The small silver disc fell out of the back of the electronic toy and lay nestled in the carpet. While his parents didn't notice it from their vantage point 5 and 6 feet up, the shiny object did catch the eye of their ever-inquisitive 3-year-old who promptly popped the button battery in his mouth and swallowed.
It seemed like a good idea at the time, but after he told his parents what he had done, the boy's impulsive ingestion sent the family on a trip to the local emergency department. Thankfully, his chest X-ray was clear of any foreign body, so the battery was not in the esophagus. An abdominal film showed that the distinct radio-opaque disc had already passed into the boy's stomach.
The family was sent home with instructions to feed their son a regular diet and to perform the unpleasant but necessary task of examining all of the boy's bowel movements until the metallic culprit was found. The story ended happily since the battery was eliminated the next day and no further medical intervention was needed.
In an important 2010 study published in the journal Pediatrics, Dr. Toby Litovitz and colleagues at the National Capital Poison Center in Washington, D.C., outline the hazards of button battery ingestion and present a revised treatment guideline for medical professionals.
After analyzing 25 years of data, the Washington group notes that serious and fatal button battery ingestions are increasing in frequency. This increase coincides with the increased household use of the larger 20-mm lithium coin cells, which are now readily available and valued for their high efficiency and long shelf life.
Litovitz explains that these larger lithium batteries do not cause tissue damage by leakage, but rather by rapidly generating more tissue-damaging electrolytic current and hydroxide than other button batteries.
Button batteries lodged in the esophagus or airway are known to cause tissue corrosion and burns, therefore, any button battery ingestion in younger children should be treated as a true emergency. The authors of the poison center study advise that X-rays be performed immediately to rule out a battery in the esophagus.
Because of the danger of corrosion and subsequent complications, lodged esophageal batteries must be removed within two hours of ingestion. Complications of lithium battery ingestion include the development of fistulas or connecting tracts between the esophagus and the trachea, esophageal perforation or narrowing, vocal cord paralysis, infection and severe bleeding. Since medical complications can be delayed, little patients must be closely observed even after the battery is removed endoscopically.
If a button battery is in the stomach or intestine and the child remains asymptomatic, he can be sent home to pass the battery. Stools can be examined, and if the battery is not found, an X-ray can be repeated several days after the ingestion to make sure that the battery has been eliminated.
Specific treatment recommendations are based on age of the child and size of the battery and can be found at www.poison.org/battery/guideline.asp. Of note, the Washington researchers find that an asymptomatic individual older than 12 who has ingested a button battery less than or equal to 12-mm in size can generally be observed at home without x-rays since complications in such cases are rare.
Experts at the American Academy of Pediatrics remind health care professionals that any metallic foreign body located in the esophagus, nose or ear canal should be considered a dangerous button battery until proven otherwise. While the more innocuous coin appears as a smooth single ring on X-ray, a button battery can be identified by the appearance of its characteristic double ring or "halo sign."
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.