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About Tertiary Prevention

So… a child has already swallowed a button battery… now what?

Tertiary prevention measures can help reduce and manage complications related to button battery ingestion. 

They include: 

  • Treating health issues that result from button battery issues
  • Monitoring kids after they leave the hospital to make sure that no new complications arise 

After Treatment and Discharge from Hospital

Swallowing button batteries has been linked to many serious injuries, and in some cases, death. Health issues from swallowing button batteries may occur days or months after ingestion, treatment, and discharge from hospital. Knowing the potential health issues may help your child get a quick diagnosis and treatment. 


Your child’s doctor will discuss some symptoms to look out for, and they are also discussed on this page. 

Risk Factors for Long-Term Health Issues

1. Length of time the button battery is in esophagus

Button batteries stuck in the esophagus for longer are more likely to cause health issues

2. Age of the child

Younger children are at a higher risk of health issues 

3. Location of the button battery in the body

Upper and mid-esophagus are more common in serious health issues

4. Size of the Button Battery

Larger button batteries often cause more health issues

5.. Orientation of the Button Battery

Orientation can help predict what body parts may be injured.

Anodes facing forward are linked to worse health issues. 

Types of Complications

Vascular Fistula

Vocal Cord Paresis and Paralysis

Vocal Cord Paresis and Paralysis

(vascular = blood vessel, fistula = abnormal connection between body parts)


A vascular fistula is when the button battery burns through the esophagus and connects it to a blood vessel.

Learn More

Vocal Cord Paresis and Paralysis

Vocal Cord Paresis and Paralysis

Vocal Cord Paresis and Paralysis

§  The vocal cords are in your child’s voice box, which is directly in front of the esophagus. When a button battery sits in the esophagus, it burns and melts the surrounding tissues, which may include the voice box or the nerves that allow the vocal cords to move.  This can affect voice and swallowing.

Learn More

Tracheoesophageal Fistula

Vocal Cord Paresis and Paralysis

Tracheoesophageal Fistula

The esophagus (the tube that connects the nose and mouth to the stomach) and the trachea (the tube connecting the nose and mouth to the windpipe and lungs) are separate. The esophagus is directly behind the trachea. A tracheoesophageal fistula is an abnormal connection between these two tubes. This injury has presented months after injury.

Learn More

Tracheal Stenosis

Esophageal Perforation

Tracheoesophageal Fistula

The trachea ("wind pipe") is a tube that brings air to your child's lungs. Tracheal stenosis is the abnormal narrowing of the trachea that makes it hard to breath. This is usually due to swelling and scar tissue in the area. 

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Esophageal Stricture

Esophageal Perforation

Esophageal Perforation

Esophageal stricture refers to the abnormal narrowing of the esophagus. This makes it harder for food to pass through the esophagus to go to the stomach. A swallowing test should be done about 4 weeks after ingestion to assess for this but if not, watch for difficulty swallowing.

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Esophageal Perforation

Esophageal Perforation

Esophageal Perforation

Esophageal perforation is a hole in the esophagus that allows liquids, and food to spill into the chest or belly.

Learn More

Spondylodiscitis

Spondylodiscitis

Spondylodiscitis

Spondylodiscitis is an infection of a disc that is between two pieces of your child’s spine, and the pieces of the spine that are surrounding it (vertebrae).

Learn More

Vascular Fistulas

(vascular = blood vessel, fistula = abnormal connection between body parts)

The esophagus contains its own blood supply and is close to many large blood vessels that supply the rest of the body. When a button battery causes a vascular fistula, it means that it has created a connection between the esophagus and a nearby artery, which will cause heavy and dangerous bleeding from the artery. 


Vascular fistulas are a rare but life-threatening health issue from button battery ingestion. 


In a study of vascular issues in children after button battery ingestion, 82% did not survive. Vascular complications were found to account for 61% of deaths following button battery ingestion.

