The Dangers of Button Batteries – PediaCast 584

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Show Notes

Description

Dr Kris Jatana and Dr Hunter Holsinger visit the studio as we consider the dangers of button batteries. They are small, shiny, and powerful—and hiding inside lots of everyday items. But did you know button batteries can also cause life-threatening injuries? Tune in for details!

Topic

Button Battery Dangers

Guests

Dr Kris Jatana
Pediatric ENT Surgeon
Nationwide Children’s Hospital

Dr Hunter Holsinger
Pediatric Resident
Nationwide Children’s Hospital

Links

National Capital Poison Center (1-800-222-1222)
Battery Ingestion Hotline (1-800-498-8666)
T4CIP – Trainees for Child Injury Prevention
Trainees for Child Injury Prevention
How Small Batteries Can Become Dangerous to Children
Button Batteries are Extremely Dangerous
Button Battery Safety
Studies: Button battery-related ED visits increase significantly, early treatment needed to avoid severe complications

Episode Transcript

[Dr Mike Patrick]
This episode of PediaCast is brought to you by Trainees for Child Injury Prevention and Nationwide Children's Hospital. 

Hello, everyone, and welcome once again to PediaCast. We are a pediatric podcast for moms and dads.

This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It's episode 584.

We're calling this one the dangers of button batteries. I want to welcome all of you to the program. So, button batteries are small, shiny, and powerful.

You know what they look like. They're round and flat and often in electronics and toys and hearing aids and all sorts of things. In fact, they're hiding in lots of everyday items throughout our homes.

But did you know that these common power sources can cause life-threatening injuries in young children? They can, and probably more often than you would imagine. In fact, about once every 75 minutes, a child presents to an emergency department in the United States because of a button battery injury.

These are really important to think about because it's preventable, 100% preventable, by keeping these batteries out of the hands of children. This is important information. We're going to explore button battery safety, including what makes these batteries so dangerous, what symptoms result when they're swallowed or put up the nose or inside an ear.

What should you do if your child does that? So, if they put one in their mouth and swallow it or one in their ear or one in their nose, what do you do? And then how can we prevent these potentially tragic injuries?

We'll answer all of these questions and more. And of course, in our usual PediaCast fashion, we have two terrific guests joining us in the studio this week. Dr. Kris Jatana is a pediatric ear, nose, and throat surgeon. And Dr. Hunter Holsinger, he is a pediatric resident, both from Nationwide Children's Hospital. Don't forget the information presented in our podcast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals.

If you're concerned about your child's health, be sure to call your healthcare provider. Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at pediacast.org. So, let's take a quick break.

We'll get our experts settled into the studio, and then we will be back to talk about the dangers of button batteries. It's coming up right after this. Dr. Kris Jatana is a pediatric ear, nose, and throat surgeon at Nationwide Children's Hospital and a professor of otolaryngology at The Ohio State University College of Medicine. He also serves as Surgical Director of Clinical Outcomes and Director of Pediatric Otolaryngology Quality Improvement at Nationwide Children's. Dr. Jatana has provided leadership to both national and global button battery task forces, and he is the current chair of the Foreign Body Accidents Committee of the American Broncho-Esophageal Association. Dr. Hunter Holsinger is a second-year pediatric resident at Nationwide Children's Hospital and an aspiring fellow in pediatric critical care. Both have a passion for preventing and treating button battery injuries. That is our topic today. But first, a warm PediaCast welcome to our guests, Dr. Kris Jatana and Dr. Hunter Holsinger. Thank you both for stopping by the studio today.

[Dr Kris Jatana]
Thank you, Dr. Mike. It's great to be here.

[Dr Hunter Holsinger]
Yeah, thanks, Dr. Mike. It's a privilege to be able to talk about this with you all.

[Dr Mike Patrick]
Yeah, we are excited about it.

It turns out that last Thursday, June 12th, was National Button Battery Awareness Day, organized by Reese's Purpose. And I know we're a little late to the party, or early, if you want to think of it that way. We're 52 weeks early for the event in 2026.

But the point is that button battery safety is super important information, and we really want to raise awareness and prevent injury every single day. So, let's get into it. Hunter, what exactly are button or coin cell batteries, and where are they commonly found?

[Dr Hunter Holsinger]
Yeah, that's a great question. So often, LA people will use them synonymously. So, button or coin, they're different types of cell batteries, which are defined both by the U.S. Consumer Product Safety Commission, through a law that we'll talk about later, as any single cell battery with a diameter greater than the height of the battery. Any other battery determined by the consumer commissioned to pose ingestion hazards. So, they're different really in kind of the particular components that they contain. So, coin batteries contain lithium, button do not.

So, button cell batteries, they're often used in hearing aids, watches, things like that. Coin cell batteries, where they're particularly important, are in key fobs, flameless candles. And in particular, for this conversation with a group of pediatricians here, and surgeons, is that they're often found in childhood toys, games, remote controls.

