The Dangers of High-Powered Magnets – PediaCast 514
- Dr Leah Middelberg visits the studio as we consider the dangers of high-powered magnets. Learn who is at risk, how to recognize them, why they are dangerous, and where to turn for help if your child is injured. We hope you can join us!
- Dangers of High-Powered-Magnets
- Emergency Medicine at Nationwide Children’s
- Center for Injury Research and Policy at Nationwide Children’s
- High-Powered Magnet Exposures in Children: A Multi-Center Cohort Study
Announcer 1: This is PediaCast.
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello, everyone, and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike coming to you from Nationwide Children's Hospital. We're in Columbus, Ohio.
It's Episode 514 for March 30th, 2022. We're calling this one "The Dangers of High-Powered Magnets." I want to welcome all of you to the program.
So, we have an important safety message for you this week as we consider the dangers of high-powered magnets. And before we get too excited, we are not talking about the magnetic field itself, okay? You're not going to hear me say that strong magnetic fields cause cancer, COVID or any other medical condition.
They can erase credit card information on certain types or cards or mess up some computer hard drives. And there are some medical devices that strong magnetic fields may affect like pacemakers and internal defibrillators. But magnetic fields themselves do not cause disease or injury.
So why are we talking about high-powered magnets today? How is it that they're dangerous? Well, the danger exists when two or more high-powered magnets are swallowed because they can connect together inside the gastrointestinal tract through tissue. They can cut off blood supply and cause loss of complications including a perforation or a hole in the bowel wall. And that can be life threatening.
So today, we're going to explore this phenomenon, including what exactly is a high-powered magnet and how's it different from a regular or standard magnet. How could you identify them? How common are these injuries?
And there has been legislation and court rulings on these issues. So, we're going to talk about those. And we'll also describe other possible complications and explore risk factors, so which kids are more likely to have problems with high-powered magnets.
And we'll also share some helpful hints for families, schools, communities, industry, and lawmakers so we can all work together in keeping kids safe.
To help us with the discussion, we have a fabulous guest visiting us this week, Dr. Leah Middelberg. She is a pediatric emergency physician at Nationwide Children's Hospital and the lead author of a paper recently published in the Journal of Pediatrics, which is a publication of the American Academy of Pediatrics. The paper is called High-Powered Magnets Exposures in Children: A Multi-Center Cohort Study. So she's going to be here to talk about that project and sort of break down the research for us.
Before we get to her, let's cover our usual quick reminders. Don't forget, you can find us wherever podcasts are found. That includes the Apple and Google podcast apps, iHeartRadio, Spotify, SoundCloud, Amazon Music, and most other podcast apps for iOS and Android.
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So, let's take a quick break. We'll get Dr. Leah Middelberg connected to the studio. And then, we will be back to explore the dangers of high-powered magnets. It's coming up right after this.
Dr. Mike Patrick: Dr. Leah Middelberg is a pediatric emergency medicine physician at Nationwide Children's Hospital and an assistant professor of Pediatrics at the Ohio State University College of Medicine. She has a passion for treating and preventing injuries in kids, including those caused by high-powered magnets.
In fact, she was lead author of a paper recently published in the Journal of Pediatrics called High-Powered Magnet Exposures in Children: A Multi-Center Cohort Study.
That's what she's here to talk about, the dangers of high-powered magnets. So, let's give a warm PediaCast welcome to our guest, Dr. Leah Middelberg. Thank you so much for joining us today.
Dr. Leah Middelberg: Hi. Thank you for having me.
Dr. Mike Patrick: Really appreciate you taking time out of your busy schedule to enlighten us all on the dangers of these magnets.
So what exactly is a high-powered magnet? I think that's a fine place to start. And how are they different from just normal magnets you might have on your refrigerator?
Dr. Leah Middelberg: Yeah, absolutely. So high-powered magnets are usually made of rare earth metals, something like neodymium. These magnets and these metals are up to 30 times more powerful than like the average refrigerator magnets that might be at your home, on the refrigerator.