Symptoms:

  • Blood in vomit: most common symptom (75%) 
  • Dark blood in stool (looks black and tarry) (12%) 
  • Belly pain 
  • Less energy
  • Shock: confusion, less energy, low blood pressure, cold, moist skin 

Risk Factors:

  • Longer time to removal of button battery increases risk of fatal vascular issues
    • The average length of button battery impaction in those with vascular issues was found to be 4 days, while children without vascular complications had an average of 1.4 days of button battery impaction 
    • Even if a button battery is removed quickly, it can still cause vascular issues! Research found that most vascular issues could occur after as little as 7.5 hours of button battery impaction. 

Vocal Cord Paresis and Paralysis

paresis = weakness, paralysis = not moving

The vocal cords are in your child’s voice box, which is in front of the esophagus. When a button battery sits in the esophagus, it burns and melts the surrounding tissues, which may include the voice box or the nerves that allow the vocal cords to move. 


If vocal cords are not moving anymore, your child may have difficulty speaking, or their voice may sound different. It may also increase their risk of developing aspiration pneumonia (a lung infection caused by food or fluids going through your child’s voice box and into their lungs instead of into their esophagus). When both vocal cords are damaged, it may cause difficulty breathing and even death in a short time. This is because the vocal cords will be stuck in a closed position and stop air from going through the voice box and into the lungs. 

Symptoms:

  • Increased work of breathing 
  • Shortness of breath
  • Noisy breathing (stridor) 
  • Weak voice or cough 
  • Symptoms may get worse when your child gets an upper respiratory infection like a cold, resulting in an emergency or death. Therefore, it is important to not ignore more subtle symptoms and to have these looked at by a doctor early on

Risk Factors:

  • Location: button batteries that are stuck at the level of the hypopharynx (bottom of the throat) are more likely to damage the voice box

Tracheoesophageal Fistula

Normally, the esophagus (the tube that connects the nose and mouth to the stomach) and the trachea (the tube connecting the nose and mouth to the windpipe and lungs) are separate. The esophagus is directly behind the trachea. 


A tracheoesophageal fistula is an abnormal connection between these two tubes. 


As a result, swallowed liquids or food can go into your child's lungs, causing a lung infection (pneumonia). It also makes it difficult for your child to eat and grow, and may even lead to failure of your child’s lungs, or death. 

Symptoms:

  • Difficulty swallowing
  • Coughing while feeding
  • Frequent lung infections

Tracheal Stenosis

Often called “subglottic stenosis”

Tracheal stenosis is the abnormal narrowing of the trachea that makes it harder to breathe. This is usually due to swelling and scar tissue in the area. 

Symptoms:

  • Shortness of breath that is getting worse
  • Noisy breathing (stridor)
  • Frequent lung or upper respiratory infections (ie. pneumonia, common cold)
  • A cough that does not go away
  • A blue color in the skin or inside of the mouth or nose
  • Increased mucus production from nose or mouth

Esophageal Stenosis

Esophageal stenosis is the abnormal narrowing of the esophagus. This makes it harder for food to pass through the esophagus to go to the stomach.

Symptoms:

  • Feeling like something is stuck in your throat
  • Occasional burning feeling in chest (reflux)
  • Difficulty swallowing 
  • Weight loss or failure to thrive
  • Frequent choking episodes

Esophageal Perforation

Esophageal perforation is a hole in the esophagus that allows liquids, and food to spill into the chest or belly.

Symptoms:

  • Difficulty swallowing
  • Fever and chills
  • Low blood pressure and fast heart rate
  • Pain in the neck, chest, or belly
  • Rapid breathing
  • Increased work of breathing
  • Vomiting

Spondylodiscitis

Spondylodiscitis is an infection of a disc that is between two bones of your child’s spine, and the bones of the spine that are surrounding it (vertebrae). It is a rare complication of button battery ingestion. 


Some symptoms have been found to include neck stiffness or pain, difficulty extending the neck, difficulty swallowing, or fever. 