The problem with them is they're very shiny. They resemble a coin. They're fun to play with for kids.

And so that's where they pose a risk. And we'll talk about that.

[Dr Mike Patrick]
Yeah. And kids have a habit of putting things in their mouth without really thinking about whether there's any dangers there or not. And I can tell you, as an emergency medicine physician, if something goes in a kid's mouth, sometimes that reflex, you know, if it gets back far enough, you just swallow.

It's not like you even swallow intentionally. Your body just reacts by swallowing because it's trying to get the thing away from your airway. But we know, as we'll discover in the course of this podcast, that button batteries in the esophagus, which connects the back of the throat to the stomach, can be very dangerous indeed.

And, you know, fortunately, a lot of toys nowadays do have locking covers so that kids can't get into the battery. But I just want to point out here at the beginning that if a lot of times as consumers, we buy a whole package of those batteries, and we might just take one out and stick the others in a drawer in an open package. And so, you really want to think too about how those are stored inside the home.

And I just wanted to mention that while I was thinking about it. Dr. Jatana, why are button batteries particularly dangerous for kids and what injuries do they actually cause? Sure.

[Dr Kris Jatana]
So obviously, a child accessing a button battery, as Dr. Holsinger had alluded to, is, you know, it's a shiny object, so it's attractive to a child. And they pose insertion risks in the nasal cavity and the ear canal. We commonly will see nasal septal perforations, ear canal injuries, tympanic membrane perforations, and ear canal stenosis or narrowing that occur from these injuries within the nasal cavity of the ear canal.

From an ingestion standpoint, a child who ingests a battery, and it's multiple factors, certainly the age of the child, which is proxy for the size of their esophagus, and certainly the size of the battery from a diameter perspective plays a role. So, the 20-millimeter, 3-volt lithium batteries pose the greatest risk just because they're 20-millimeter diameter, they have 3 volts of power, so they're more likely to get stuck, they have more power to cause injury more quickly. And essentially, the tissue of the esophagus, you know, the human body is 70% water and, you know, we have saliva in our esophagus.

And basically, the battery with that wet tissue wrapped around it when it's lodged causes very rapid injury. And what happens is the water actually breaks down into hydrogen gas and what we call hydroxide ion. And hydroxide ion is essentially a highly alkaline or high pH substance that just builds up in that esophagus or nasal cavity or ear canal, wherever it's lodged, frankly, you know, very quickly.

So, when they get lodged in the esophagus, they pose, you know, a serious injury risk, a life-threatening injury risk, because within two hours, serious injury can occur. And so, this highly alkaline caustic injury that occurs in the esophagus starts to occur within 15 minutes. And so, because of that rapid rate of injury to the tissue, you know, the tissue can break down very quickly.

And, you know, knowing that the thickness of the esophagus is, you know, from 3 to 6 millimeters depending on the age of the child, it doesn't take long to get through the esophagus and cause a perforation, a road essentially into the airway that's right in front of the esophagus, damage important nerves like the recurrent laryngeal nerve, which basically allows us to provide innervation to our vocal cords. So, our sort of speech and swallowing can be affected when those nerves are injured. And then beyond that, you know, more life-threatening situations also include erosion into major blood vessels, such as the aorta, branches off the aorta, which can be immediately life-threatening from massive hemorrhage.

And a long-term sort of risk of these injuries in the esophagus are, you know, developing a stricture or stenosis of the esophagus. So, it makes it very difficult for a child to be able to swallow, especially solid foods through the esophagus that obviously connects sort of the back of the throat to the stomach. And so, a lot of children require gastrostomy tubes, so tubes placed directly in the stomach for feeding because they can't eat by mouth.

And also, when there's, you know, either bilateral vocal cord paralysis or other tracheal injury, a lot of these children do require a tracheostomy tube. And that's actually what got me motivated about 15 years ago when I was a fellow to, you know, get involved with advocacy around preventing these injuries is I placed a tracheostomy tube into an otherwise healthy two-year-old child, and I felt like this is something that we can really work to prevent. Yeah.

[Dr Mike Patrick]
You know, damage starting within 15 minutes and like serious damage within a couple of hours, this really is a medical emergency. And so, if these batteries, if you think your child has swallowed one or put it in the nose or the ear, this is not something that you wait until the next morning to take them to your doctor's office. You need to get them to an emergency department and preferably a pediatric one that has the resources that you would need if that's available.

But it's timing is of the essence with these injuries, right?

[Dr Kris Jatana]
Absolutely. And the clock is ticking from the moment the battery is lodged within the body because that current can cause that injury very rapidly. And so, we encourage parents and caregivers to essentially, you know, if they suspect or witness their child insert a button battery into the ear canal or nasal cavity or ingest one, whether they witness it or they suspect it, if it's a possibility, you know, getting to the nearest emergency room is what we recommend.

