Battery-Related ED Visits in Kids ‘Remain Too Frequent,’ Study Suggests

Rates of pediatric battery-related emergency department (ED) visits increased significantly from 2010 to 2017, with children ages 5 and younger making up the majority of cases, an observational study showed.

Among a nationally representative sample, an estimated 70,322 (95% CI 51,275-89,369) battery-related ED visits occurred during the study period (9.5 visits per 100,000 children annually), reported Mark D. Chandler, MPH, of Safe Kids Worldwide in Silver Spring, Maryland, and colleagues.

There was a statistically significant increase in ED visits from 2010 to 2017 (P=0.03), which then insignificantly decreased from 2017 to 2019, they noted in Pediatrics.

“Unfortunately, despite all existing injury prevention efforts, battery-related ED visits remain too frequent,” Chandler and team wrote. “Regulatory efforts and adoption of safer button battery designs by industry to reduce or eliminate ingestion injuries in children are critically needed.”

Perhaps unsurprisingly, children ages 5 and younger had the highest rates of these visits (24.5 visits per 100,000 children). Visits were much less common among 6- to 17-year-olds (2.2 visits per 100,000 children). The mean age of patients being seen for battery-related visits was 3.2 years.

The most common type of batteries involved were button batteries, which accounted for 84.7% of visits. These small disk-shaped batteries are becoming increasingly common due to their use in smaller electronics, such as toys, digital watches, hearing aids, and remote controls. These types of batteries are especially risky due to their size and the ease with which they can be removed from devices, the authors suggested.

In this study, in cases where the intended use of the battery was noted, most came from watches (29.7%) and toys/games (28.8%).

The most common action that led to an ED visit was ingestion (90%), followed by nasal insertion (5.7%), ear insertion (2.5%), and mouth exposure (1.8%).

“Young children use their senses to explore their environments and often put objects into their mouths, ear canals, or nasal passages,” Chandler and team explained. “As toddlers become increasingly mobile and curious, their risk of foreign body ingestion increases.”

In as little as 2 hours after ingestion, a button battery’s contact with moist tissue can cause rapid hydrolysis of water into highly alkaline hydroxide ions. This in turn results in liquefactive necrosis, which can progress even after removal of the battery, they noted.

For this study, Chandler and team used data on ED visits collected from the National Electronic Injury Surveillance System for children from 2010 to 2019. Using narrative descriptions and diagnosis codes, battery-related cases were coded into four exposure routes: ingestion, mouth exposure, ear insertion, and nasal insertion.

Mouth exposure was limited to cases where the battery caused chemical burns, and ingestion cases were limited to situations where the battery was swallowed intact.

Chandler and colleagues noted that the study’s sample size was limited to battery-related exposures that resulted in an ED visit, potentially underestimating the number of these exposures. Information on battery type, exposure route, and intended use was also limited, which could have led to misclassification. Finally, they acknowledged that it was unclear if the increase in rates of ED visits was due to increased exposures, increased severity, changes in health-seeking behavior of parents, or changes in treatment protocols.