Pediatric Battery-Related Emergency

Department Visits in the United

States: 2010–2019
Mark D. Chandler, MPH,a Khudeja Ilyas, MPH,a Kris R. Jatana, MD,b,c Gary A. Smith, MD, DrPH,b
Lara B. McKenzie, PhD, MA, FAAHB,b J. Morag MacKay, MSca

To describe the epidemiology of battery-related emergency department (ED) visits

OBJECTIVES: abstract
among children aged <18 years in the United States from 2010 to 2019 and compare with
previous study findings.
METHODS: Data on ED visits were obtained from the National Electronic Injury Surveillance
System. Using narrative descriptions and diagnosis codes, battery-related cases were coded
into four exposure routes: (1) ingestion, (2) mouth exposure, (3) ear insertion, and (4) nasal
insertion.
RESULTS:An estimated 70 322 (95% confidence interval: 51 275–89 369) battery-related ED
visits among children aged <18 years occurred during the study period, or 9.5 per 100 000
children annually. Button batteries were implicated in 84.7% of visits where battery type was
described. A statistically significant increase in the ED visit rate occurred from 2010 to 2017
(P 5 .03), followed by a nonstatistically significant decrease from 2017 to 2019. The ED visit
rate was highest among children aged #5 years compared with those 6 to 17 years (24.5 and
2.2 per 100 000 children, respectively). The mean patient age was 3.2 years (95% confidence
interval: 2.9–3.4). Ingestions accounted for 90.0% of ED visits, followed by nasal insertions
(5.7%), ear insertions (2.5%), and mouth exposures (1.8%).
CONCLUSIONS: Pediatric battery-related ED visit rates continued to significantly increase from
2010 to 2017, with children aged #5 years having the highest rates. Prevention efforts have
not significantly reduced injury rates; therefore, regulatory efforts are needed. Ultimately,
hazard reduction or elimination through safer button battery design is critical and should be
adopted by the battery industry.

Full article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2022-056709

WHAT’S KNOWN ON THE SUBJECT: Button batteries are a
a
Safe Kids Worldwide, Silver Spring, Maryland; bNationwide Children's Hospital, Columbus, Ohio; and cGlobal Injury potential source of serious injury among children,
Research Collaborative, Columbus, Ohio especially when ingested. If lodged in the esophagus,
DOI: https://doi.org/10.1542/peds.2022-056709 devasting injury can result within hours. Previous studies
suggest that button battery ingestions among children
Accepted for publication Jun 23, 2022 aged #5 years are increasing.
Address correspondence to Mark D. Chandler, MP H, Department of Research, Safe Kids Worldwide, WHAT THIS STUDY ADDS: An estimated 7032 battery-
1Inventa Place, 6th Fl. West, Silver Spring, MD 20910. E-mail: mchandler@safekids.org related emergency department visits occurred annually
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). among children aged <18 years from 2010 to 2019, more
than twice the number reported from 1990 to 2009. The
Copyright © 2022 by the American Academy of Pediatrics visit rate demonstrated a statistically significant increase
FUNDING: No external funding. from 2010 to 2017.
CONFLICT OF INTEREST DISCLAIMER: Dr Jatana has a patent-pending coin/battery metal
detector device under development and receives royalties for a patented, commercially To cite: Chandler MD, Ilyas K, Jatana KR, et al. Pediatric
available medical device, not related to nor discussed in this article, from Marpac Inc; Battery-Related Emergency Department Visits in the United
is a shareholder in Zotarix LLC, Landsdowne Laboratories LLC, and Tivic Health Systems; serves States: 2010–2019. Pediatrics. 2022;150(3):e2022056709

