely.

Battery diameter and chemical system can be determined from the imprint code.  National Button Battery Ingestion Hotline number is 202-625-3333.  Call the Poison Center Hotline for questions and help with identification 1-800-222-1222.