Button batteries are small, coin-shaped power sources found in countless household electronics, from remote controls to small toys. When a child, typically a toddler, swallows one, it constitutes an immediate and life-threatening medical emergency. The smooth, shiny nature of these objects makes them attractive to young children. If a battery becomes lodged in the esophagus, it can inflict devastating, permanent damage rapidly. Immediate action is required to prevent catastrophic internal injury.
The Mechanism of Rapid Internal Injury
The danger from an ingested button battery comes from an electro-chemical reaction, not chemical leakage. When the battery lodges in a moist environment like the esophagus, the tissue and saliva complete an electrical circuit. This current flow causes the electrolysis of surrounding tissue fluids.
This electrolysis rapidly generates hydroxide ions at the battery’s negative pole. Hydroxide is a highly alkaline substance, similar to lye, which quickly raises the local tissue pH to levels as high as 12 or 13. This extreme alkalinity leads to liquefaction necrosis. Unlike acid burns, alkaline burns dissolve protein and fat, allowing the caustic injury to spread deeper into the tissue layers.
Tissue injury can begin in as little as 15 minutes of contact. Severe injury, including full-thickness esophageal burns or perforation, can occur within two hours. The caustic burn can continue to progress for days or weeks, even after the battery is removed, due to the residual alkaline environment.
Recognizing the Signs of Unwitnessed Ingestion
Diagnosing ingestion is challenging because nearly half of all cases are unwitnessed, and initial symptoms often mimic common childhood illnesses. Caregivers must maintain high suspicion if a child, especially under five years old, has access to electronics containing these batteries. Observable signs can be non-specific and intermittent.
Common symptoms include drooling, difficulty swallowing (dysphagia), and refusal to eat or drink. The child may also exhibit a persistent cough, noisy or labored breathing (stridor), or chest discomfort. Vomiting, particularly if blood-tinged, indicates severe injury. A hoarse voice or wheezing may also be present because the battery can press on the adjacent windpipe.
Immediate Emergency Steps to Take
If button battery ingestion is suspected, the response must be immediate. The first action is to call the National Poison Control Center at 1-800-222-1222 or call 911. Medical professionals will provide time-sensitive instructions. Do not wait for symptoms to worsen or attempt to make the child vomit.
Do not give the child anything to eat or drink until advised by a medical professional. If the child is over 12 months old and being transported to the hospital, administer two teaspoons of honey every 10 minutes, for up to six doses. This temporary measure is designed to coat the battery and neutralize the alkaline environment, slowing damage while en route. Once at the hospital, an X-ray confirms the object’s location and identifies it as a battery, often distinguished from a coin by its characteristic “double halo” or “step-off” appearance.
Recovery and Preventing Future Incidents
Once the battery is located, an emergency endoscopic procedure is required for removal, ideally within two hours of ingestion. After removal, deep tissue damage can continue to progress. Surgeons may irrigate the injury site with a neutralizing agent, such as a dilute acetic acid solution, to halt the ongoing alkaline burn.
Long-term complications are common, including the formation of esophageal strictures, which may require multiple follow-up endoscopies and dilation procedures. The burn may also damage adjacent structures, leading to vocal cord paralysis or the development of a tracheoesophageal fistula (an abnormal connection between the esophagus and the windpipe). Preventing future incidents requires securing all devices that use these batteries, such as remote controls, with strong tape or screws. Old or spent batteries should be disposed of safely, as even a “dead” battery retains enough residual charge to cause catastrophic injury.