Button batteries — the kind found in many small household gadgets — are a serious safety hazard for infants and toddlers, who tend to pop them in their mouths, often leading to serious burns to the esophagus. Fortunately, a new study finds that drinking honey or Carafate (a cherry- flavored duodenal ulcer prescription) may reduce the damage in many cases.
“Button batteries are ingested by children more 2,500 times a year in the United States, with more than a 12-fold increase in fatal outcomes in the last decade compared to the prior decade,” said Ian N. Jacobs, MD, Director of the Center for Pediatric Airway Disorders and a pediatric otolaryngologist at Children’s Hospital of Philadelphia (CHOP). “Since serious damage can occur within two hours of ingesting a battery, the interval between ingestion and removal is a critical time to act in order to reduce esophageal injury.”
Jacobs and co-principal investigator Dr. Kris Jatana say their study identifies “protective interventions for both the household and hospital setting that can reduce injury severity.”
“Our recommendation would be for parents and caregivers to give honey at regular intervals before a child is able to reach a hospital, while clinicians in a hospital setting can use sucralfate (Carafate) before removing the battery,” Jacobs said. However, the authors caution against using these substances in children who have a clinical suspicion of existing sepsis or perforation of the esophagus, known severe allergy to honey or sucralfate, or in children less than one-year-old due to a small risk of botulism.
“Our results will change the practice guidelines for how medical professionals acutely manage button battery ingestion,” Jatana said.
Because of their size, candy-like shape and shiny metallic surface, button batteries have posed a risk for toddlers for decades. When the battery reacts with saliva and tissue of the esophagus, it creates a hydroxide-rich, alkaline solution that essentially dissolves tissue.
Children with an esophageal button battery may present with symptoms of sore throat, cough, fever, difficulty swallowing, poor oral intake or noisy breathing. This can cause severe complications like esophageal perforation, vocal cord paralysis and erosion into the airway or major blood vessels. The longer it takes for the battery to be removed, the higher the risk for these children, particularly those without access to hospitals with specialized anesthesiologists and endoscopists experienced in removing foreign objects.
The research team wanted to find ways to reduce the severity of the injuries in both a home and clinical setting and test their effectiveness in a live animal model, in this case, laboratory pigs. The team screened various options, including common household beverages such as juices, sodas, and sports drinks, in laboratory experiments.
In experiments conducted on cadavers and live animals, both honey and Carafate provided a physical barrier and neutralized the tissue pH increase associated with battery ingestion, the study found. Both reduced injury severity compared with other common household liquids, including apple juice, orange juice, sodas, sports drinks, and maple syrup.
“We explored a variety of common household and medicinal liquid options, and our study showed that honey and sucralfate demonstrated the most protective effects against button battery injury, making the injuries more localized and superficial,” said Jatana. “The findings of our study are going to be put immediately into clinical practice, incorporated into the latest National Capital Poison Center Guidelines for management of button battery ingestions.”
Button battery safety
Button batteries are commonly found in households, and they should always be stored in a secured container, out of reach of children,” said Jatana. “Parents and caregivers should check all electronic products in the home and make certain that the battery is enclosed in a compartment that requires a tool to open and periodically check to ensure it stays secure over time.”
The study was published in The Laryngoscope.