Parents need to be watchful and look closely at the children’s activities to avoid unknowingly children swallowing foreign bodies. The incidence of children swallowing harmful substances is on the rise which could turn out to be fatal if not immediately attended.
8 months child was brought to Belgaum Children Hospital, Kirloskar Road Belagavi recently with complaints of inability to swallow and excessive salivation. The child swallowed the button battery from the TV remote while playing. On examination, the child was irritable and had copious secretions in the mouth. After examining the child Dr. Vijay Pujar, Sr. Pediatric Surgeon advised X-ray which confirmed the presence of a radio-opaque foreign body in the upper esophagus. Dr. Pujar conducted the emergency endoscopy and retrieved the corroded Button Battery (fig2). Grade II esophageal injury was noticed at the site of impaction. The child is discharged from the hospital and the first follow-up is done and the child is doing well.
Figure 1 X-Ray RO shadow in neck
Fig 2 Corroded Button battery
Discussion: Foreign body ingestion is common in infants and young children. Most of them are harmless as they are vomited or passed out in stools. But Button Battery ingestion (BBI) poses a major risk as is associated with severe complications than any other foreign bodies.
Button batteries (BB) are Flat rounded metal objects used as an electric energy source in household items like calculators’ toys remotes and wristwatches. Loose button batteries are easily available to toddlers for ingestion. America reported more than 3500 cases in a year in 2010 and now it is believed to be 7 times more as every house now has multiple electronic gadgets. According to the Center for Disease Control (CDC), the Button batteries are the most harmful in young children below 5 years as they get impacted in the throat and cause significant morbidity and mortality. Batteries can cause damage due to three mechanisms: direct pressure on the mucous membrane (pressure necrosis), leakage of battery contents (chemical damage), an electrical current generated by contact of the battery poles against the mucus membrane in the esophagus (electrical damage). Possible complications due to impaction in the esophagus (from erosive battery chemicals) include fatal exsanguination via aorto-esophageal fistulation, formation of trachea-esophageal fistulae), esophageal and tracheal stenoses, vocal cord paralysis, empyema, and spondylodiscitis. Studies have shown that Electrical or thermal injuries may start as early as 15 minutes after impaction hence sooner removal achieved is better. Children with these injuries need close supervision and long-term follow-up as are associated with a high incidence of developing late complications.
Prevention: Incidence of BBI has steadily risen since 2009, approx. 6,000 cases per Anum are reported according to the American Academy of Pediatrics (AAP). As newer Lithium batteries are bigger and have higher voltage (3.0 v) are more prone to accidents and they can be life-threatening. More than 60 children have lost their life due to the ingestion of button batteries in the USA. This is a serious medical emergency and can be prevented by increasing awareness in the general public.
Treatment: In case of suspicion of BBI in a child, it should be immediately taken to the hospital. Endoscopic removal and assessment of the severity of the injury is the treatment of choice. Closed observation for a prolonged period is necessary as tissue damage may continue even after removal.
BBI is a new health hazard encountered more frequently than few years back. Speaking to myarogya.in Dr. Vijay Pujar appealed to parents to be more vigilant and keep all the small objects away from reach of the children.