Consumer Health vs. the Button-cell Battery

Technology is wonderful.  It has not only improved our everyday lives, but it has expanded our world dramatically. There are times, however, when manufacturers incorporate new technology into consumer goods before fully considering the consequences to the consumer.  This is particularly dangerous when producing products for children and the elderly.

Is your child at risk?

In the risk assessment business we often talk about foreseeable use and misuse (or in the case of toddlers and young children, foreseeable creative use.). What this really means is that any new product design must be evaluated in relationship to the developmental and typical behavior patterns of the end-user. Children develop through clearly defined stages of physical, emotional, cognitive, and social development.  One can safety foresee that toys sold to children under three years old, for example, are almost always going to be chewed, sucked, pulled, twisted, banged, thrown, placed into any opening in the body, or have any appendage placed into any opening in the toy. That’s just what toddler do - all day long.

As children grow older, they tend to  try to test the limits of any given toy. They may try using it in a new way, like wearing a plastic bucket as a hat.  They want to take things apart and see if they can put it back together again.  This often results in a small part that didn’t start out as, nor was ever intended to be, a small part.

We know that caregiver vigilance is an important component to child safety. Realistically a caregiver does not have their eyes on young children every minute of every hour of every day.  In fact, some studies have shown that mother and child are awake and home together (supervised) only about 6.50 hours per day.  That leaves 17.5 hours per day that a child is not directly in the caregiver’s sight.  The explorative nature of young children, combined with the moments of non-supervision is what might be called “The Danger Zone.”  These are moments when plastic totes are pulled over the head to cover nose and mouth, or small parts, like small button-cell batteries, are swallowed.  And this is also where our exciting new technology becomes a risk.

If the child has access to a toy or household item that is powered by button cells batteries, a particularly dangerous scenario is present.  Dr. Toby Litovitz , a physician in Washington, D.C. has been gathering incident-report data from the National Battery Ingestion Hotline, set up through the National Capital Poison Center. Her study of this data shows a dramatic increase in incidents in which swallowing button-cell batteries caused acute injuries and fatalities have dramatically increased. In fact, they have increased sevenfold since 1985!

Dr. Litovitz’s research revealed that the majority of the serious injuries occurred in children four years or younger; but older adults whose vision or cognitive awareness is compromised have also been reported in increasing numbers. They often mistake the small discs for candy or medication. Batteries can become accessible in everyday household products like the TV remote control, toys and games, musical greeting cards, flashing jewelry, and calculators.   In the Unites States alone, at least 3,500 reported incidents annually are related to people swallowing button-cell batteries.

These small batteries are a growing concern. At only 3/4 inch (20 mm) or less in diameter, parents may be completely oblivious to the fact that their child has just swallow the battery. In fact, according to the data studied by Dr. Litovitz, ninety-two percent of fatal incidents, and fifty-six percent of major incidents occurred with the ingestion being unobserved.

When are small batteries such a threat to human health? 

In the majority of the cases, the button-cell battery will pass quickly through the body and be rid of in the stool. Still, sometimes the small battery gets caught in the esophagus where it can really do some damage on the lining tissue. The moist lining of the gastrointestinal tract produces the chemical hydroxide around the battery which serves as a current conductor. This lets current flow through the battery as it rests on the lining. This can result in burns to the throat and esophagus.  The longer the battery remains in the system, the more damage it can do all along the intestinal tract and stomach.  To put the severity in perspective, a battery allowed to remain in the system for just two hours can cause long-term or permanent damage. 

National Poison Control

And here’s the rub.  If parents/caregivers are not even aware the battery has been swallowed, this damage may be happening without them knowing it.  The child may begin to show signs of a tummy ache, or even a slight fever, but the fact that the child swallow a dangerous battery is not likely going to be the first thing a parent thinks of. In the meantime, the current is at work in the gastrointestinal system, completely unbeknownst to the parent, or even the ER physician.  This is what makes the diagnosis of the condition so difficult. According to Consumer Product Safety Commission (CPSC), the nations leading authority on consumer product safety, more than 66% of these button-cell related incidents were  initially misdiagnosed. With time of treatment being so critical, misdiagnosis can mean long-term damage to breathing, vocal cords or colon walls.

Dr. Litovitz found one other surprising and troubling trend.  She discovered that the most dangerous battery type was actually the 3 volt batteries that were 20mm or larger in diameter. Since the button-cell batteries may pass through a child’s system quickly without any harm at all, the larger, higher voltage batteries have a higher chance of getting stuck in the  esophagus.  Many of these battery-related incidents require major surgery, and even after surgery, permanent damage remains. Deaths have resulted in the worst cases.  

Is there a solution?

As the consumer good manufacturers rush to satisfy public demand for newer, better and more powerful technology, the continued increase in these serious injuries appears to be inevitable.  For this reason, many countries including the USA, EU member states, Japan, Korea and Australia have been buzzing about creating safety specifications for the use of  these batteries. The Button Cell Battery Safety Act of 2011 (SB1165) was introduced in June 2011. The intent of the bill is to protect consumers against the hazards associated with ingestion of the small batteries by mandating that the CPSC create standards that require child-resistant closures on battery-operated consumer goods.

Beyond that, a public education plan should be developed and implemented to raise public awareness of the potential risk of kids or elderly vs. battery-operated products. Asking the right questions is essential to quick diagnosis. It is unlikely that this serious type of scenario can be fully eliminated completely, but with more efforts by manufacturers to make batteries inaccessible, and increased awareness of parents, caregivers, pediatricians and ER doctors -  the numbers might be significantly reduced.

The National Capital Poison Center has developed a list of safety precautions to follow in the case of a swallowed battery,  You can find these by opening this link. It might be wise to print this out, study it and educate your family on the serious nature of batteries if swallowed.   The  center in Washington, DC, operates a 24/7 hotline for battery ingestion cases. They can be reached by phone at 202-625-3333. To find your local poison center call 1-800-222-1222.

Photo: Brick/Getty

IMPORTANT NOTE:  Don't forget your pet when it comes to batteries.  The same scenario that proves so dangerous to our children or eldery, also apply to our pets.  If you suspect your pet has swallowed a battery, act fast and call the ASPCA Animal Poiron Control center's 24/7 emergency hotline at (888) 426-4435.