And they're often shiny, even small, little products that unfortunately can be really enticing to children. They started showing up in children's toys and things like building sets in the early 2000s. And then about 2008, 2009, we started seeing them in desks sets or kind of like fidget sets. And they'll come in sets of every up to 100s of these tiny, small powerful magnets. And unfortunately, these can be extremely dangerous.
Dr. Mike Patrick: It's always difficult when something fun for some people is dangerous for other people because it's something that you want to do and play with. And putting these balls together, I'm sure folks have seen those as the desks sets, where you have those magnetic balls, and they stick together really tight.
But we know that they're dangerous. Before we move on to why they're dangerous, regular magnets are not rare earth metals, right? They're made up of iron, cobalt, nickel, or some combination of those things.
Dr. Leah Middelberg: Yeah, they're often called ferrite or ceramic magnets, but there's those the standard like little alphabetic letter type of magnet that you may see stuck to your fridge. And the kind of the way you can tell the difference, just a quick way is when you're holding them or playing with them at home, they're not really going to powerfully attract to each other. But these rare earth magnets just powerfully attract to each other, even though the surfaces.
Dr. Mike Patrick: So, if you're unsure whether you have high-powered magnet or regular magnet, just try to put them together and if they go together kind of weakly, yeah, that's regular. But if there's a bang together, then you know that's a high-powered magnet regardless of the shape.
Dr. Leah Middelberg: Yeah, absolutely.
Dr. Mike Patrick: Okay, so tell us then why are these things dangerous? It's not the magnetic field that we're worried about, right?
Dr. Leah Middelberg: Right. They're dangerous because they are so strong, but there are other things that obviously make them dangerous, how small they are, how shiny they are. Unfortunately, little ones frequently put things in their mouth. This is developmentally very normal. Anybody that's been around kids or has kids has probably seen this.
And foreign bodies or swallowing something that's not food is a pretty common thing we see in the pediatric emergency room all the time. And the vast majority of foreign bodies that kiddos swallow are essentially benign. Anything that's big enough and the location, it can be dangerous. But most things are going to pass by themselves without a lot of extra help form us and kids are going to do really well.
But unfortunately, there are certain products that when they're swallowed, that product into themselves can be really dangerous for kiddos, things like button batteries and, definitely, these high-powered magnets.
And the thing we see is that again these magnets are so strong, they'll attract to each other across body tissue even.
So, magnets can attract to each other, trap tissue in between the magnets. And that trapping can cause the tissue to die, to cause holes in the tissue in the case of these magnets being swallowed. And all that's happening in the kiddo's gut. It can cause bad twisting of the gut or blockages, can lead to serious infections. And unfortunately, there'd been cases of bleeding to even death.
Dr. Mike Patrick: Yeah, so really good point. So, the magnets, when you have two or more can attract one another across tissues. If you get a hole in the tissue, we know there's a lot bacteria inside the gut. And then that bacteria can spill outside of the gut into the abdominal cavity. And then you got a raging infection, which can get into the bloodstream and cause sepsis. And kids can die from that.
And it can happen fairly quickly too, right?
Dr. Leah Middelberg: Yeah, it can. And unfortunately, often the initial symptoms of an injury from a high-powered magnet may be very common-looking, right? Kiddos get bugs all the time, vomiting, fever, belly pain. Those are really common symptoms we see and just child have in general.
So, without knowing that the kiddo had swallowed a magnet, we may not know for a period of time that that what's going on and that can be really dangerous, especially in little ones that can't tell us that they swallowed magnets. Or even, unfortunately, in older kids that are may be embarrassed to tell somebody that they swallowed a magnet.
So, if there's concern with these products in a home and a child has these symptoms, really helpful to give that information because it may lead to finding that diagnosis.
Dr. Mike Patrick: Yeah. Something to keep in mind for parents, but also the providers out in the crowd. I guess that should become a question that we ask when kids come in with vomiting and even with fever. We may assume it's a viral infection, but maybe one question we should be asking is, "Hey, are there any high-powered magnets at home? And if so, is there a possibility that your child swallowed two or more?"
And if so, get an X-ray just to be sure. Because if you do have a perforation, you could certainly have a fever following that along with vomiting. And that really could just look like a viral infection when it's not.