Yeah.

[Dr Mike Patrick]
Hunter, how common do we see these? I mean, is this something that's rare or is it something we see on a regular basis?

[Dr Hunter Holsinger]
Yeah, these are extremely, extremely common. I was actually just in the emergency room for a two-week rotation around a month ago. And we had a kid, man, he was about 18 months old, who put a button battery in his nose, and we had tried to extract it quickly, but we knew the dangers and so we quickly called ENT, and they had to go to the OR.

I don't really know what ended up happening with the child, but we were very prompt and so was the family. And it's incredibly wild because around every 75 minutes, a kid will present to the ED with a button battery ingestion. And what's challenging about that is the ED visits are doubling over the last decade.

Specifically in the year 2019, there was over 3,400 ingestions. Most of them occurred in kids under six years of age, and then one and a half percent experienced those severe complications that Dr. Jotana was talking about. And three deaths occurred that year from those ingestions.

And interestingly enough, the number of serious injuries and deaths, in addition to just the number of ED visits, has increased ninefold in the last decade.

[Dr Mike Patrick]
Yeah, I want to pause and just state that again, that about every 75 minutes, a child in the United States presents to an emergency department with a button battery injury. That's a lot. And the highest risk is in children who are under five years old.

So, if you have, and they're the ones too that are more likely to put something in a nose or an ear or in their mouth and not be able to tell you, you know, what is happening. And it ends up that there are severe injuries and deaths that occur from this. And it's completely preventable injuries and preventable deaths.

But with them being often young kids, you know, as you mentioned, you know, 15, 18 months of age, what sort of symptoms? I mean, they can't necessarily tell you that they put a battery someplace. What should parents be on the lookout for, Hunter?

[Dr Hunter Holsinger]
Yeah, that's a great question. And often very frustrating and challenging in someone who can't tell you, explain the pain or their symptoms. So oftentimes in the more acute setting, there might be, you know, cold like symptoms.

And really, it just depends on where the foreign body is. So, you know, I'd like to talk, Dr. Tatano talked about what the hydrolysis reaction can cause injury very quickly. But you know, if it was put, the foreign body was put in the ear, you know, I have a kid who's presenting with almost like ear infection, tugging at the ears, you know, they might have some discharged blood.

But the foreign bodies that get aspirated end up in the lungs, sort of presents, you know, that difficulty breathing, you might have kind of a noble wheeze, something like that. And then often, you know, when we're starting to develop that erosion and that injury, you can have food refusal, vomiting, coughing, like I said, difficulty breathing, dark red stools, if there's bleeding or there's been esophageal injury. And so, it's a wide array of presentations, which makes identifying it as a parent very challenging.

[Dr Mike Patrick]
You know, one of those things I always use the term like a parent radar, you know, if mom or dad thinks something is off, get that checked out right away. So, you know, in the emergency department, they're going to know to look in all the places and hopefully not miss anything if some unusual symptoms are happening. Kris, what should parents do if they suspect their child has swallowed a button battery?

You know, we've said, get to an emergency room right away. What does that look like at home? Sure.

[Dr Kris Jatana]
So, because the rate of injury when a battery's lodged in the esophagus is so rapid, we started to look at mitigation strategies for how to slow that rate of injury as sort of a first aid solution, you know, for children. So, if a parent suspects or witnesses their child swallowed a button battery and it was ingested at home, what is an option that's in their kitchen? And so, once we did some research to look at what the actual mechanism of action is for how the battery, you know, injures the human tissue, we realized that it was a highly alkaline caustic injury.

And so, when we think back to our chemistry days of acid base reactions and ways that we can neutralize a strong base, such as the battery type reaction with a weak acid. And what are some of the weakly acidic solutions that are palatable for children so they'll swallow them, that are viscous so that they can sort of coat the battery, and then they're weakly acidic so they help to neutralize that highly alkaline material that's produced very rapidly. And so, we tested actually over 30 to 40 compounds that are commonly found in the kitchen that are weakly acidic to figure out what the optimal solution is.

And we actually found honey works really well. And so, you know, the National Capital Poison Center guidelines based on our research we published several years ago have recommended giving honey if you suspect or witness your child swallows a button battery, if they're able to obviously swallow it, you know, if they vomit, we recommend stopping that. But it's basically two teaspoons, which is 10 milliliters every 10 minutes.

And the repeated dosing is just to continue to reinforce that coating around the battery until a child can get medical attention to have it emergently removed from the esophagus. And so, continuing that every 10-minute honey, two teaspoons, as long as a child's able to tolerate swallowing it. Obviously, if they vomit or they are unable to swallow, you know, just focus on getting to the nearest emergency room.