Read More

Studies Referenced in This Article

Akilov, K. A., Asadullaev, D. R., Yuldashev, R. Z., & Shokhaydarov, S. I. (2021). Cylindrical and button battery ingestion in children: A single-center experience. Pediatric Surgery International, 37(10), 1461–1466. https://doi.org/10.1007/s00383-021-04953-8 


Akinkugbe, O., James, A. L., Ostrow, O., Everett, T., Wolter, N. E., & McKinnon, N. K. (2022). Vascular complications in children following Button Battery Ingestions: A systematic review. Pediatrics, 150(3). https://doi.org/10.1542/peds.2022-057477 


Duan, Q., Zhang, F., Wang, G., Wang, H., Li, H., Zhao, J., Zhang, J., & Ni, X. (2020). Vocal cord paralysis following lithium button battery ingestion in children. European Journal of Pediatrics, 180(4), 1059–1066. https://doi.org/10.1007/s00431-020-03830-1 


Fuentes, S., Cano, I., Benavent, M. I., & Gómez, A. (2014). Severe esophageal injuries caused by accidental button battery ingestion in children. Journal of Emergencies, Trauma, and Shock, 7(4), 316. https://doi.org/10.4103/0974-2700.142773 


Krom, H., Visser, M., Hulst, J. M., Wolters, V. M., Van den Neucker, A. M., de Meij, T., van der Doef, H. P., Norbruis, O. F., Benninga, M. A., Smit, M. J., & Kindermann, A. (2018). Serious complications after button battery ingestion in children. European Journal of Pediatrics, 177(7), 1063–1070. https://doi.org/10.1007/s00431-018-3154-6 


Labadie, M., O’Mahony, E., Capaldo, L., Courtois, A., Lamireau, T., Nisse, P., Blanc-Brisset, I., & Puskarczyk, E. (2018). Severity of button batteries ingestions: Data from French Poison Control Centres between 1999 and 2015. European Journal of Emergency Medicine, 25(4). https://doi.org/10.1097/mej.0000000000000528 


Leinwand, K., Brumbaugh, D. E., & Kramer, R. E. (2016). Button Battery Ingestion in Children: A Paradigm for Management of Severe Pediatric Foreign Body Ingestions. Gastrointestinal Endosc Clin N Am, 26(1), 99–118. https://doi.org/doi: 10.1016/j.giec.2015.08.003. 


Mubarak, A., Benninga, M. A., Broekaert, I., Dolinsek, J., Homan, M., Mas, E., Miele, E., Pienar, C., Thapar, N., Thomson, M., Tzivinikos, C., & de Ridder, L. (2021). Diagnosis, management, and Prevention of Button Battery Ingestion in childhood: A European Society for Paediatric Gastroenterology Hepatology and nutrition position paper. Journal of Pediatric Gastroenterology & Nutrition, 73(1), 129–136. https://doi.org/10.1097/mpg.0000000000003048 


Poupore, N. S., Shih, M. C., Nguyen, S. A., Brennan, E. A., Clemmens, C. S., Pecha, P. P., McDuffie, L. A., & Carroll, W. W. (2022). Evaluating the management timeline of tracheoesophageal fistulas secondary to Button Batteries: A systematic review. International Journal of Pediatric Otorhinolaryngology, 157, 111100. https://doi.org/10.1016/j.ijporl.2022.111100 


Sethia, R., Gibbs, H., Jacobs, I. N., Reilly, J. S., Rhoades, K., & Jatana, K. R. (2021). Current management of Button Battery Injuries. Laryngoscope Investigative Otolaryngology, 6(3), 549–563. https://doi.org/10.1002/lio2.535 


Soto, P. H., Reid, N. E., & Litovitz, T. L. (2019). Time to perforation for button batteries lodged in the esophagus. The American Journal of Emergency Medicine, 37(5), 805–809. https://doi.org/10.1016/j.ajem.2018.07.035 


Young, A., Tekes, A., Huisman, T. A. G. M., & Bosemani, T. (2015). Spondylodiscitis associated with Button Battery ingestion: PROMPT evaluation with MRI. The Neuroradiology Journal, 28(5), 504–507. https://doi.org/10.1177/1971400915611142 

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