PEDIATRICS Volume 150, number 3, September 2022:e2022056709 ARTICLE

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 In 2019, foreign body ingestion
(FBI) was the fourth leading cause
for calls to poison control centers
for children aged 5 years and
younger in the United States.1 Young
children use their senses to explore
their environments and often put
objects into their mouths, ear canals,
or nasal passages.2,3 As toddlers
become increasingly mobile and
curious, their risk of FBI
increases.4,5
Previous studies have identified
batteries, when ingested, as
important sources of serious injury
and death among young
children.5–14 Button batteries (BBs)
are small, disc-shaped cells used to
power an increasing number of
consumer electronic devices found
in the home, including toys, digital
watches, hearing aids, and remote
controls. BBs are often easy to
remove from such devices and can
lead to devastating injury in as little
as 2 hours after ingestion.10,13,15
Although larger lithium cells ($20-
mm diameters) present greater risks
of lodging in the esophagus,13,15,16
smaller 1.5 voltage, nonlithium BBs
can also cause severe or life-
threatening esophageal injuries,
especially for children aged <1
year.14,17 The electrical current
generated by the BB in contact with
tissue leads to rapid hydrolysis of
water into hydroxide ions (highly
alkaline pH) and resultant
liquefactive necrosis. Unfortunately,
liquefactive necrosis can progress
even after the BB is removed,
leading to delayed complications.18
Nasal BB insertion can also cause
complications including nasal septal
perforation and periorbital cellulitis,
and ear canal insertion can lead to
tympanic membrane perforation,
hearing loss, and facial nerve
paralysis.10
In the United States, batteries are
among the most common sources of
FBI that result in children
presenting to emergency
2 CHANDLER et al
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departments (EDs), with BBs being
the most frequently implicated
battery type.5,10,12,15,19–23 Children
aged #5 years are at greatest risk,
with a peak incidence among 1- and
2-year-olds.10,12,15,19,24,25 A 2012
study by Sharpe et al reported a
statistically significant increase in
both the number and rate of
battery-related ED visits among
children aged <18 years from 1990
to 2009, particularly during the last
8 years of the study. Three-fourths
of injuries resulted from battery
ingestion, and the remainder from
ear, mouth, and nasal insertion. BBs
were implicated in 84% of cases
where battery type was known.12
The objectives of the current study
were to:
1. describe the epidemiology of
battery-related ED visits among
children aged <18 years from
2010 to 2019 and the extent to
which ingestions were involved;
and
2. compare the results to those
previously found by Sharpe et al.
METHODS
Data Source
Data on battery-related ED visits
among children aged <18 years
occurring from January 1, 2010, to
December 31, 2019, were obtained
from the National Electronic Injury
Surveillance System (NEISS).26
Operated by the US Consumer
Product Safety Commission (CPSC),
NEISS is a sentinel surveillance
system that uses a stratified
probability-based sample of 100
US hospitals. Statistical weights are
applied to produce national
estimates of consumer product-
related injuries presenting to EDs.
The NEISS includes data on patients’
demographics, injury diagnoses,
affected body parts, disposition, and
consumer products involved. A brief
narrative field is included, providing
further circumstantial information
for each case.
Variables and Case Selection
ED visits involving battery
exposures were identified using the
NEISS product code 884
(batteries).27 Cases were categorized
into #5 years and 6 to 17 years of
age. Patient disposition codes were
dichotomized as hospitalized
(admitted and treated and
transferred) and not hospitalized
(treated and released, held for
observation, or left without being
seen). Case narratives were
reviewed to categorize 3 battery
types:
1. cylindrical (included those
described as “cylindrical,” “AA,”
and “AAA”);
2. BB (included those described as
“button,” “disc,” “flat,” “round,”
and “circular”); and
3. unknown (not documented or
insufficient detail).
Body part and diagnosis codes were
used in conjunction with case
narratives to categorize 4 exposure
routes: (1) ingestion, (2) mouth
exposure, (3) nasal insertion, and
(4) ear insertion. Cases not
involving exposure to internal areas
of the body were excluded. Further,
because of small sample size,
national estimates for 12 cases
involving insertion into the vagina
or rectum could not be calculated
and were therefore excluded from
the study. Mouth exposures were
limited to cases in which the battery
resulted in chemical burns in the
mouth. Ingestions were limited to
cases in which the battery was
swallowed intact. Cases categorized
as ingestion were further
subcategorized as “suspected
ingestion” or “confirmed ingestion.”
There were 2868 unweighted cases
identified for the study period.
 Excluded from the study were cases
where the battery was not
swallowed intact (n 5 47) and cases
