Why a swallowed button battery is a hidden hazard for children

Moments after three-and-half-year-old Mio Vettenterä accidentally swallowed the button battery from his family’s selfie stick in September 2016, he ran crying to his mother, Minttu, to tell her.

Alarmed, Minttu brought her to their local emergency room in Riihimäki, a town in southern Finland.

An x-ray showed that the battery had lodged in Mio’s oesophagus, but the hospital didn’t have the right tools to remove it. By the time doctors at a second hospital got the battery out, seven hours had passed, and it had severely damaged the boy’s oesophagus and burned a hole in his trachea.

He required 20 reconstructive surgeries to his oesophagus—most of them in that first year—and for a few months had to be fed through a tube.

Now age ten, Mio’s oesophagus must be monitored for scar tissue buildup, which could impact his ability to eat comfortably.

Since Mio’s ordeal, says Minttu, “so many people have told me that they never realised just how dangerous those batteries are.”

Both shiny and small, button batteries are extremely appealing to toddlers 

Tucked away in many everyday items—including TV remote controls, car key fobs, hearing aids, musical greeting cards, and fitness watches—button batteries go largely unnoticed, but we should not ignore them.

While these items power some of our most common devices, they have been known to be very dangerous when they fall into the wrong hands.

Round and flat, the silvery coin-like batteries can be particularly fascinating to preschoolers, who may be tempted to pop them in their mouths.

“They are tiny, shiny, and similar in size to some sweets, making them very attractive to young children,” says Delia Rickard, deputy chair of the Australian Competition & Consumer Commission in Canberra.

“If swallowed, a button battery can get stuck in a child’s throat and cause a chemical reaction that burns through tissue, causing death or serious injury.”

This kind of catastrophic scenario is a growing concern in many countries, due to the increasing presence of button batteries.

Much more energy is being packed into much smaller batteries, says Hans Craen, secretary general of the European Portable Battery Association (EPBA) in Brussels. “And we’ve seen an increase in items that require them.”

The National Safety Council, based in the US state of Illinois, has identified that the number of serious injuries or deaths as a result of button batteries has increased nine-fold in the last decade.

And the younger the child, the higher the risk. “The zero-to-five age group is more likely to experience battery-related problems compared to the older kids or adults,” says Dr Madhavan Ramaswamy, a clinical fellow on the tracheal team at Great Ormond Street Hospital for Children in London.

It’s difficult to know exactly how many children sustain injuries or die each year from ingesting button batteries, because reporting isn’t required in most countries.

Still, according to Ramaswamy, the Great Ormond Street Hospital for Children reports seeing about one child per month with significant internal burns caused by swallowing a button battery.

In the Netherlands, roughly 15 children are injured and two die from button battery ingestion each year. And in Australia, three children have died since 2017 and one child per month is seriously injured.

One of the main issues is that these batteries are easy to access. While items marketed to children, like toys, have compartments that screw shut, many everyday devices—including LED lights, calculators and glucometers—do not.

Without those, children can pry batteries free, or batteries can fall out if the device is dropped.

A lack of education about the risks is also a big hurdle: many adults leave used batteries lying around, wrongly assuming that they aren’t harmful.

There are no special symptoms that signal a swallowed button battery, which can mean it takes several hours for parents to get their children to A&E

One reason young children sustain button-battery injuries is their narrow oesophagi. If an older child or adult swallows a button battery, it’s less likely to become lodged; it can then pass freely into and through the person’s digestive system.

When a button battery does get caught in the oesophagus, it presses against delicate tissue while also coming into contact with saliva. The liquid activates the battery’s current and forms hydroxide, which burns the oesophagus and causes tissue damage.

All button batteries contain lithium, alkaline, silver oxide, or zinc. In recent years, more devices have required the lithium kind, which have numerous advantages, including excellent energy-to-weight ratios and a slower loss of charge when not in use.

However, lithium batteries’ bigger size—often 20 millimeters or larger—and the fact that they release more energy make them more dangerous if swallowed.

The immediate side effects of one getting stuck are coughing, vomiting, wheezing, drooling, and difficulty swallowing, but because these are things children commonly do, it can be difficult to pinpoint that the child is reacting to a battery.

“There are no symptoms that are exclusive to swallowing a button battery,” Ramaswamy says. “And when the kids are of non-verbal age, they may be crying, they may be in discomfort, but they can’t actually tell you there’s something hurting in their throat or that it’s burning.”

The European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) recommends removing a button battery within two hours of ingestion. However, when parents aren’t aware of what’s happened, it may stay in the child’s throat for hours or even days.

“If a button battery goes through the oesophageal wall, then very soon it damages the trachea or one of the big arteries, like the aorta,” says Dr Lissy de Ridder, an author of ESPGHAN’s position paper on button battery ingestion and a pediatric gastroenterologist at Sophia Children’s Hospital/Erasmus Medical Center in Rotterdam, Netherlands.

“If it burns a hole in the aorta, then a child may quickly bleed to death.”

If there is any suspicion that a child has swallowed a button battery, get to an emergency department as quickly as possible, so doctors can take x-rays.

Many countries now require toy manufacturers to make sure their toys have child-resistant packaging

Prompted by child injuries and fatalities, in June, Australia became the first country in the world to enact safety and information standards to reduce the risk of harm from button batteries.

Battery manufacturers and suppliers there are now required to use child-resistant packaging and warning labels, and must create secure compartments for products containing button batteries.

In Europe, EPBA and ESPGHAN have partnered to raise awareness about the dangers of button battery ingestion and to have an impact on legislation and safety standards.

The UK introduced additional safety requirements in 2021. And while there is currently no legislation in Canada, in the US a bill demanding extra safety standards became law in August of this year.

“To change legislation, you need robust lobbying, like our US and Australian colleagues have done,” says Dr. Christos Tzivinikos, a member of ESPGHAN’s button battery task force and head of the pediatric gastroenterology section at Al Jalila Children’s Specialty Hospital in Dubai.

“Building on the important groundwork around safety standards that the EPBA has done, we are now also lobbying strongly in Europe. We just need to drive our efforts even further—and that’s what ESPGHAN has been trying to do.”

For now, the industry is enacting some change on its own. Reputable battery manufacturers already sell button batteries in child-resistant packaging across Europe, according to Craen. And some are investigating whether additional measures could help.

Possible ideas include coating batteries with a bitter substance so that children spit them out, and incorporating a dye that will color the child’s mouth or tongue upon ingestion to tip off parents.

In the meantime, widespread awareness of the hazards of button batteries is crucial to avoid further tragedies.

As de Ridder says, “There are millions of batteries around the world already. Selling the new ones in a protected seal doesn’t do the job on its own.”

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