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April 18, 2019

BehindTheMedspeak: Two spoonfuls of honey may limit damage from button batteries

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That's news to me: since button battery swallowing by little kids became a thing, all I've ever seen have been stories about life-threatening complications and deaths from their ingestion.

From the New York Times:

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There has been a dramatic rise in the number of young children ingesting coins, toys and other foreign objects, including potentially fatal button batteries, a new study has found.

According to the report, which was published last week in the journal Pediatrics, the rate of foreign-body ingestions among children under the age of 6 in the United States nearly doubled between 1995 and 2015, rising by about 92% during the 21-year study period — and increasing by about 4% annually.

"It is a very upward trajectory," said Dr. Danielle Orsagh-Yentis, the lead author of the study and a pediatric gastroenterology motility fellow at Nationwide Children's Hospital in Columbus, Ohio, calling the trend "jarring."The researchers analyzed nearly 30,000 cases where children under 6 had ingested foreign objects.

They then estimated that more than 759,000 children had been evaluated in United States emergency departments for such ingestions during the two decades studied, and the number of estimated cases grew from more than 22,000 in 1995 to nearly 43,000 in 2015.

It was unclear how much of the increase could be attributed to improvements in case reporting over the years.

But Dr. Orsagh-Yentis said she thought the rise was partly because of the proliferation of electronics with button batteries, which are found in a multitude of household items including thermometers, remote control, and toys.

Button_battery_sizes

As a whole, battery ingestions increased 150-fold during the study period, the researchers reported.

Button batteries, which can be fatal if ingested, were found to be the most common type of battery that young children swallowed.

"They're in everyone's house, whether they realize it or not," Dr. Orsagh-Yentis said.

When a battery is swallowed, it can trigger a series of chemical reactions that could result in burns, causing "significant tissue injury even within two hours," according to the American Academy of Pediatrics, and potentially lead to perforation or hemorrhage.

The A.A.P. suggests giving two teaspoons of honey to children older than 1 year who have recently swallowed button batteries.

Researchers have found that it can help protect the tissue near the battery and reduce injuries. 

But doctors warn not to delay medical treatment."It's definitely something you don't wait on. It should be a trip to the emergency room," said Dr. Aldo Londino, a pediatric ear, nose and throat surgeon at The Mount Sinai Hospital in New York City. "Early detection is the key to effective treatment."

Foreign-body ingestions are common "in a general sense" among children under 6, Dr. Orsagh-Yentis said.

In 2017, these ingestions were the fourth most common reason for calls to poison control centers in the United States for children in this age group, according to the National Poison Data System, and accounted for nearly 64,000 reports.

At Mount Sinai, Dr. Londino said he had noticed a trend where he and other doctors were "getting called more and more for foreign body removal."

In the last six months, he said, he has removed a marble; the bottom half of a Lego man, "which was a challenge because of the shape"; and a coin — each from the esophagus.

Getting to the doctor quickly is critical for safe and successful extraction, he added, especially given how dangerous some objects can be.

According to the study, the most commonly ingested items were coins, most often pennies.

In 2015, coins accounted for more than 58% of ingestions, and of all of the patients hospitalized during the two decades studied, nearly 80% had ingested coins.

Other types of objects ingested included toys, jewelry, nails, screws, hair products, magnets, and Christmas decorations.

Most of the ingestions occurred among children ages 1 to 3, the study said.

Jewelry and hair products were disproportionately ingested by girls, whereas boys were more likely to ingest screws and nails.

The researchers used data obtained from the National Electronic Injury Surveillance System, which reports on product-related injuries treated in emergency departments in about 100 hospitals in the United States.

The study said that because the data did not include children who were cared for by their primary care providers (nor those who made calls to poison-control centers or who didn’t seek medical treatment at all) the actual number of children who swallowed such objects may be larger. 

Dr. Orsagh-Yentis said the study underscores the need for more vigilance and to keep unsafe products as safely stored as possible.

"That means keeping them at elevated locations so the children can't get to them as easily, keeping them in secure locations and, particularly, keeping them out of children's sight so they're not even thinking about them," she said.

If parents believe that a child might have swallowed something dangerous, Dr. Orsagh-Yentis recommended bringing the physician an example of the object or the packaging it came in if there is time to do so.

Taking a picture of the type of object swallowed can also be "immeasurably helpful" to a doctor, she added.

April 18, 2019 at 02:01 PM | Permalink


Comments

During my earlier years I had a tendency to pick up things from the ground and, if they were shiny and looked somewhat clean, put them in my mouth, and – involuntarily but inevitably – swallow them. This was never embarrassing to me, and most often I would casually inform my parents about what had happened. Once it was an orange plastic button (fairly easily described by a 4 year old), but another time I came home after preschool and matter-of-factly informed my father that I had swallowed a funeral coin. This had him quite perplexed, and he asked me to describe the “funeral coin”. I told him it was a sleek silver coin with a cross on it, upon which he realised what I was describing was a button battery. This didn’t seem to faze him that much, so he told me I had swallowed a battery, and then he leaned in closer, looking intently at my eyes.

“Pippi, your eyes are shining.”

I ran to the mirror, but alas, by the time I reached the light had gone out.

Posted by: Pippi | Apr 20, 2019 5:21:50 AM

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