Dr. Leah Middelberg: Absolutely. Unfortunately, by the time you have some of the more severe symptoms, you already have an injury and probably pretty sick from these. So, if you're having kind of mild symptoms but there's these magnets in the house, so one question I like to ask families is, "Any chance your kiddos could have swallowed something, puts something in their mouth they shouldn't?" It's really just important information to keep in mind.
Dr. Mike Patrick: Absolutely. So then how common are these injuries? And has their incidents changed over time?
Dr. Leah Middelberg: So, like we said, swallowing foreign bodies is really common. These magnets are little bit hard to put exact numbers to, but estimated thousands of injuries since they hit the market in early 2000s and really, that number greatly increased after 2009, when these high-powered desk sets entered the market.
In fact, in 2011, it was estimated over 2,700 cases alone in that year. There has been some changes in the number of cases we see over the last decade or so. And that mainly has to do with some federal regulations that have surrounded these products.
So, in 2012, the Consumer Product Safety Commission recognized that there were these significant injuries happening for kiddos from these products and they recalled high-powered magnet sets or certain high-powered magnet sets. And then, they went through the process of putting in a federal rule set which effectively banned high-powered magnet sets that went through about 2014.
I actually was lucky enough to be part of a group last year that looked at a study utilizing the US Poison Control data system. And we looked at the number of calls related to magnet exposures over the last 15 years that these magnets have been available in the United States.
We looked at a period of time before the Consumer Product Safety Commission acted with their federal ban, during the ban when it was in place and then after the ban. It was unfortunately recalled in 2016 due to some legal challenges by manufacturers. And what we saw was that the ban was pretty effective. From the period the CPSC ban was in place, there was a decrease in magnet calls by about 33%.
And after the ban was overturned in late 2016 and magnets entered the market in 2017, we saw a huge jump in numbers, 400% increase in the number of calls.
And in fact, in just 2018 and 2019, from our time period of 2008 to 2019, just those two years encompassed about 40% of all magnet related calls. So unfortunately, we saw a huge jump in the numbers over the last several years that these products have reentered the market.
Dr. Mike Patrick: So just to kind of sum that up for folks, these products came on the market in the early 2000s. And then by 2012, we were having almost 3,000 injuries a year of kids. And so, the Consumer Product Safety Commission went through the process of banning them. And then, that went through in around 2014 or so.
And then, when that happened, the number of yearly injuries dropped dramatically. But then a company challenged that in federal court and actually Justice Neil Gorsuch, who's now in the Supreme Court, is the one who wrote the majority opinion. And he said the injury data was too uncertain and imprecise to constitute substantial evidence for the Commission's finding on the risk of injury. So, they felt like, well, you haven't really proven well that it was magnets that did this although it's sort of silly.
But anyway, so they struck down that rule and then the magnets came back on the market around 2016 or so. And then, the number of injuries has just skyrocketed since then, yes?
Dr. Leah Middelberg: Yeah, exactly, and so after 2016 when magnets reentered the market, they were supposed to only be marketed to children 14 years and older. But unfortunately, we don't just see injuries in that age group and that's not always strictly enforced. And so, these products are still a concern for all children.
Dr. Mike Patrick: And when you say it's only for 14 and older, a lot of times, there's also a five-year-old in the house.
Dr. Leah Middelberg: Exactly.
Dr. Mike Patrick: And so, they still get exposed to them. Sort of in response to this whole scenario with now them being back on the market and there being more injuries, you and your team have embarked on a research project to kind of look more deeply at these injuries. Tell us about the aim of your study.
Dr. Leah Middelberg: So pediatric emergency medicine doctors, pediatric GI doctors, pediatric surgeons all over the country were seeing these injuries. And we felt we are seeing more of them which has since been proven with a lot of good data. And that obviously made anybody who cares about these injuries and our patients really do what we can to study this further and be able to help in any kind of prevention efforts.
So, you're exactly right. The federal court that overturned the federal rule set did say there is insubstantial evidence. So, what do we need in the side of that? We need more evidence.
So, we sought to look at high-powered magnet injuries form hospitals, children's hospitals, across the country and really see what was going on in this post-federal rule set time period. So, we partnered with folks all over the country from all of these subspecialists to get more data.