where the battery was in the mouth
but did not result in chemical burns
(n 5 36), resulting in a final sample
of 2785 unweighted cases.
Statistical Analysis
Data were analyzed by using Stata
14.2 statistical software. National
estimates were calculated using
CPSC-provided statistical weights.
The CPSC considers a national
estimate to be unstable and
potentially unreliable when: (a) the
estimate is <1200, (b) the
unweighted number of cases is <20,
or (c) the coefficient of variation
exceeds 33%. Estimates not meeting
these stability requirements were
noted as such in results tables. Data
from the US Census Bureau were
used to calculate population-based
rates.28 Statistical analyses included
the calculation of relative risks with
95% confidence intervals (CIs).
Simple or piecewise linear regression
was performed, as appropriate, to
evaluate the statistical significance of
secular trends using a 5 0.05. This
study was determined exempt from
review by the institutional review
board at Children’s National Hospital.
RESULTS
There were 70 322 battery-related
ED visits among children aged <18
years from 2010 to 2019, for an
annual average of 7032 per year, or
9.5 visits per 100 000 children
(Table 1). The ED visit rate was
highest among children aged #5
years compared with children aged
6 to 17 years (24.5 and 2.2 per
100 000, respectively [mean age:
3.2 years, 95% CI: 2.93–3.42,
median: 2 years]). Most patients
(n 5 59 218, 84.2%) were aged
#5 years and more than half
(n 5 40 311, 57.4%) were male.
One-year-olds had the greatest
number of battery-related ED visits
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of any other single year of age
(n 5 19 226, 27.3%) (Fig 1).
From 2010 to 2017, the rate of
battery-related ED visits per
100 000 children increased
significantly among both those aged
<18 years (7.0–14.3, respectively;
P 5 .03) and #5 years (16.8–38.4,
respectively; P 5 .03), followed by a
nonsignificant decrease among both
age groups from 2017 to 2019
(14.3–8.7, P 5 .28, and 38.4–22.8,
P 5 .27, respectively) (Fig 2). There
was also a nonsignificant decrease
among both age groups from 2013
to 2015 (9.7–6.9, P 5 .31, and
25.7–17.4, P 5 .31, respectively).
The rate among children aged 6 to
17 years remained relatively
unchanged during the study period
and was the same in 2010 as in
2019 (2.0 per 100 000 children).
Among all patients, 12.0%
(n 5 8410) were hospitalized
(Table 2). Patients aged 6 to
17 years were 1.65 times (95% CI:
1.58–1.73) more likely to be
hospitalized than patients aged
#5 years. Of cases where battery
type was described (n 5 48 642,
69.2% of cases), most involved BBs
(n 5 41 175, 84.7%). Of cases where
the battery’s intended use was
described (n 5 25 880, 36.8% of
cases), the most frequently were
watches (n 5 7696, 29.7%) and
toys/games (n 5 7458, 28.8%),
followed by hearing aids (n 5 2679,
10.4%), remote controls (n 5 2524,
9.8%), flashlights (n 5 1653, 6.4%),
and all other product types
(n 5 3870, 14.9%).
Exposure Routes
Among all patients, ingestions were
the most frequent exposure route (n
5 63 281, 90.0% [mean age: 3.0,
95% CI: 2.8–3.2; median: 2]),
followed by nasal insertion
(n 5 4006, 5.7% [mean age: 3.5,
95% CI: 3.1–3.9, median: 3]), ear
insertion (n 5 1738, 2.5% [mean
age: 7.2, 95% CI: 6.1–8.2, median:
6]), and mouth exposure (n 5 1297,
1.8% [mean age: 5.2, 95% CI:
3.7–6.7, median: 4]). Ear insertion
was the only exposure route for
which patients aged 6 to 17 years
predominated (n 5 1118, 64.3% of
ear insertions), and this age group
was 9.62 times (95% CI:
8.74–10.59) more likely to present
with an ear insertion than patients
aged #5 years.
Table 3 displays the characteristics
of ingestion cases compared with all
other exposure routes combined.
Patients in both the ingestion and
noningestion groups were
predominately aged #5 years
(n 5 53 800, 85.0%, and n 5 5418,
77.0%, respectively) and male
(n 5 36 003, 56.9%, and n 5 4328,
61.5%, respectively). There was no
change in the proportion of patients
who were hospitalized when
comparing ingestion to noningestion
cases.
Two-thirds (n 5 43 415, 68.6%) of
ingestion cases were confirmed
ingestions. Patients with confirmed
battery ingestion were 1.98 times
(95% CI: 1.87–2.08) more likely to
be hospitalized than those with
suspected ingestions. Where battery
type was described for ingestion
(n 5 43 937, 69.4%) and
noningestion (n 5 4705, 66.8%)
cases, BBs were most frequent
(n 5 37 109, 84.5%, and n 5 4066,
86.4%, respectively). Among all
cases, BB ingestions were 2.1 times
(95% CI: 1.92–2.30) more likely to
result in hospitalization than
cylindrical battery ingestions. The
likelihood of BBs being the ingested
battery type was about the same
among patients aged #5 years
compared with patients aged 6 to
17 years (relative risk: 1.03; 95% CI:
1.02–1.04).
When the trend in ED visits for
battery ingestions alone is
3
 TABLE 1 Demographic Characteristics of Children <18 Years Presenting to US Emergency Departments for Battery-Related Exposures, Present Study
Period (2010–2019) and Previous Study Period (1990–2009)
Present Study (2010–2019) Sharpe et al Study (1990–2009)12