I think the important thing to remember is if you don't have honey immediately available in your kitchen, don't stop at the store to get it, just go to the nearest emergency department and let them know of your concern of your child potentially swallowing a battery or swallowing a battery if you witnessed it. And that way they can expedite care and in the hospital setting, honey or Sucralfate are equivalent as far as efficacy of slowing that rate of injury. So, we did find that there's an existing medicine that's commonly used for gastrointestinal ulcers that can be effective as a weak acid.

It's cherry flavored. It's also as effective as honey at reducing that rate of injury, you know, in the hospital setting. And so those are two options to help slow that rate, you know, before it can be removed.

Yeah.

[Dr Mike Patrick]
Is the Sucralfate also 10 milliliters every 10 minutes like the honey?

[Dr Kris Jatana]
So, it's the same dosing. It's 10 milliliters or two teaspoons approximately every 10 minutes. And the guidelines are written, you know, for six doses sort of pre-hospital, three doses in the hospital.

So, a total of nine. But the thought was with anesthesia input that if a child has to go to the operating room, we just don't want their stomach full of either solution. But I think we have to take those into account on an individual basis for each patient because there are some parts in the United States where patients have to be transported for two or three hours.

You know, to get to a pediatric center for these types of removals. And so, weighing risk benefit, you know, those are just guidelines of sort of the nine total doses. But there are children that benefit from, you know, even longer durations should there be a longer transport.

[Dr Mike Patrick]
Do you encourage emergency departments to have honey in stock in the department so they're not ordering it like, I don't know, from Instacart or from the pharmacy? Maybe the pharmacy has it, but it can take way more than 10 minutes to get up to the emergency department.

[Dr Kris Jatana]
Sure. Good question. So here at Nationwide Children's, we stock honey in the emergency department as well as Sucralfate for this purpose.

And, you know, other emergency departments at major pediatric centers and community hospitals across the country, we also encourage, you know, having one or both immediately available. American Academy of Pediatrics recommends, you know, honey basically after the age of 12 months or one year. And, you know, just because of the potential risk of botulism, that risk is extremely low with domestically sourced honey, frankly.

But so, the Sucralfate is obviously an option for under 12 months, but there are places in the world that even give the honey, you know, under 12 months because that risk is so minimal compared to the risk of, you know, the battery related injury, especially if the Sucralfate is not readily available. You know, where those patients are located, you know, around the world. So, it has been safely given under 12 months of age as well.

[Dr Mike Patrick]
I've read that sometimes you can see a blue residue like on the tongue or the saliva, the spit might have a blue color to it. Is that something that we should be on the lookout for?

[Dr Kris Jatana]
Yes, absolutely. So, Energizer actually came out with a new technology this past year where it has a bitter coating on one side of the battery but also has a blue dye that gets activated by the saliva. So, through their testing, the lips, the tongue, parts of the oral cavity can turn blue.

It could be on the child's fingers because they were putting it in their mouth and the saliva got on their fingers. But it's something to be aware of for parents, caregivers, and urgent care emergency room providers, as well as pediatricians, that if a child does have a blue tongue, it's just something to think about. It may not be, you know, the candy they ate.

It may be something else and, you know, just keeping that in a differential. Also, it's important to recognize that not every button battery is going to be one of those, you know, special technology Energizer batteries that have that coating. And so just, you know, not having a blue tongue or blue mouth or blue fingers, you know, doesn't exclude the diagnosis of a button battery ingestion either.

But something to certainly be aware of that it exists, and we may be seeing patients present with those symptoms. Yeah.

[Dr Mike Patrick]
So, we've done, we think that our child has ingested a button battery and we're doing the honey every 10 minutes. We get them to the emergency department. If there's a lot of traffic between you and the ER, maybe even call 911 just to get there faster.

Once you get to the emergency department and the honey's continuing every 10 minutes or the Sucralfate and we call our ENT colleagues, what are the next steps? What do you guys do for this? Sure.

[Dr Kris Jatana]
So usually if we know that a patient's coming in, so I think, you know, outside providers that see these patients that are transferring them to Nationwide Children's, for example, you know, direct communication to us through the PCTC line is really important so that we're aware that they're coming. And, you know, certainly we can answer questions about, you know, any of the mitigation strategies that could be, you know, used on the way and expedite, you know, the plan for removal. And typically, these patients will get an x-ray upon arrival.

And that x-ray is just to confirm the location of the battery, whether it's truly lodged in the esophagus or it's already passed into the stomach or beyond. And we just never know because it's dependent on the diameter of the battery and the size of the child, age of the child. So, you know, these factors play a role and not every battery gets stuck.

But if they do get stuck, we don't want to miss that opportunity to get it out as fast as possible. So, you know, we work really closely with our emergency department colleagues on, you know, communicating well when these patients come in so that we can expedite care, get the x-ray, go to the OR emergently if it's lodged in the esophagus. And both pediatric ENT as well as pediatric surgery, we actually share coverage of esophageal foreign bodies as far as, you know, managing them.

