Dr Aalisha Mariam Karimi1†, Dr Louise Oduro-Dominah2
1Anaesthetic Registrar, Great Ormond Street Hospital, London, UK
2Anaesthetic Consultant, Addenbrookes Hospital, Cambridge, UK
Edited by: Dr Catherine Riley, Anaesthetic Consultant, Sheffield Children’s Hospital,
Sheffield, UK
Corresponding author email: aalisha.karimi@nhs.net
Published 26 March 2024

KEY POINTS

• Button battery ingestion is a medical emergency; management is incumbent on timely recognition and appropriate imaging.
• Life-threatening complications can occur in less than 2 hours following ingestion of button batteries.
• Oesophageal impaction is most likely in children younger than 6 years and with batteries greater than 20 mm in diameter. These have the highest risk of complications.
• Oesophageal injury may require airway protection, mobilisation of multiple teams, preparation for major haemorrhage, techniques to mitigate further injury, endoscopy and transfer to an appropriate centre.
• Potentially fatal injury can occur weeks after the removal of a button battery from the oesophagus.
• Prevention strategies include raising public awareness, liaising with industry to provide appropriate safety warnings and developing safer battery compartments in products.

INTRODUCTION
The growing presence of domestic electronic equipment has led to an increase in button battery (BB) ingestions in the paediatric population, with associated morbidity and mortality. Remote controls, games and toys are most frequently implicated.1 Impacted batte-ries can cause ulceration, perforation and fistula formation within hours, possibly leading to severe complications and even death.The incidence of BB ingestion was just under 11 per million in the United States in 2019, of which the majority (53%) were in children younger than 6 years, indicating that this is the highest-risk age group. Of BB ingestions, 2.8% experienced moderate complications, severe complications or death, with only 3 deaths.2 Those at increased risk of ingestion also include older children with learning difficulties, who may persist in swallowing small objects. A 7-fold increase in relative risk of severe morbidity secondary
to BB ingestion in the past 20 years has been reported.3This has led to prevention initiatives, such as that from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN).4 Worldwide, working groups, task forces, as well as the families of affected individuals have campaigned for safety standards around BBs to be established in consumer law, for example, in the United States (Reese’s law, August 2022).5 In the United Kingdom, NHS England published a Patient Safety Alert6 in 2014 following cases involving delays in the recognition and treatment of BB ingestion in children (5 cases of severe injury over a 4-year period, with 1 death). ENT UK also published a
consensus guideline in 2019.7 The British Paediatric Surveillance Unit are undertaking a national study to investigate the incidence, interventions, complications and outcomes following BB ingestions in children, to better inform clinical care, prevention measures and policy.8 From a legal perspective, the Office for Product Safety and Standards have produced a guidance for businesses that manufacture, import, distribute or sell any products that use button batteries.9