Estimated
Characteristic Actual Sample National Estimate (%)a 95% CI Rate per 100 000 Children National Estimate (%) Rate per 100 000 Children
Total 2785 70 322 (100.0) 51 275–89 369 9.5 65 788 (100.0) 4.6
Age, y
#5 2322 59 218 (84.2) 42 657–75 779 24.5 51 618 (78.5) 10.8
6–17 463 11 104 (15.8) 8080–14 127 2.2 14 170 (21.5) 1.5
Sex
Male 1633 40 331 (57.4) 29 200–51 462 10.7 39 517 (60.2) 5.4
Female 1152 29 991 (42.7) 21 641–38 341 8.3 26 156 (39.8) 3.8
a
Column percentages may not sum to 100.0% due to rounding.

considered, there was a significant
increase among both children aged
<18 years (5.6–13.5, respectively;
P 5 .02) and children aged #5 years
(12.6–36.4, respectively; P 5 .02)
from 2010 to 2017, followed by a
nonsignificant decrease among both
age groups from 2017 to 2019
(13.5–8.2, P 5 .303, and 36.4–21.9,
P 5 .296, respectively). For BB
ingestions alone, the ED visit rate per
100 000 children increased
significantly from 2010 to 2017, both
among children aged <18 years
(2.6–7.1, respectively; P 5 .02) and
children aged #5 years (6.1–19.3,
respectively; P 5 .03), followed by a
nonstatistically significant decrease
among both groups from 2017 to
2019. Similar to the overall trend,
there was, again, a nonsignificant
decrease from 2013 to 2015 among
FIGURE 1
Estimated number of battery-related ED visits among children aged <18 years by age, United States,
2010–2019.
both children aged <18 years and
children aged #5 years in the rates
of overall battery ingestions (8.6–6.1,
P 5 .29, and 22.9–15.8, P 5 .19,
respectively) and BB ingestions alone
(5.6–3.8, P 5 .08, and 14.4–9.4,
P 5 .09, respectively).
DISCUSSION
The battery-related ED visit rate per
100 000 children has continued to
rise in the last decade and was 2.1
times higher during 2010 to 2019
compared with 1990 to 2009 (9.5
and 4.6 per year, respectively).12
There was an average of 1 battery-
related ED visit every 1.25 hours
among children aged <18 years
during 2010 to 2019 compared with
1 battery-related ED visit every 2.66
hours during 1990 to 2009.12
The significant increase in battery-
related ED visits among children
aged <18 years observed from 2010
to 2017 appears to have been
primarily driven by a 2.3-fold
increase in the rate among the #5-
year-old age group between the 2
study periods. Although a
nonsignificant decrease in rates was
observed from 2013 to 2015, the
reason for this is unknown.
In alignment with Sharpe et al,12
ingestions were the most common
exposure route, with children aged
#5 years accounting for 85%
(n 5 53 800) of ingestion cases.
Previous research has similarly
found that a smaller proportion of
battery ingestion cases involve older
children, although those cases tend
to have less severe outcomes.5,11,12
This may be partly due to younger
children having a smaller esophagus
and thus being predisposed to
esophageal foreign body impaction.
Furthermore, parents and caregivers
may be unaware that a young child
has ingested a battery until
significant and often life-threatening
symptoms develop. In the current
study, battery-related ED visits were
more frequent among 1-year-olds
than any other single year of age,
and the mean patient age between
the 2 study periods decreased from
3.9 years to 3.2 years,12 indicating
that children presenting at EDs may
be getting younger.