Dr. Mike Patrick: And then, kind of describe what exactly you did. So, your study's method, how did you go about moving forward to get these data?
Dr. Leah Middelberg: We contacted a lot of children's hospitals, a lot of friends across the country. And we end up having 25 children's hospitals from across the US participate which is really great. We looked at cases of pediatric high-powered magnet visits, so families, patients who came to pediatric emergency room or came to our clinic or came to our urgent care in one of these hospitals from 2017 to 2019 for a high-powered magnet exposure.
So that included swallowing or accidentally inhaling a high-powered magnet product. But also, kiddos who might have inserted a magnet into their nose, their ears, anything.
We want to basically get the full gamut of what the injuries from these products could look like. And it was really important for us to be able to get some outcome data from these injuries because that didn't really exist in a lot of other previous data on this topic.
So, we wanted to see, out of these kiddos who have been exposed, these high-powered magnets, how many are getting really injured? How many ends up needing a surgery or procedure to remove these products or to fix damage that hadn't been done? So, we collected a lot of information about these cases including grey outcome data.
Dr. Mike Patrick: The 25 children's hospitals that you mentioned, they're also pretty representative of the entire country, as I was looking through your study. So, there were hospitals obviously here in Ohio, in Nationwide Children's Hospital. Other hospitals in the Midwest, at New York, Florida, Texas, California. So really all across the country to show that this is a problem nationwide, not necessarily just in one area or another.
And I think one of the things that we have to remember is it's not just the magnet exposure itself that can be a danger. But the treatment can be a danger too because you got to go fish these things out and that may take putting tubes down into the GI tract or surgery. And so, you can have complications from the treatment as well. And so, I'm sure that your study kind of look at that too, right?
Dr. Leah Middelberg: Yeah, absolutely. We obviously need to do what we have to do to keep children safe. But interventions like you're talking about can on to themselves have effects that we don't want. So, anesthesia for instance or just the process of diagnosing, having a high-powered magnet in your system and then potentially following it with serial X-rays, to see, "Hey, what's happening? Where are these moving? Is there anything new or different that we're worried about happening?"
The serial X-rays are frequent radiation exposure which we're so cautious about in pediatrics because we know it's something than can be long-term dangerous for kiddos.
Dr. Mike Patrick: Yeah, really good point. So, tell us about your results, what did you find in terms of magnet exposure in kids?
Dr. Leah Middelberg: We had almost 600 kiddos in our study. So about 596 children were included from ages as young as two months to 18 years old. And the majority of the kiddos that presented for high-powered magnet related injury did require hospitalization.
So, 56% required hospitalization and almost one in ten actually had a potentially life-threatening injury, something like that, an obstruction of the bowel or the gut or a hole like we talked about in the tissue, bleeding. Or even that dangerous twisting of the gut can sometimes happen.
The vast majority, like 96%, were swallowed. There were several cases of other insertions and magnets being inhaled but vast majority unfortunately are magnets that get swallowed into the GI tract of kiddos.
And then, talking about procedures that may be needed to remove these products, 46% of the kiddos, almost half of the kids in our group actually needed the procedure. So, whether that was a scope going down, a camera going down to retrieve things or an actual surgical procedure, almost half needed something like that to retrieve the magnets and they didn't kind of pass by themselves.
Dr. Mike Patrick: Yeah, and we know that there can be long-term complications when you have open bowel surgery. So not just the scope going down, but when you actually have to go through the stomach and the skin to get in, those kids can get bowel obstruction from adhesions later on in life. So again, there's a lot of potential complications from this other than the acute injury of the magnet being in there at that moment for sure.
So, in terms of significance of these findings then, what's next?
Dr. Leah Middelberg: We collected a lot of great data. We're hoping to look at some things a little bit more carefully even still because the good news is that there seems to be some new movement from the Consumer Product Safety Commission. A new recall was instituted at the end of 2021. And there's a new proposed rule set that's being discussed currently. But that can take a lot of time for those things to go through.
