Swallowing batteries in children - What you should know

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Articles by Doctor Le Van Quang - Ear - Nose - Throat Doctor - General Surgery Department - Vinmec Nha Trang International General Hospital

Baby swallowing battery if not handled in time will be life-threatening. Even many oral methods of getting batteries stuck in a child's body not only do not work, but on the contrary, make the situation worse. The information in the following article will be useful to you when dealing with a situation where a child swallows a battery.

1. Overview of children swallowing batteries

In this day and age, the widespread and varied use of popular battery-powered electronic devices also increases the risk of accidental battery swallowing in young children. Especially small, flat, or button-shaped batteries. Early management, assessment, and management of these situations is essential before intensive medical interventions can be undertaken.

Fortunately, most (about 97% of cases) usually have only mild symptoms or most do not require medical intervention.
Most batteries pass through the digestive tract without incident. Normally, it is only when a battery becomes trapped in the nasopharynx, pharynx, trachea, esophagus, or gastrointestinal tract that local damage results in ulceration, perforation, or fistula formation. Lesions can be acute or delayed, and long-term sequelae can occur days to weeks later.
Most cases of battery swallowing occur in children under 6 years of age. Another common audience is people older than 60 years old, especially patients with dementia ...

2. Mechanism of injury to children swallowing batteries

Several mechanisms of injury have been proposed including tissue necrosis from local compression, corrosion by leakage of battery material, heavy metal poisoning, and direct discharge.
When the flat battery is placed in an acidic environment such as in the digestive tract, an electrochemical reaction occurs leading to the dissolution of the cathode. This process generates an electric current, leading to electrolysis and liquefaction necrosis.
Battery disc stuck in the stomach, corroding and fragmenting. Erosion and fragmentation occurs in the stomach for more than 48 hours. Approximately 3% of disc batteries were fragmented in the gastrointestinal tract, and 10% showed more severe effects at the sites of gastric mucosal folds.
Serious injuries and sequelae are often caused by battery blockages in the esophagus and pharynx. Lithium batteries often cause more severe damage due to their high capacitance, causing more tissue damage.

3. Basic instructions for handling in case of suspected battery swallowing

In case the child swallows the battery, parents absolutely do not induce vomiting such as hooking the throat, giving vomiting drugs... At the same time, parents can give honey to drink immediately and on the way to the hospital during in case of children >12 months and older (because honey is not safe for babies under one year old). Batteries swallowed within the previous 12 hours (because the risk of esophageal perforation is increased after 12 hours).

3.1. How to use honey

Drink 10ml (2 teaspoons) of honey, every 10 minutes, a maximum of 6 doses. Various types of honey can be used, such as commercial or natural honey Note: Honey does NOT replace the immediate removal of a battery stuck in the esophagus. Honey only helps to slow down the development of battery damage to the body.

3.2. Why give honey?

Honey is used to encapsulate the battery and prevent local hydroxide generation. This slows down the process of alkaline burns to adjacent tissues. Efficacy is based on a 2018 study (Anfang et al.) that evaluated the laboratory and experimental protective effects of different esophageal fluids of honey and sucralfate (Carafate®). Both honey and sucralfate (Carafate®) effectively prevent battery-induced pH increases and reduce the depth of esophageal damage.
In addition to giving honey, you do NOT give the patient anything to eat until an X-ray is taken to remove the esophageal foreign body. If the patient is asymptomatic, take 5 minutes to check the details of the battery type, size, code/type of the manufacturer, to determine as accurately as possible the specific information of the battery.

If the patient is under 12 years of age, try an X-ray immediately to determine the location of the battery. Batteries located in the esophagus can cause severe burns in as little as 2 hours. Patients with a battery in the esophagus may initially be asymptomatic, but can subsequently cause serious injury or death, especially in children under 1 year of age. If the patient is > 12 years of age and diameter battery > 12 mm or unknown, take an X-ray immediately to determine the location of the battery. If the patient is > 12 years of age and the battery is ≤ 12 mm in size, no X-ray is required to locate the battery. battery if all of the following are met:
Patient has been completely symptom-free since taking the battery. Swallow only 1 battery Do not swallow/eat magnetic materials included Batteries have been reliably determined based on manufacturer code or measurements of an identical cell and <12 mm in diameter. No history of previous esophageal surgery, esophageal stricture/stenosis, motility disturbance or other esophageal disease. Trusted, mentally competent patient (or caregiver) and agrees to report development of symptoms prior to battery use or during the following month if metabolism is not documented and understood the importance of promptly seeking assessment of symptoms that may be associated with battery ingestion. Parents should not use laxatives when babies swallow batteries because they are not effective or polyethylene glycol electrolyte solutions because effectiveness has not been proven and it is not known if the solution enhances electrolytes or not.

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References
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