Button batteries are small, coin-shaped power sources found in numerous household electronics. If swallowed, ingestion is a time-sensitive medical emergency requiring immediate action to prevent devastating internal injury. These objects are easily accessible to young children in items like remote controls, toys, and key fobs. Recognizing the urgency is paramount, as internal damage from a lodged battery can be shockingly fast.
The Mechanism and Speed of Internal Injury
The danger of a button battery lodged in the esophagus stems from a rapid electrochemical reaction, not the leakage of battery contents. When the battery becomes stuck, the moist tissue of the esophagus completes an electrical circuit across the battery’s poles, utilizing saliva or mucus as the electrolyte. This current flow causes the hydrolysis of water in the surrounding tissue, generating hydroxide ions at the negative terminal. Hydroxide is a highly alkaline (caustic) substance, similar to lye, which rapidly causes a chemical burn known as liquefactive necrosis.
Tissue damage can begin within minutes of impaction, sometimes documented as quickly as 15 minutes after the battery lodges in the esophagus. Corrosion progresses quickly, and a lodged battery can lead to severe tissue damage and perforation within two hours. The severity of the injury is directly related to the duration of contact and the battery’s diameter; larger 20mm or greater lithium cells pose the highest risk. A battery that passes quickly into the stomach is less likely to cause severe complications because the stomach’s strong acid can neutralize the electrical discharge.
Immediate Steps and Emergency Protocols
If button battery ingestion is suspected, the immediate priority is to contact emergency medical services or Poison Control for guidance and transport to an emergency room. Do not attempt to induce vomiting; this will not remove the battery and could cause further damage if it is already partially lodged. Nothing should be given by mouth except for a temporary protective agent, and only if the child is over 12 months of age and able to swallow safely.
If the child is over one year old and ingestion occurred within the past 12 hours, pasteurized honey can be administered as a temporary measure to slow the chemical reaction. The honey coats the battery and esophageal tissue, creating a temporary buffer that helps neutralize the corrosive hydroxide ions until definitive medical care is reached. A dose of 10 milliliters (about two teaspoons) can be given every 10 minutes, up to six doses, while en route to the hospital. This protocol is a bridge to care and must not delay the urgent trip to the emergency department for definitive removal.
Medical Assessment and Removal Procedures
Upon arrival at the medical facility, the first step is an immediate X-ray to confirm the battery’s location, size, and orientation. A button battery is distinguished from a coin on an X-ray by its characteristic “double-rim” or “halo” effect on the front view and a “step-off” appearance on the side view. If the battery is lodged in the esophagus, emergent removal is required, ideally within two hours of ingestion to minimize severe injury.
The preferred method for removing a battery lodged in the esophagus is an endoscopy, which uses a flexible tube with a camera to directly visualize and extract the object. If the battery has passed into the stomach, observation with follow-up X-rays may be an option for smaller batteries. However, larger batteries (20mm or more) may still warrant removal due to the risk of complications. After successful removal, the medical team inspects the damaged tissue and may irrigate the area with a dilute acid, such as 0.25% acetic acid, to neutralize residual alkaline material.
Recovery and Long-Term Monitoring
Even after successful removal, the injury caused by a button battery can continue to progress for days or weeks. The caustic burn causes deep tissue damage, requiring careful monitoring for delayed complications. Long-term follow-up is necessary, particularly to screen for esophageal strictures—narrowings of the esophagus caused by scar tissue formation.
Follow-up procedures, such as repeat endoscopies or barium swallow studies, are often scheduled weeks after removal to assess healing and identify developing strictures. Additional serious complications include tracheoesophageal fistula (an abnormal connection between the esophagus and the windpipe) or vocal cord paralysis. In the most severe cases, the burning can erode into the aorta, creating an aortoesophageal fistula, which leads to life-threatening hemorrhage and requires immediate, specialized surgical intervention.