What is the treatment for a child who has ingested a battery?

Emergency Management of Button Battery Ingestion in Children

Button battery ingestion in children requires immediate endoscopic removal within 2 hours of ingestion if the battery is lodged in the esophagus, as this can rapidly lead to severe tissue damage and life-threatening complications. 1

Initial Assessment and Diagnosis

1. Immediate radiographic evaluation

   • Obtain plain radiographs (X-rays) of the neck, thorax, and abdomen to confirm presence, location, size, and form of the battery 1
   • Button batteries appear as a round, radiopaque object with a characteristic double-ring or "halo" appearance on X-ray

2. Clinical presentation

   • Many children may be asymptomatic initially (88% in one study) 2
   • Symptoms can be nonspecific: fussiness, decreased appetite, drooling, difficulty swallowing, hematemesis, or abdominal pain 3
   • Absence of symptoms does NOT rule out serious injury

Emergency Management Algorithm

If battery is in the esophagus:

1. URGENT endoscopic removal within 2 hours (maximum 6 hours) 1, 4

   • Flexible endoscopy is first-line approach
   • Rigid endoscopy may be considered for tight impaction, particularly in upper esophagus
   • Combined techniques (balloon extraction with forceps retrieval) may be used for difficult cases

2. Pre-endoscopy interventions (while awaiting removal):

   • For ingestions ≤12 hours: Consider honey or sucralfate administration (should NOT delay endoscopy) 4
   • Do NOT administer activated charcoal 5, 1
   • Do NOT give fluids by mouth 1

3. For delayed diagnosis (>12 hours):

   • Perform CT scan to evaluate for vascular injury before removing the battery 4
   • Higher risk of complications including tracheoesophageal fistula and aortoesophageal fistula 6

If battery has passed beyond the esophagus:

1. For asymptomatic patients with early diagnosis (≤12 hours):

   • Monitor with repeat X-ray in 7-14 days if not already passed in stool 4

2. For delayed diagnosis (>12 hours):

   • Consider endoscopy to screen for esophageal damage and CT scan to rule out vascular injury even in asymptomatic children 4

Post-Removal Care

1. Immediate post-removal assessment:

   • Document mucosal damage and extent of esophageal burns 1
   • Consider nasogastric tube placement if significant erosion is found

2. Follow-up care:

   • Scheduled endoscopic evaluation within 2-4 weeks to assess for stricture formation, even if asymptomatic 1
   • Monitor for delayed complications for at least 2-4 weeks after ingestion 1
   • Obtain plain radiographs to confirm complete passage and check for retained fragments 1

Complications to Monitor

1. Early complications:

   • Esophageal perforation
   • Tracheoesophageal fistula
   • Aortoesophageal fistula (potentially fatal)

2. Delayed complications:

   • Esophageal stricture formation
   • Tracheoesophageal fistula development
   • Vascular injury
   • Cadmium toxicity (particularly with nickel-cadmium batteries) 1

Important Cautions

• Damage can occur rapidly - severe burns with sequelae can develop in just 2-2.5 hours 7
• Injuries may extend and worsen even after battery removal 7
• Most fatal (92%) or major outcome (56%) ingestions are not witnessed 7
• Misdiagnosis is common (27% of major outcomes and 54% of fatal cases) due to nonspecific presentations 7
• 20-mm lithium batteries pose the highest risk for severe outcomes 7

Prevention Strategies

• Proper battery storage and disposal out of children's reach
• Secure battery compartments in electronic devices
• Public education about dangers of button batteries
• Prompt reporting to poison control centers (800-222-1222 in US) 5