Button batteries — they’re small devices found in almost every home, and awareness about the dangers they raise to children may be even smaller. The tiny, dime-like pucks cause injuries, even deaths, every year because of accidental ingestion. To breakdown what’s going on and why it’s important to raise awareness ahead of the holidays, The Atlanta Journal-Constitution spoke with Dr. Maneesha Agarwal, a Children’s Healthcare of Atlanta pediatric emergency medicine physician.
According to a 2024 study out of the University of Sydney, severe injury can happen within two hours of a child ingesting a button battery. Those who did not have the button battery removed within six hours were almost eight times more likely to die. Seventy-one button battery ingestion fatalities have been recorded by the National Capital Poison Center since 1977, equating to roughly 1.6 deaths per year.
The fatalities don’t tell the whole story though. Emergency department visits for battery ingestion are significantly on the rise, and those affected can be permanently disfigured in the process.
What happens when a child eats a button battery?
“So when you swallow a button battery, especially when you’re a small child, it can get stuck in your esophagus,” Agarwal explained. “This is the highest risk situation. When it’s stuck there, you have the saliva in contact with the button battery and in contact with your esophageal mucosa, so the button battery starts to release a charge. Even if your button battery doesn’t have enough energy to power whatever it was in (like a remote or toy), it still has enough charge left for this chemical reaction. You start to get this very alkaline environment. Your pH in the area gets really high. When you have a super high pH, you can start to get like this burn we call necrosis.”
The cells die as the injury burrows deeper into the throat, eroding the esophagus. From there, the necrosis seeps into the aorta or some other major blood vessel nearby.
“One of the risks of these button batteries in the esophagus is, even when the surgeon goes in and pulls that button battery out really fast, the injury can keep progressing over time because it’s a chemical one,” she said. “It’s not just a mechanical injury. Surgeons usually have these kids admitted for at least a couple of days. They may have to go in and do multiple procedures. These kids can have really complex, long hospital courses where, again, they need multiple procedures. They may need a feeding tube for a while. It can really be a life altering situation for any child.”
According to the associate professor and 10-year physician, preventing these incidents begins with raising awareness.
“I think everyone in the American public knows your kid needs to be in a car seat when they leave the hospital after they’re born,” she said. “It’s kind of common sense, like how you don’t let your toddler have access to a swimming pool without anyone around. But a lot of people still don’t recognize the risks of button (battery) injuries. And they’re everywhere. They are in musical greeting cards. That’s the one that always shocked me, because I love getting them for my kid. And my mom still likes to sometimes give them to my children, and I had to have a conversation with her.”
It’s also common for parents to let their children play with their keys, but modern key fobs are also powered by button batteries. From remote controls to bedside clocks, they’re a common power source.
Button battery-related incidents are also on the rise.
Why are there more button battery-related incidents every year?
“I didn’t see a bunch of these cases when I was in training, and I finished my training in 2014,” Agarwal said. “I feel like I’m seeing more cases on a regular basis, even in my decade attending here at Children’s Healthcare of Atlanta.”
The Atlanta-based Centers for Disease Control and Prevention reported a 2.5-fold increase in cases from 1995 to 2010. According to a study by Safe Kids Worldwide, reports of battery-related injuries in children were over twice as high from 2010 to 2019 as they were from 1990 to 2009. During the 2010s, roughly 1 in 10,000 U.S. children went to the emergency room for battery-related injuries every year.
“Personally, in my clinical experience, I probably see a child who has potentially swallowed a button battery about once every month or two, but I’m only one doctor,” she added. “It’s to the point that I think every physician and every nurse that works in our emergency department knows if a family comes in saying, ‘I think my kid swallowed a button battery,’ they know it’s an emergency. We need to get the X-ray ASAP.”
Incidents are on the rise, but determining why will take more research. According to the Atlanta doctor, the lack of awareness to the dangers and increasing prevalence of the power sources may be partially to blame. The batteries themselves may also play a role.
“Part of the challenge is that button batteries are more powerful than ever,” she explained.
“They have a lot more charge and they can cause more injury. They are getting a little bit bigger in size, so they’re more likely to get stuck in the esophagus as well.”
“I haven’t seen good hard evidence that the severity is getting worse,” she later added. “I will say that when I was in residency and fellowship, we knew that batteries were dangerous, but I don’t think I came across any fatalities until I became an attending. Over time, we have had fatalities from button battery ingestions at Children’s.”
How do you prevent your child from eating a button battery?
The best way to avoid injury is to take preventive measures. Small, young children are curious by nature, so keeping track of what batteries are in their environment is key.
“Try to limit their exposure to batteries in your home period,” the doctor advised. “If there are greeting cards (with button batteries) in your home, get rid of them. If you have things that have button batteries in them, that your kid doesn’t need to have access to, keep it away from them.”
“My kids don’t play with my keys, even though that is a favorite toy of many children,” she continued.
If a device in your home uses button batteries, dispose of the batteries as soon as they are replaced.
“This is not something you just lay out on your desk,” she said. “It should be stored in your desk, out of sight, away and secure, just like any other dangerous item.”
You can also wrap your battery in tape before throwing it away to reduce the chance that a child can contact its dangerous surface.
“The other thing that I had never really thought of that one of our surgeons brought up is that when you get toys or other electronic goodies, sometimes they’ll have extra button batteries on the side, or you have to put the battery in there yourself,” Agarwal added. “Especially with the holidays coming up and kids getting all sorts of toys, when you open up that package, make sure you’re not flinging out a loose button battery somewhere on the floor for someone to discover later on.”
What do you do when your child has eaten a button battery?
If prevention has failed because your child has ingested a button battery, it’s time to act — quickly.
“If you think your kid has swallowed a button battery, the first thing to do is to head to your closest emergency department and you have to look at your kid,” she said. “Are they having trouble breathing? Are they vomiting profusely? If that’s happening, you probably want to call 911 and have an ambulance take you to the closest hospital rather than you driving yourself. But if your kid has swallowed a button battery and they’re asymptomatic at the time and you can stay calm driving, it’s totally reasonable to drive your child to the ER.”
If your child is over one year old — and only then — you will want to give them honey, if you have any on hand. Children under one can suffer botulism from honey, so don’t even give it in an emergency situation like this.
“There is really great research that has come out, and it’s shown that if you give a teaspoon of honey every 10 minutes over the course of an hour, it can coat the button battery and hopefully prevent that electrochemical reaction that causes that burn,” she said.
You should not give your child water, as that can have the opposite effect and worsen the injury. Acquiring honey should never be prioritized over swiftly seeking medical treatment, however. If it’s readily on hand, it can stave off further damage.
“It’s so funny because we will have our nurses sometimes running to the cafeteria to get packets of honey, and they kind of look at me like I’m crazy, but it’s the protocol,” she said.
If you child has ingested a button battery, immediately seek emergency care. You can also call the National Capital Poison Center at 1-800-222-1222 for help.
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