And that's our practice here at Nationwide.

[Dr Mike Patrick]
So, it's really important to get it out as soon as possible, right? Absolutely.

[Dr Kris Jatana]
So, if it's stuck somewhere, that's where it's causing a problem as long as it's, you know, got some residual voltage essentially. So, the tissue acts as basically a way to short the battery through the negative and positive pole kind of junction and, you know, that current that causes that highly alkaline injury rapidly, you know, is the concern. And so, you know, even though not every battery is going to get stuck, we have to make sure it doesn't get stuck.

And that's what we do by getting the x-ray and understanding when the ingestion potentially happened. We do have some cases where, you know, a lot of these children do have vague symptoms as Dr. Holsinger alluded to earlier. And so, you know, they can present with symptoms of just a common viral illness that we see in children.

And when they're unwitnessed ingestions, it's a challenge for us to make that diagnosis quickly because, you know, we didn't get the history that my child swallowed something. And so those are, you know, challenging situations. And I think, you know, one of the reasons that we focused on some innovation around, you know, ways that we can try to, you know, noninvasively diagnose and screen children that may have ingested a coin or button battery, which we've done in collaboration with the Electro Science Lab and Nationwide Children's to essentially develop a new technology to trial and test clinically to see if we can screen patients, you know, within 10 seconds essentially for a coin or battery without radiation.

[Dr Mike Patrick]
I would imagine it's tough to determine if it's a button battery or an actual coin, which has completely different implications. So, it's really important that parents have an idea of what's around the house and what their child might have gotten into.

[Dr Kris Jatana]
And they can look very similar to a parent from a distance. They're both shiny and round. And so, I think, again, if you suspect something of that shape or size is ingested, it's best to assume the worst of it being a battery and go to the emergency department, you know, start honey if you suspect there's a chance of it.

You know, there's very low risk to doing that until the diagnosis can be confirmed and treatment can be offered.

[Dr Mike Patrick]
And then Hunter, there's Reese's Law that's out there now. Tell us about that.

[Dr Hunter Holsinger]
Yeah, so I think to fully understand Reese's Law, you have to know who Reese was. And so, Reese was in 2020, was a 16-month-old girl, completely normal leading up to this, who initially to parents developed some URI symptoms, cough, congestion, runny nose, was diagnosed by a pediatrician with a viral URI. And then parents took her home and noticed that they were missing a battery, took her to the emergency department where an x-ray showed a foreign body in the esophagus and unfortunately underwent multiple different surgeries, including tracheostomy and unfortunately expired as a result of the suggestion and sequelae from it.

And so, she's one of many, as Dr. Jatana has mentioned previously, who have developed severe, severe complications from this. And so, as a result, there was a piece of bipartisan legislation that was actually signed into law in 2022 by President Biden that requires any button or coin cell battery that's either sold, manufactured, distributed in commerce, imported in the U.S. and beyond, to have several different components aimed at preventing injury. So, the first is child-resistant packaging.

So, they must be secured in a way that requires a tool or at least two independent and simultaneous hand movements to open it. And those things are hard to do. I've experienced that recently.

Also include child-resistant compartments. So, these toys that we mentioned that often contain these button batteries, they are tested to see if they withstand abuse testing so that the batteries are not easily accessible by children. And then in addition, there must be warning labels on both packaging products.

And also, I've seen that there's certain, these labels that have QR codes that can give information to families about, you know, button batteries in general.

[Dr Mike Patrick]
Yeah. Yeah. So important.

Kris, what are some things that parents can do to prevent button battery injuries at home?

[Dr Kris Jatana]
Sure. So as Dr. Holsinger alluded to with Risa's Law, and I actually worked very closely with the Risa's Purpose Foundation and Trista on that legislation. And, you know, it got bipartisan support right off the bat.

I mean, child safety is a high priority for, you know, all legislators. And I actually was part of a team that also presented the U.S. Consumer Product Safety Commission back in 2011. And, you know, we tried to get similar legislation passed back then and just didn't get a lot of traction at that time.

And, you know, we were happy that we could accomplish this legislation in 2022. But you have to keep in mind that just because it's passed in 2022 doesn't mean it's effective that date. So, you know, it passed in August of 2022, it became effective in March of 2024.

And so, what that means is those child-resistant compartments that Dr. Holsinger had alluded to, the warning labels and battery packaging that's also child-resistant that Dr. Holsinger had mentioned, you know, those went into a mandatory effect basically in March of 2024. And so, it's going to take time for households to get safer because we don't necessarily automatically replace all of our electronic products, you know, in March of 2024. And so, we have to keep vigilant on battery-containing items within the home and make sure that they're compliant with these types of concepts of having a secure compartment.