4 CHANDLER et al
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FIGURE 2
Annual rate of battery-related ED visits among children aged <18 years old by age group and year,
United States, 2010–2019.
Where battery type was known, BBs
accounted for similar proportions of
ingestions among children aged <18
years for both study periods (84.5%
during 2010–2019 and 83.8%
during 1990–2009).12 The significant
increase in BB ingestions among
children aged <18 years found by
Sharpe et al12 also continued during
the first 8 years of the current study
period, driven by increases among the
#5-year-old age group. This increase
may reflect an increase in BB-
powered products in the home,
leading to increased exposure.8,16,29
Although the NEISS does not
provide detailed information
regarding outcomes after patient
discharge from the ED, the rise in
the proportion of battery-related
hospitalizations between the
1990–2009 and 2010–2019 study
periods may indicate that injuries
are increasing in severity. Other
reports have confirmed increasing
incidence of injury severity and
death after BB ingestions that has
paralleled the introduction and
increased use of larger ($20 mm
diameter), 3-voltage lithium BBs in
the home.10,15,25,30,31 Litovitz et al
reported a 6.7-fold increase in the
proportion of BB ingestions
resulting in major or fatal outcomes
from 1985 to 2009, with outcomes
being significantly worse for
ingestions of $20 mm lithium-
powered BBs and children aged <4
years.15 Further, 12.6% of children
aged <6 years who ingested a $20
mm BB suffered a major effect such as
tracheoesophageal fistula, esophageal
perforation, fistulization into major
vessels, esophageal strictures,
spondylodiscitis, or vocal cord
paralysis.15 A mechanism for improved
reporting directly by medical
professionals who manage these cases
may allow for more detailed reporting
and understanding of BB ingestion
treatment and outcomes. One example
is the recently developed GIRC app
(Google Play and App Store, www.
globalirc.org), a free, Health Insurance
Portability and Accountability Act-
compliant smartphone application for
clinicians to anonymously report
pertinent injury details, including up to
3 photographs of the BB or other
object removed, symptom severity,
removal techniques, complications,
treatment provided, and clinical
outcomes, to a centralized, global
database.32
When intended battery use was
described, toys/games, watches, and
hearing aids predominated;
however, the proportion of batteries
intended for watches increased from

TABLE 2 Disposition, Battery Exposure Route, and Battery Type Involved Among Children <18 Years of Age Presenting to US Emergency Departments
for Battery-Related Exposures, Comparing 2010–2019 and 1990–2009
% National Estimatea National Estimate
Actual Sample National Estimate Estimated 95% CI Percentage Point Change
Characteristic 2010–2019 2010–2019 2010–2019 2010–2019 1990–200912 1990–200912 to 2010–2019
Dispositionb
Not hospitalized 2394 61 911 45 113–78 710 88.0 92.6 4.6
Hospitalized 391 8410 5725–11 095 12.0 7.3 4.7
Exposure route
Ingestion 2482 63 281 45 916–80 646 90.0 76.6 13.4
Nasal insertion 185 4006 2741–5272 5.7 10.2 4.5
Ear insertion 82 1738 1078–2398 2.5 5.7 3.2
Mouth exposure 36 1297 453–2141 1.8 7.5 5.7
Battery typec
Button 1714 41 175 27 864–54 486 84.7 83.8 0.9
Cylindrical 283 7467 5340–9594 15.4 16.2 0.8
a
Column percentages may not sum to 100.0% due to rounding.
b
For comparison purposes, “admitted” and “transferred to another hospital” disposition categories reported by Sharpe et al were grouped in the current study as “hospitalized,”
and “treated and released,” and “other” were grouped as “not hospitalized.”
c
Battery type could not be determined for 30.8% (n 5 21 680) of estimated cases in the current study and 35.2% (n 5 23 133) of estimated cases in Sharpe et al.

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 TABLE 3 Demographic Characteristics, Treatment Disposition, and Battery Type Involved Among Children <18 Years of Age Presenting to US
Emergency Departments for Battery-Related Exposures, Ingestion Versus All Other Exposure Routes, 2010–2019
Ingestion All Other Exposure Routes

Estimated Estimated
Characteristic Actual Sample National Estimate (%) 95% CI Actual Sample National Estimate (%) 95% CI
Total 2482 63 281 (100.0) 45 916–80 646 303 7041 (100.0) 4947–9134
Age, y
#5 2082 53 800 (85.0) 38 530–69 070 240 5418 (77.0) 3775–7061
6–17 400 9481 (15.0) 6919–12 043 63 1623 (23.0) 890–2355
Sex
Male 1438 36 003 (56.9) 25 696–46310 195 4328 (61.5) 3005–5651
Female 1044 27 278 (43.1) 19 717–34 840 108 2713 (38.5) 1657–3768
Disposition
Not hospitalized 2132 55 724 (88.0) 40 435–71 014 262 6187 (88.0) 4247–8128
Hospitalized 350 7557 (12.0) 4998–10 115 41 854a (12.0) 472–1235
Battery typeb
Button 1532 37 109 (84.5) 24 759–49 459 182 4066 (86.4) 2725–5408
Cylindrical 261 6828 (15.5) 4787–8868 22 639a (13.6) 140–1139
a
National estimate is potentially unstable because the national estimate is <1200 or the coefficient of variation is >33%.
b
Battery type could not be determined for 30.6% (n 5 19 345) of estimated ingestion cases and 33.2% (n 5 2335) of estimated cases with other exposure routes.