And unfortunately, even if something's eventually passed, it doesn't completely eliminate these products from households. We know that sometimes these products are just around for years. And so, they can still be causing injuries. So, we definitely want to continue to look at the data and see what other things that can be helpful especially for providers who are treating these kiddos to be able to glean.
I think some other interesting things we discovered from this particular study is the age of the patient involved. So, the average age of the kids in our study was almost eight years old. Like we talked about at the beginning, foreign bodies being swallowed by kids is typically a young kid problem, kids less than five years old. So, this is older than that group.
We have some reports about these products being used in older kiddos, preteens, teenagers, to do things like simulate oral piercings and then unintentionally being swallowed. Or like we talked about they'd be strong that they attract to each other, that these children may be kind of trying to separate them with their teeth and unintentionally swallowing them.
So, there is a concern in the older kids for these injuries as well. But still, 95% of the kids in our study were less than 14 years old. So, like we were talking about with the current federal regulations where these products are only supposed to be marketed and sold to those that are 14 and older, clearly, that data does not reflect that and that kids of all ages are still getting access to these products and having injuries.
Dr. Mike Patrick: Yeah, absolutely. So, your data, if we think about the conclusion of your project, the conclusions that you drew, that these high-powered magnets can lead to injury in kids and oftentimes do. And when those injuries occurred, there's a frequent need for recurrent radiation exposure and hospitalization and the need for surgical interventions of one kind or another.
And so, this is a real problem and certainly, the federal government can come in and make the rules and ban these things again to help protect our kids. But until that happens, what can parents do to keep their kids safe from these high-powered magnets?
Dr. Leah Middelberg: Yeah, these injuries, our study definitely showed, unfortunately, when you're exposed to high-powered magnets, injuries could be common, serious, costly. And we're cognizant of the fact that these injuries are not just costly in a medical sense but costly to the time and the energy and the life impacts to these families when they have to stay in the hospital for things like that.
The best way to really kind of prevent these injuries is obviously to hopefully have these products not available to children. And one of the best ways to do that is to keep them out of homes where children spend time.
Having conversations with your kids about these products being dangerous and why they're dangerous is important, especially children that may seem older, that they may not seem like you have to worry about them swallowing non-food items anymore.
Much like we talked about, there's ways that unfortunately these items could be unintentionally swallowed, even for the older kiddos. So having conversations with them about these products being dangerous.
There was a Magnet Injury Prevention Act that was proposed in Congress in 2019-2020. Unfortunately, it hasn't been taken up for further action but calling your congressional leaders to encourage them to do so can always be helpful, never a bad thing.
And like we talked about pictures where if you're suspicious that your child has ingested a high-powered magnet, calling your doctor or talking to the local poison control center to get some guidance and potentially needing a hospital visit is really important to either if the exposure did happen to prevent injuries.
Dr. Mike Patrick: Yeah, absolutely. So, if I'm an adult who enjoys tinkering around with these magnets in a desk set, maybe I should take those to work, where there aren't going to be any kids around to be injured by them.
And then, what about schools and communities? It would seem like they would be kind of a fun thing to have in schools and day cares. But really, we probably shouldn't have them there, right?
Dr. Leah Middelberg: Exactly, yeah. We saw a little over 12% of the group that we looked at actually said that the magnets that they were exposed to, they were exposed to it a daycare setting or a school. So, you're exactly right. And this is consistent with other studies that have come out, that non-home environment is a still a place of potential risk.
So, we probably should have conversations and some education for schools and education providers just so they're aware as well. And then, there are other great ways to demonstrate I think for science purposes the magnetism or magnetic pulls, especially using products that are maybe weak enough where they can't cause damage, or large enough where they can't be ingested.
And again, always having conversations with our own kids so they know, "Hey, my friend is playing with these at school. They brought them from home. Maybe I don't need to play with them, too."
Dr. Mike Patrick: Yeah, absolutely. And so, if you are a school and daycare worker and you're listening to this podcast, it's something to be aware of. Maybe look around your room, your facility, and see if these things are available. And if they are, talk to the folks in charge and maybe get those out and away from kids so that they don't swallow them.
