Swallowing lithium batteries: A powerful new danger to kids

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In the world as seen through the eyes of a child, one of those tiny hearing-aid batteries might look like an ‘Iron Man’ pill. Or swallowing a lithium cell or two might make you run like the Energizer Bunny.

So, a lot of batteries -- particularly the ‘button batteries’ used to power calculators, hearing aids and a host of handheld digital devices-- are going down the hatch. Between 2007 and 2009, the American Assn. of Poison Control Centers received reports of 3,461 to 3,758 button-battery ingestion incidents yearly.

A new study published Monday in the journal Pediatrics says that lithium cell batteries -- especially those that are 20-millimeters (about three-quarters of an inch) or larger -- have become a particularly common danger to children.

Far from creating indefatigable bunnies or comic-strip characters, the ingestion of these batteries can have very bad consequences indeed: vocal cord paralysis, esophageal narrowing, and destruction or perforation of the trachea or gastric wall, causing bleeding that can be -- and has been -- fatal to some children. A total of 13 children died between 1985-2009 and 73 had ‘major outcomes’ that caused an acute health crisis or ongoing health problems for the child. And in the past decade, roughly, 92.1% of the fatal and major cases involved 20-mm lithium cell batteries.

The Pediatrics study notes that from 1985-2009, there was a 6.7-fold increase in the incidence of button-battery ingestions with serious or fatal outcomes. More than 90% of those who experienced a major injury were under 4 years of age.

Like coins, grapes and hot dogs, button batteries can cause a choking hazard by lodging in the throat and sitting atop the windpipe. But unlike coins, grapes and hotdogs, lithium cell batteries generate an external electrolytic current (while weakened, this current even flows from a largely expended battery). When it’s in contact with fluid-filled tissue such as a child’s esophagus, the battery’s current causes a chemical reaction that creates hydroxide at its negative pole. The hydroxide burns and causes ulcers and perforations in that tissue. As it burns through the walls of the esophagus or the gastro-intestinal canal, it can cause internal bleeding that can be catastrophic.

In three of the most serious cases reviewed, the battery had been lodged in a child’s throat for only two-to-two-and-a-half hours--long enough for severe burns. ‘The window of opportunity for injury free removal of an esophageal battery is [less than] 2 hours, considerably shorter than previously reported,’ wrote the authors, who hail from the National Capitol Poison Center and several universities in and near Washington, D.C.

-- Melissa Healy