I think storing batteries in a secure, locked compartment out of sight and out of reach of children when they're new batteries is really important. And also, for used batteries, having a process that's safe to dispose of them. And there's actually not a lot of recommendations that are given on battery packaging and a lot of electronics as to how to dispose of them because it's a state-by-state regulation.

And, you know, one of the things that we actually researched several years ago and published on is just a common household, you know, taping of the battery can be effective at, you know, reducing that risk of injury. And we showed that in a tissue model that does not raise the pH of the tissue. It did not cause any visible injury if these were lodged into animal models.

And so, you know, a simple, the battery doesn't power the device, but it still may have residual charge that can cause injury if it's lodged in the body. It's really important for people to remember that. It's just because the light doesn't turn on the candle doesn't mean that it can't cause injury in the body.

And so, making sure that those old batteries are properly disposed of and wrapping it bi-directionally with any household tape is equally effective and safe to reduce the likelihood of that. Should it be ingested or maybe reduce the likelihood of it being ingested just because you don't see the shiny object that you would typically see. And there's also beyond just ingestion and sort of risk of injury from that standpoint, you know, having that battery actually taped is a barrier for reducing risk of fire in the garbage and things like that.

So, you know, there's a lot of benefits to doing that sort of simple practice with any kind of household tape. So, I think those are things to keep in mind. I think it's just really important to be aware that this risk exists and that there's a lot of products in every household that do contain these batteries and just making sure that parents and caregivers can keep their children safe.

[Dr Mike Patrick]
Yeah. When folks change the batteries, especially out of toys, and there may be a cover that has a little screw, sometimes you think, oh, do I have to put that screw back in? It's going to make it harder the next time I have to change the battery.

Those are critical. I mean, you really want to make sure that your kiddo cannot get into the battery compartment at all, right? Yes, absolutely.

[Dr Kris Jatana]
I think making sure that, you know, that the compartments are secure is really critical. You know, anytime there's trauma to different types of electronics over time as well as just keeping in mind that, you know, to periodically check and sort of keep inventory on what products in your home do have these types of batteries, you know, for that reason, so that they can periodically be checked for ensuring that they stay secure over time.

[Dr Mike Patrick]
Yeah. Hunter, what are some innovations that are helping improve button battery safety? You know, we talked about the blue dye and the bitter coating on the button batteries.

Are there some other innovations that can help keep kids safe?

[Dr Hunter Holsinger]
Yeah, so like you and Dr. Tatana mentioned, a lot of those challenges in packaging and things are extremely important. One of the things we talked about earlier with Energizer was that blue dye that will result from that alkaline reaction. Also, bitter coatings to decrease the likelihood that kids will keep the object in their mouth.

That's been done with Energizer in Duracell. And then another thing they're working extensively on is new battery designs. And so, we've talked about how these batteries cause issue in a moist environment, but there are certain new battery designs that have these pressure activated switches that only allow the flow of current, which is where all this injury is coming from, when they're compressed in a device and not in this moist environment like the esophagus.

And another one would be a sort of eco-friendly battery tech. So, you know, we talked about the risk of fires and these things are left in the trash. And so having something that's more biodegradable or non-toxic alternative would be good, even if ingested.

[Dr Mike Patrick]
When I think about lithium batteries, I think we don't necessarily want those in the landfill. That really ought to be disposed of as you would other dangerous type batteries.

[Dr Hunter Holsinger]
Yeah, for sure. And it's interesting, many different stores have battery cycling programs, you know, such as Best Buy, Staples, Home Depot, Lowe's, where these can be dropped off. And additionally, different household hazardous waste facility centers, you know, it's obviously dependent on where you're at and how close you are to one.

But these are places as well that where you can drop off these used batteries. Yeah.

[Dr Mike Patrick]
Now, if you're going to drop off used batteries, that means you probably have saved it somewhere in your house. So, you really, again, want to put tape on both sides, wrap the tape around it, and still keep it away from kids locked up if you're storing them until you can take them to recycling type center. Absolutely.

Kris?

[Dr Kris Jatana]
I just wanted to add to what Dr. Holzinger was discussing as far as the safe battery concept. And so, this is something that we've been focused on nationally and even internationally for several years, and ways that we can encourage and promote the concept of industry developing a safe battery technology. And I think there's different ways you can kind of think about safe versus safer.

And I think that, you know, it's safer to have, you know, a bitter coating than to not have a bitter coating. Potentially, you know, it doesn't necessarily prevent a child, though, from having an ingestion and having a severe life-threatening injury. If it gets lodged in the esophagus, it's still going to cause the same injury.

And so, you know, we know with other types of hazards that are ingested that bitter bitterants have not always prevented, you know, ingestions. And we've had children that have ingested bitter coated batteries around the United States. And it's just, it is a deterrent.