And then, what about industry itself? It's tough because the purpose of companies is to make money and they have stockholders that they have to report to. And so, I'm sure that they make money selling these magnets. But we also want to be ethical in our business behavior, right? And so, what advice do you have for companies that may be manufacturing these items?
Dr. Leah Middelberg: I think the federal rule set that was in place from 2014 to 2016 had a really good thought process for this, which is these magnets should either not be strong enough, where if they 're swallowed, they're going to cause internal damage to kiddos and attracts so strongly to cause that damage. Or they should be large enough where they can't be swallowed.
So, the common refrigerator magnet, that ceramic or ferrite magnet, if you swallow it, obviously, we want to make sure it's not one of those high-powered magnets. So, it's still a concern, still talk with your doctor or poison center. But at the same time, they're not strong enough where they're usually going to cause the level of injuries that we see with these high-powered magnet products.
So, the federal rules that reflected that, and I think manufacturers, keeping that in mind when they're manufacturing products would be extremely helpful in preventing these injuries.
The other problem is the marketing. So, I do a fair amount of research online of these products. And as a result, I'm sure a lot of you guys can sympathize, but I get a lot of targeted ads for shiny colorful high-powered magnet products. And it's been shocking to me that these ads will say things like "Fun for all ages," and "Perfect Gift for children". So that language is obviously really misleading and kind of gives a veil of safety that isn't there.
So, I would challenge the distributors of products to also kind of try to act responsibly here. And to make sure we're calling out false advertisements and try to really encourage stores and online marketplaces to remove dangerous products from their sales.
Dr. Mike Patrick: Yeah, really good points. And hopefully, there are some people in the audience from the industry that may be able to take that advice to heart.
And then, in terms of the federal government, you mentioned that there may be some movement on this in the future?
Dr. Leah Middelberg: Yes, the Consumer Product Safety Commission is reviewing the reinstitution of a federal rule set similar to that of 2014. So right now, it's a proposed federal rule set, and this process takes a lot of time for careful review and comments from a lot of different parties involved and can take years to kind of fully be enacted. But we're really hopeful that a repeat federal rule set will be in place and really will be able to help protect children.
But in the meantime, parents, please search your houses and talk to your schools, talk to the daycare place. Any place your kids spends time, please think about these high-powered magnets, and make sure that your kids are not exposed to them. Because ultimately, you can prevent this by prohibiting exposure.
We really appreciate you taking time to talk to us today. I had mentioned that you are a pediatric emergency medicine physician at Nationwide Children's. Before you go, tell us a little bit more about emergency medicine at our hospital.
Dr. Leah Middelberg: I love pediatric emergency medicine. Like you said, I'm passionate about treating sick children and injured children and I'm passionate about hopefully preventing those injuries too. But the Emergency Department is a great environment especially at Nationwide Children's to work. We have a great staff. And our nurses and physical therapists and physicians are all a really great team.
Especially over the last couple of years, we have really worked fantastically together to do what we can to help and protect and treat the kiddos of Columbus and really, all over. We see kiddos from all over.
I am particularly passionate and interested in injury. For a lot of the reasons, we kind of talked about, the fact that injury feels so preventable, right? Illnesses unfortunately happen, we do what we can prevent those. But injuries often feel like the thing that we can really enact the change upon and help prevent.
And so, one of the things I'm super interested in is looking at injuries, what can we do to learn more about how they happen, who they happen to, and hopefully let that inform prevention and trying to keep children as safe as possible.
Dr. Mike Patrick: Absolutely. For those who like to learn more about Emergency Medicine at Nationwide Children's, I will put a link in the show notes. Also, a link to the Center for Injury Research and Policy at Nationwide Children's, which really makes a concerted effort to prevent injuries in kids.
And then, I'll also put a link to the article that you authored, High-Powered Magnet Exposures in Children: A Multi-Centered Cohort Study. We'll have a link in the show notes for that as well.
So, Dr. Leah Middelberg, once again, pediatric emergency physician at Nationwide Children's Hospital. Thank you so much for being here today.
Dr. Leah Middelberg: Thank you guys so much for having me.
Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that.
Also, thanks to our guest this week, Dr. Leah Middelberg, pediatric emergency physician at Nationwide Children's Hospital.
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