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Button cell batteries: Swallowing can lead to severe health damage in small children

43/2018, 23.11.2018

The BfR and BfR Committee for the Assessment of Intoxications advise parents to keep batteries out of the reach of children

If button cells are swallowed, they can get stuck in the oesophagus and severely damage the mucosa. The "Assessment of Intoxications" committee of the German Federal Institute for Risk Assessment (BfR) therefore recommends particular care. In the last ten years, several hundreds of cases involving the swallowing of button cell batteries have been reported to the BfR by hospitals and poison information centres. The health damage is caused above all by the discharge current of the batteries. "We therefore advise all parents to keep button cells out of the reach of infants and small children. Once a button cell has been swallowed, the person should be treated in hospital without delay," recommends BfR President, Professor Dr. Dr. Andreas Hensel.

Due to the increasing distribution of battery-operated devices in all walks of life, children can come more and more in contact with button cells and swallow them. Complications could arise if the battery gets stuck in the oesophagus, because current starts to flow when contact is made with the moist mucosa. Hydroxide ions, which can cause severe chemical burns, are formed in the border area between the button cell and the mucosa. There is a special risk for small children if they swallow large button cells (over 20 mm in diameter), because it is highly likely that these will get stuck in the narrow oesophagus of small children.

If the button cell can pass through the oesophagus, complications are rarely to be expected.  In cases of this kind it is usually sufficient to wait for the natural excretion of the battery under medical supervision.

If the button cell gets stuck in the oesophagus, no symptoms or only slight discomfort are developed initially. Vomiting, loss of appetite, fever or coughing set in after several hours. As time progresses, more and more tissue damage is caused at the contact point between the battery and the oesophagus which can lead to bleeding and necrotisation of the tissue. The oesophagus can scar and constrict as sequela. In rare cases, the complications can result in death.

The more the battery is charged, the more severe the health damage can be.

The BfR recommends immediate examination in a children’s clinic if there is justified suspicion that a button cell battery has been swallowed.

Doctors must report cases of poisoning, including suspected cases, to the documentation and assessment point for intoxications at the BfR. In addition to cases of poisoning through chemical substances and poisonous plants, this obligation to notify also covers the swallowing of button cells and the risk of chemical burns that this involves. The basis for the obligation to notify is Art. 16e of German Chemicals Act.

Important tips and information on cases of intoxication and asphyxiation in infants and small children are contained in the BfR brochure "Risk – Cases of Intoxication in children" (in german):

The free BfR app "Poisoning accidents with children" contains on-site first aid measures for cases of poisoning and asphyxiation (in german):

About the BfR

The German Federal Institute for Risk Assessment (BfR) is a scientifically independent institution within the portfolio of the Federal Ministry of Food and Agriculture (BMEL) in Germany. It advises the Federal Government and Federal Laender on questions of food, chemical and product safety. The BfR conducts its own research on topics that are closely linked to its assessment tasks.

This text version is a translation of the original German text which is the only legally binding version.

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