You know, I think it's an opportunity to reduce the likelihood of a child potentially swallowing it. It's better than nothing for sure. But I think ultimately what we're looking for is just a new novel technology that if that battery becomes lodged in the esophagus, it's truly safe.

It's going to act like a coin in the esophagus. It's not going to erode a hole through the esophagus. And there's three technologies that are currently under development in the U.S. and abroad with different sort of nuances to how they work. But the concept is the same that, you know, they can shut down the battery very rapidly so that that severe injury doesn't occur. And so, the battery industry is actively working on this. They've really taken some ownership of focusing time and resources on a safe battery technology.

And the American Academy of Otolaryngology Head and Neck Surgery has published a position statement highlighting how safe battery technology is defined. And this has been endorsed by the American Academy of Pediatrics, the American College of Surgeons, and numerous other national medical organizations have either endorsed or supported this statement to help keep kids safe.

[Dr Mike Patrick]
You know, our podcast is really aimed for parents, but we have a lot of medical providers who also tune in. What role can we as medical providers play in prevention? Sure.

[Dr Kris Jatana]
So, I think, you know, one of the things that motivated me was just, you know, having a child that I took care of that, you know, had a severe injury and a life-threatening result of that injury, you know, needed a tracheostomy tube placed. And I think that, you know, all of us as healthcare providers, you know, in various roles, you know, can continue to look for opportunities where, you know, this could have been prevented or this could have been, you know, maybe a different scenario or outcome for this child, you know, through some sort of treatment. So, I think there's some just novel thinking and rethinking kind of old ideas.

And, you know, one of the things with battery injuries is historically it used to be thought that the battery would leak, and all the injury was caused by the leakage of the substrate within the battery. And I think we realized that it was actually the current that drives that. And that's what led us to understanding that mechanism more, determining ways that we could potentially mitigate that.

Because historically, when you had a strong base injury, you know, neutralization was never thought of as a solution. It was actually thought of as causing worse injury by what we call an exothermic reaction, which is basically, you know, heat or thermal injury to the tissue. And so, that that would never be done because of that evidence of, you know, what happens in a chemistry beaker in the lab.

And so, I think that, you know, rethinking a lot of the old ideas for various types of injuries and mechanisms injuries, I think will lead to a lot of innovative solutions for, you know, prevention of injury. I think that, you know, encourage healthcare providers to look for those opportunities and a lot of them are outside the walls of the hospital and, you know, ways to collaborate with, you know, non-medical professionals on solutions because, you know, it really takes a team effort. It's not something that any individual can do without working together with others and in different disciplines and sitting down at the table and finding ways to keep kids safe like we did with, you know, the button battery related ingestion injury risk.

And there's a lot of other, you know, hazards out there that I think, you know, healthcare professionals can continue to advocate for safety on.

[Dr Mike Patrick]
Yeah, yeah, absolutely. Great opportunity to get involved, too, in the legislative process and the patient safety and child safety processes that are out there in terms of communities and laws and such. Even in the exam room, bringing up button batteries during well-child visits, you know, there are just so many things that pediatricians want to bring up during well-child checks and all of them are important.

It seems like this might be something you could even have like an infographic that's a poster on the wall, you know, in the exam room, just in pediatric offices just to say, hey, these things are dangerous, you know, with some tips on how to keep your kids safe. Just, you know, all sorts of ways that pediatricians can get that message across to families when they see them in their offices is also going to be important. And then when we do see these injuries, is this something that should be reported, Kris?

Yes.

[Dr Kris Jatana]
So, I think this is a challenge because it's a lot of different pediatric injuries. If they're not reported, we can't collect data and data is what drives the change, whether it's, you know, safety measures or industry change. But, you know, reporting these injuries is really critical.

There's a national button battery ingestion hotline that's available for guidance if a parent or caregiver or medical professional has questions about the management, that hotline does exist. Also, the National Capital Poison Center is a resource. It could be called for advice or management, and they do track when they get these calls, and they record that data.

The one thing that is missing in some of those other data sources or in the literature is just we don't have, we haven't had a great way to capture the whole picture and, you know, the presenting symptoms, the injury, the management, the clinical outcomes. And I think that's what led us to actually creating a new tool for medical professionals to actually do that. And so, we actually started a nonprofit organization called the Global Injury Research Collaborative for the purpose of housing, you know, novel injury data.

And so, it's a smartphone app for medical professionals and only medical professionals can use it in the sense of reporting. But it takes a couple minutes for somebody who took a foreign body out to report a case to this global database. And our hope is we can use this data over time to, you know, better understand medical management trends, outcomes, how do we optimize them.

And we also have the ability to take pictures of the foreign body after it's removed by the surgeon or the endoscopist, which is really valuable for better understanding choking and ingestion hazards at a broader level. Because we know from even small parts hazards that, you know, there's a lot of research that needs to be done still on, you know, what really constitutes a high risk for choking and ingestion hazards. And so, you know, continuing to try to get that data is really important for the long term of how we can make safer products and keep kids safe.