13.7% during 1990 to 200912 to
29.7% during 2010 to 2019. The
leading products identified during
both study periods align with
previous analyses of calls to poison
centers for the management of
battery exposures in the United
States and Australia.713 Litovitz et al
reported that, in 61.8% of calls to
the National Battery Ingestion
Hotline in the US, children had
obtained the battery themselves
directly from the product.13
Although the decreases in rates of
overall battery- and BB-related ED
visits from 2017 to 2019 did not
reach statistical significance, they
may signal the beginning of a
downward trend attributable to
multisectoral prevention initiatives
in recent years. Prevention efforts
initially focused only on preventing
exposure to BBs and educating
parents and other caregivers about
the hazards BBs present. For
example, in 2011, Safe Kids
Worldwide and Energizer partnered
to launch the “Battery Controlled”
campaign, which used media and
community outreach to spread
public awareness of the risks of BB
ingestion.33 In 2012, the National
Button Battery Task Force was
formed by the American Academy of
Pediatrics and American Broncho-
Esophagological Association as a
multidisciplinary effort of
representatives from relevant
organizations in industry,
government, poison control, clinical
medicine, and public health to develop,
coordinate, and implement strategies
to reduce the incidence of BB injuries
in children.10 Although the National
Button Battery Task Force also
supports education of parents and
caregivers, they recognized that
education alone is not enough and
have advocated for voluntary
standards addressing product design
and packaging.17 Standards such as
UL60065 and UL4200A require that
lithium battery compartments require
2 or more independent movements or
the use of a tool to open them. In
2017, the CPSC updated ASTM
F963–17 to require that BB-powered
toys intended for children aged <14
years include warning labels and
instructions to inform consumers of
BB risks. Although these standards are
an improvement, they have yet to be
expanded to include all BB-containing
household items commonly associated
with child exposure. In August 2022,
“Reese’s Law” was passed by the US
Congress with bipartisan support and
signed into law. This new law will
require the CPSC to develop
child-resistant testing standards for
BB packaging and BB-powered device
battery compartments, and that
BB-powered devices include labeling
clearly identifying ingestion risk and
instructing consumers to keep such
products out of reach of young
children.30
BB manufacturers have also
introduced features to prevent
ingestions, including child-resistant
packaging and hazard warning
labels.14 In 2020, Duracell released a
BB option with a nontoxic bitter
coating to try to discourage
ingestions; however, use of
bitterants has not prevented
ingestion of other hazards, so the
efficacy of this approach with BBs
has yet to be established.34–36 Other
industry efforts are targeted toward
reducing injury severity in the event
of BB ingestion. For example,
Landsdowne Laboratories has
designed an innovative technology
(ChildLok), which aims to reduce
liquefactive tissue necrosis when a
BB becomes lodged in the
esophagus.37 If proven effective,
such safety technologies should
immediately be widely adopted by

6 CHANDLER et al
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 battery manufacturers.
Another issue is safe disposal of
BBs. BBs no longer powering a
device may still have enough
residual charge to cause injury when
lodged inside the body, yet current
packaging does not clearly define
safe disposal after removal from a
device. A recent study involving
wrapping BBs bidirectionally in
common household tapes found no
further drop in voltage, no change in
esophageal tissue pH, and no visible
tissue injury in esophageal tissue
models, suggesting a safer disposal
solution. However, the authors
caution that taped BBs should still
be removed emergently if
swallowed.
Finally, novel clinical mitigation
strategies for reducing the rate of
injury pre- and post-removal have
been developed for esophageal BB
impactions and incorporated into
the National Capital Poison Center
Button Battery Ingestion Triage and
Treatment Guideline.14,15,18,38
Although not a substitute for
emergent BB removal from the
esophagus, these strategies can be
considered to help slow the rate of
injury during emergency
transportation.
LIMITATIONS
This study has several limitations.
The study sample is limited to
battery-related exposures that
in a leadership position on the National Button Battery Task Force; and serves on the medical advisory board of the Global Injury Research Collaborative,
which is a US Internal Revenue Service-designated, 501(c)(3) nonprofit organization. The other authors have indicated they have no potential conflicts of
interest relevant to this article to disclose.
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