Every three hours, a child under the age of 18 visits an emergency room to be treated for button battery ingestion. In 2013 alone, 3,366 button battery ingestions were reported to the National Poison Data Center (NPDC), including 13 children who suffered severe injuries and 4 who died. The first description of a button battery ingestion fatality in the medical literature was published in 1977, when a 2-and-a-half year old child swallowed a camera battery. The NPDC says that since then, 38 more children under the age of 5 have died.
Many of the remote controls, electronic toys, flash lights, watches, greeting cards and car key fobs we rely on in our everyday life run on button batteries, also known as coin cell batteries. Children often gain access to the button batteries because the gadgets do not have strong enough battery compartments to withstand the wear and tear of daily use. Kids also pick the batteries out of packaging that isn’t childproof or from products that are thrown away. Because many products lack warning labels, parents are unaware of the significant dangers.
Smaller batteries, the size of a dime or smaller, most frequently pose a risk of burns when the child sticks them in a nose or ear. But lithium batteries about the size of a nickel (20 mm diameter), which contain about 3 volts of electricity, can easily become lodged in the throat or esophagus. Once the battery is in the child’s throat, esophagus or intestines, there is enough electricity left – even in batteries that were thought to be “spent” – to produce hydroxide that burns through the tissues. In less than two hours, a child can suffer esophageal burns and perforations, tracheal damage, severe blood loss from intrusion into a vessel, vocal cord paralysis, or even death. Sometimes the injuries do not appear until several days after the battery is surgically removed. Children who suffer serious injuries can require surgery, tracheostomy tubes to help them breathe and feeding tubes for nutrition.
According to the NPDC, since 1985, there have been more than 70,000 reported button battery ingestions. Other than a spike in 1991 and 1992, there were under 2,000 ingestions annually until 2002, when the number jumped to 2,478 and kept rising. Deaths also significantly increased, from 2 in 1986 to a high of 19 in both 2010 and 2011. Part of the problem is that unless the child is observed swallowing the battery, parents and doctors are often not aware that’s what is causing their symptoms until it is too late.
A task force of medical, public health, industry, poison control, and government professionals said in Pediatric Button Battery Injuries: 2013 Task Force Update, published in the International Journal of Pediatric Otorhinolaryngology, that between 2006 and 2012, there was a five-fold higher rate of major or fatal outcomes from ingestions than there was in the previous two decades. More than 12 percent of children under 6 years old who swallowed a 20 mm lithium battery suffered a major injury.
“The increased marketing and use of lithium coin cells, especially the 20 mm diameter cells, is responsible for the increase in severity,” said the task force. “Currently, nearly all severe button battery ingestion cases involve lithium cells; the few exceptions occur with ingestions in very young children (younger than one year of age).”
The Consumer Products Safety Commission, the American Academy of Pediatrics, and other safety advocates have spent the last few years trying to educate consumers of the dangers, and some battery manufacturers like Energizer have strengthened their packaging to make it more childproof. But that reduced ingestions only a small bit – from 3,457 in 2012 to 3,366 in 2013.
On March 16, Underwriters Laboratories (UL) announced a new standard for button or coin cell batteries, UL 4200A: Standard for Safety for Products Incorporating Button Cell Batteries of Lithium and Similar Technologies, which will go into effect on Nov. 10, 2015. The voluntary standard, which only includes household products used in areas where children are normally present, defines the methods product makers should use to prevent the battery from being removed or falling out. It requires performance tests, including abuse tests, to determine the potential for an accidental battery release. It also specifies warning language and labels about the potential hazard of severe internal burns. A previous standard, ANSI/UL 60065: Standard for Audio, Visual, and Similar Electronic Apparatus-Safety Requirements, requires that button batteries be contained in a structure that requires a tool or a minimum of two simultaneous, independent movements to open.
While stronger battery compartments and more prominent warnings might prevent some ingestions, researchers are hard at work trying to develop batteries that will be safe even when ingested. Recently, researchers at Harvard University, the Massachusetts Institute of Technology, Brigham and Women’s Hospital, and Massachusetts General Hospital have devised a new way to coat a button-cell battery with a special material called Quantum Tunneling Composite (QTC), which is a material used in touch screens. Waterproof and pressure-sensitive, QTC acts like an insulator outside of the battery unit, preventing the battery from conducting electricity after being swallowed, but allowing the battery to conduct electricity when compressed in the battery compartment. Their research, Simple Battery Armor to Protect Against Gastrointestinal Injury From Accidental Ingestion, was published online at the Proceedings of the National Academies of Science.
The researchers tested the battery in a pig, showing that the coating acted as an insulator in the animal’s stomach, but worked perfectly in a device like a laser pointer. Traditional batteries caused substantial tissue damage. They are now working on getting the coating as thin as possible with the goal of applying it to three-volt batteries and insuring that they work in standard housing such as AV equipment. The ultimate challenge is to work with industry to develop a manufacturing process for the 5 billion batteries manufactured every year. The trio also has sought guidance from the National Capitol Poison Control Center.
Children will continue to be harmed by button batteries until battery compartments and product packaging are made more secure, warning labels are clear about the danger and the batteries themselves are designed safer.
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