[Dr Mike Patrick]
And we'll put links in the show notes to those resources that you had mentioned so folks can find them easily over at pdacast.org. This is episode 584, so you'll find those links there. Before we go, Hunter, this whole episode really was initialized, I guess you'd say, by the Trainees for Child Injury Prevention, or T4CIP.

And they do have a day of action where they really try to get the word out and prevent injuries in kids. Tell us a little bit more about T4CIP and the day of action.

[Dr Hunter Holsinger]
Yeah, so T4CIP is important. Injury prevention in kids in general is important because injuries are the leading cause of death in children 1 to 19. So, there's a lot of work that needs to be done to prevent injury in these kids.

So T4CIP is essentially a year-long training program for med students, residents, and fellows. It has over currently 80 trainees from 30 states and 53 institutions. It is sponsored by the Center for Injury Research and Policy in Columbus, which is NIH-funded, and the AAP section of Pediatric Trainees and Council on Injury, Violence, and Poison Prevention.

And so, as a member of T4CIP this year, we have monthly meetings, leading experts, Dr. Jotana came and gave a talk to us a while ago, and we have these biannual days of action. We just had a day of action a couple weeks ago where we tried to draw public attention to the dangers of button battery ingestion, both the prevention and the treatment of, as well as in the past we've done these day of actions on firearm injuries, safe sleep, drowning prevention, things that are incredibly prevalent. And through this organization, it helps us promote interesting engagement in child injury prevention.

How do we as trainees engage with both patients, families, and people who are involved in making decision makings with the hope that we, in our future, are driven towards these avenues to have both local and national change?

[Dr Mike Patrick]
Yeah, really, really important work. And we'll put links to T4CIP, Trainees for Child Injury Prevention, in the show notes so you can find those easily, along with the other resources that we have talked about. We also have an article from the National Safety Council about button batteries being extremely dangerous.

And for the providers in the crowd, the American Academy of Pediatrics puts out a news report on a regular basis, and they look at studies that button battery-related ED visits have increased significantly, and early treatment is important to prevent severe complications. So, if you want to see more of the research that's involved behind all of this, there are links to that in the show notes as well. So definitely head over to pediacast.org, episode 584, and you'll find all of those resources there in the show notes. So once again, Dr. Kris Jatana, Pediatric Ear, Nose, and Throat Surgeon at Nationwide Children's Hospital, and Dr. Hunter Holsinger, Pediatric Resident, also at Nationwide Children's. Thank you both so much for stopping by today.

[Dr Kris Jatana]
Thank you for having us.

[Dr Hunter Holsinger]
It was a pleasure. Thank you both.

[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. We really do appreciate that. Also, thanks again to our guests this week, Dr. Kris Jatana, Pediatric Ear, Nose, and Throat Surgeon, and Dr. Hunter Holsinger, Pediatric Resident, both at Nationwide Children's Hospital. Don't forget, you can find our podcast really wherever podcasts are found. We are in the Apple Podcast app, Spotify, iHeartRadio, Amazon Music, Audible, YouTube, and most other podcast apps for iOS and Android. Our landing site is pediacast.org.

You'll find our entire archive of past programs there, along with show notes for each of the episodes, our terms of use agreement, and the handy contact page if you would like to suggest a future topic for the program. Reviews are helpful wherever you get your podcasts. We always appreciate when you share your thoughts about the show, and we love connecting with you on social media.

You'll find us on Facebook, Instagram, Threads, LinkedIn, X, and Blue Sky. Simply search for PediaCast. If you are a pediatric provider or you know a pediatric provider, which really all of you should if you have kids because your kids should be seeing one, please let them know that we have a podcast for them.

And if you happen to be a pediatric provider, well, we have a podcast for you. It is similar to this program. We call it PediaCast CME.

That stands for Continuing Medical Education. We turn the science up a couple notches and offer that free credit. It's category one credit, by the way, for those who listen, and that includes physicians, of course, but also nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists.

And since Nationwide Children's is jointly accredited by all of those professional organizations, it's likely we offer the credits you need to fulfill your state's continuing medical education requirements. Shows and details are available at the landing site for that program, PediacastCME.org. You can also listen wherever podcasts are found.

Simply search for PediaCast CME. And if you are a faculty member in academic medicine, we have a podcast for you as well called FAMEcast. It is a faculty development podcast from the Center for Faculty Advancement, Mentoring, and Engagement at The Ohio State University College of Medicine.

So, if you are a teacher in academic medicine or a faculty member in any of the health sciences, then this is a podcast for you. And you can find FAMEcast at Famecast.org and wherever podcasts are found by searching for FAMEcast. Thanks again for stopping by.

And until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody.