About Secondary Prevention

What is secondary prevention?

Secondary prevention means acting quickly to diagnose and treat a child after they have swallowed a button battery to prevent further problems.

With button battery ingestions becoming more common, it's important to understand how a child who has recently swallowed one may show symptoms.

Symptoms of button battery ingestion can include:

Difficulty swallowing
Vomiting
Drooling
Chest or abdominal pain
Fast heartbeat
Fever
Blood in vomit or in stool
Coughing
Difficulty breathing or talking
Ear pain
Decreased appetite

Remember that these symptoms are non-specific, and some kids may not show any symptoms at all!

How Button Batteries Cause Damage

When a button battery gets stuck in the esophagus, it can cause damage to the surrounding area within just 15 minutes.

The tissues of the esophagus bridge the terminals of the battery which lets the electricity flow.

The negative end of the battery quickly causes an increase in pH (how acidic or basic a substance is) to as high as 12, (7 is neutral or normal inside your body) leading to tissue death and deep bodily injuries within two hours

Learn more about Button Battery Complications

What To Do If Your Child Swallows a Button Battery

1. Take your child to the emergency department right away & tell them your child swallowed a button

Your child will need the button battery removed right away. Nothing should delay going to the emergency department. Every minute counts.

2. Consider feeding them honey

Do this on the way to the hospital. In the hospital they may give your child more honey or a medicine called sucralfate

In studies done outside the body, honey and sucralfate have been shown to help neutralize the burning effects of button batteries.

If your child is older than 1 year, can still swallow, and it's been less than 12 hours since they swallowed the battery, give them honey.
- 10 millilitres (mL) of honey by mouth every 10 minutes, for up to 6 doses.
For children under 1-year-old that can still swallow, give them sucralfate by mouth if available and within 12 hours of swallowing the button battery
- 10 mL sucralfate every 10 minutes for up to 3 doses

Do this on your way to the hospital. Do not delay going to the hospital to give honey or sucralfate.

3. Do not let your child eat or drink anything

If your child eats or drinks, they may have more medical complications such as choking on their food, drink or vomit.

Do NOT try to make your child vomit.

At the Hospital

Doctors will immediately order x-rays to confirm the button battery and it's location.

The double ring/"halo sign" and "step sign" help doctors know that it is a button battery instead of a coin or other object.

X-rays are the only way to confirm a battery has been ingested and to know where it is. Treatment varies depending on location.

Sometimes, your child may be urgently transferred to a larger hospital

Not every hospital has the specialists and tools needed to remove button batteries. In this case, your child will be urgently transferred to a larger hospital for more specialized care.

If the button battery is in the esophagus, doctors will take your child to the operating room and remove the button battery

Doctors at the hospital will choose the most quick and safe method to remove the button battery from the esophagus. This will be based on your child’s age, size, past medical history, symptoms, location of the button battery and size of the button battery.

Your child will likely need to be put to sleep for the button battery to be safely removed. You may meet with an anesthesiologist (doctor that puts patients to sleep) to discuss this.

The surgery: "Rigid Esophagoscopy and foreign body removal"

A stiff tube is put in your child’s mouth and guided into their esophagus. This allows your child’s doctor to see inside your child’s throat. Your child’s doctor will be able to pass different tools through this tube to safely remove the button battery, look for damage, and clean any remaining debris.

Risks of Surgery

Your child’s doctor will discuss risks.

Complications often include: Injury to the lip and/or tongue (bruising, small cuts, bleeding, swelling) or damage to teeth.

More serious complications such as a tear or hole made in the esophagus, mediastinitis (inflammation of the space in the centre of your child’s chest), pneumothorax (collapsed lung), and tearing of the artery that brings blood to the brain may also occur.

References within this article:

Lerner, D. G., Brumbaugh, D., Lightdale, J. R., Jatana, K. R., Jacobs, I. N., & Mamula, P. (2020). Mitigating Risks of Swallowed Button Batteries: New Strategies Before and After Removal. Journal of pediatric gastroenterology and nutrition, 70(5), 542–546.

Krom H, Visser M, Hulst JM, Wolters VM, Van den Neucker AM, de Meij T, van der Doef HPJ, Norbruis OF, Benninga MA, Smit MJM, Kindermann A. Serious complications after button battery ingestion in children. Eur J Pediatr. 2018 Jul;177(7):1063-1070.

Anfang RR, Jatana KR, Linn RL, Rhoades K, Fry J, Jacobs IN. pH-neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury. Laryngoscope. 2019 Jan;129(1):49-57. doi: 10.1002/lary.27312. Epub 2018 Jun 11. PMID: 29889306.

National Capital Poisons Center. National capital poison center button battery ingestion triage and treatment guideline. Available at: https://www.poison.org/battery/guideline.