Button batteries are small, coin-shaped power sources found in a growing number of household electronics, from remote controls to toys and key fobs. Their size and ubiquity make them an increasing threat, particularly to young children who might ingest them. When swallowed, the danger is not primarily a risk of choking, but rather a swift internal injury caused by a chemical process. This process can begin rapidly and cause catastrophic tissue damage long before an ingestion is realized.
The Rapid Chemical Mechanism of Injury
The destructive potential of a lodged button battery is rooted in an electrical and chemical reaction that begins almost immediately upon contact with moist tissue. When the battery becomes stuck in a wet environment, such as the throat, the surrounding tissue and saliva complete an electrical circuit between the battery’s poles. This current initiates water hydrolysis, rapidly breaking down water in the mucosal tissue.
Hydroxide ions are generated at the battery’s negative pole. These ions are a strong alkali, similar to lye, and their accumulation quickly raises the local tissue pH to a highly corrosive level, often between 10 and 13. This extreme alkaline environment leads to deep, progressive tissue destruction known as liquefactive necrosis, which dissolves proteins and fats.
Visible injury can begin in as little as 15 minutes, and severe, irreversible damage can occur within two hours. Even a battery that appears “dead” retains enough residual electrical charge to generate this caustic reaction. The corrosive process can continue to deepen and spread through the tissue even after the battery has been medically removed, contributing to long-term complications.
Severe Damage from Esophageal Lodgement
The esophagus is the most susceptible and dangerous site for a button battery to become lodged, most frequently in the narrow upper portion. Unlike the stomach, where the battery often passes, the esophagus is a muscular tube that allows the battery to remain stationary. The battery’s disc shape and the esophagus’s moist walls create ideal conditions for the current to be maintained and the alkaline burn to take hold.
The liquefactive necrosis destroys the esophageal wall, leading to deep ulceration and potential perforation. This damage is severe because the esophagus lies close to vital structures in the chest. A burn can erode through the posterior wall and damage the trachea, creating a tracheoesophageal fistula.
A far more devastating consequence is the battery eroding into a major blood vessel, such as the aorta. This event, known as an aortoesophageal fistula, causes catastrophic, life-threatening internal bleeding. Larger batteries, especially those 20 millimeters or greater, are more likely to become stuck and cause rapid damage.
Immediate Action and Medical Intervention
Recognizing button battery ingestion is difficult because initial symptoms are often vague and mimic common childhood illnesses. Caregivers should be alert for non-specific signs that a foreign object is lodged in the throat. These include coughing, drooling, difficulty swallowing, refusal to eat or drink, vomiting, chest discomfort, and noisy breathing.
If ingestion is suspected, immediate emergency medical attention is necessary. The child must be taken to an emergency department, and staff should be informed that a button battery is the suspected object. Do not attempt to induce vomiting or give the child anything to eat or drink until medical imaging has been performed.
An X-ray is required to confirm the presence and precise location of the battery, which typically appears as a double-ring or halo sign, distinguishing it from a coin. Once located in the esophagus, the battery requires urgent endoscopic removal, which must be performed within two hours of ingestion to reduce the risk of severe injury.
If the child is over 12 months old and able to swallow, a physician may administer doses of honey or a sucralfate suspension. These substances help neutralize the caustic pH on the battery’s surface and limit the extent of the burn before removal.
Safe Storage and Product Design
The most effective way to prevent these severe injuries is through proactive measures focused on safe storage and secure product design. All loose button batteries, both new and used, must be stored in a high, locked location, inaccessible to children. Even a spent battery retains enough charge to cause a dangerous reaction, so they should be treated with the same caution as new ones.
Proper disposal involves immediately placing clear tape over both sides of the used battery to prevent a short circuit before taking it to a designated recycling facility. Equally important is checking all household devices that contain these batteries, including key fobs, hearing aids, small remotes, and singing greeting cards. The battery compartments on these items should be secured with screws or child-resistant locking mechanisms. Consumers can add an extra layer of protection by placing strong, coin-sized tape over any battery compartment that is easily opened.