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Swallowed button cells can cause serious damage to the health of small children

28/2023, 11.12.2023

Often underestimated danger from devices with button batteries

Whether it's light decorations or little toys on St. Nicholas Day - many products that are powered by button cells are used at Christmas time in particular. This increases the risk of children getting their hands on them and swallowing them while playing. If the button cell gets stuck in the oesophagus, there is a risk of serious damage to the mucous membrane. Over the past ten years, the BfR has been informed by clinics and poison centres of several hundred cases from in which button cells have been swallowed. According to a survey in the current BfR Consumer Monitor, 58 per cent of respondents are not aware of this risk. The BfR is therefore providing more information about the dangers of button cells and urgently advises keeping button cells out of the reach of infants and small children.

BfR President Professor Dr Dr Andreas Hensel: "We advise keeping button cells out of the reach of infants and small children. If a button cell has been swallowed, the person should be examined in a clinic immediately."

State Secretary Dr Christiane Rohleder: "Button cells can be very dangerous, especially for small children, if they are swallowed while playing. But many parents don't know this. It is therefore important that the Federal Institute for Risk Assessment informs the public more about this, especially around Christmas time. When buying toys, consumers should make sure that they have been tested for safety. The GS mark for "Tested Safety", which is regulated by the state but is voluntary, provides guidance in this regard. The CE mark, on the other hand, is mandatory for toys, but it only contains the manufacturer's own statement that the product fulfils the legal requirements without this having been checked by an independent body."

Button cell-powered devices are ubiquitous during the Christmas period. Toys with button cells that are placed on the market in the EU must be secured so that direct access to the button cell is not possible (e.g. by means of a battery compartment secured with screws). However, LED tea lights, Christmas lights, greetings cards with music and remote controls for lighting are also often powered by button cells. Here too, caution is required to prevent button cells from being accidentally swallowed by children. When storing new and used button cells, parents should also ensure that all button cells (even supposedly empty ones) are kept out of the reach of children.

If a button cell is swallowed, this is often not noticed at first. It is particularly dangerous if it gets stuck in the oesophagus. Contact with the moist mucous membrane causes a current to flow. Hydroxide ions are formed at the interface between the button cell and the mucous membrane, which can lead to severe chemical burns. Large button cells (diameter of more than 20 mm) are especially dangerous for small children as they are more likely to get stuck in the narrow oesophagus.

If the button cell gets stuck in the oesophagus, there are often no symptoms or only mild discomfort at first. After a few hours, vomiting, loss of appetite, fever or coughing occur. As time progresses, tissue damage increasingly occurs at the point of contact between the button cells and the oesophagus, which can lead to bleeding and tissue death. As a late consequence, the oesophagus can become scarred. In rare cases, these complications can even lead to death.

The more the battery is charged and the longer the button cell remains in the oesophagus, the greater the damage to health can be. If the button cell can pass through the oesophagus, complications are rarely to be expected. In these cases, it is usually sufficient to wait for the button cell to excrete naturally under medical supervision.

The BfR advises immediate examination at a paediatric clinic even if there is a reasonable suspicion that a button cell has been swallowed. Doctors report cases of poisoning, including suspected cases, to the BfR's Poisoning Documentation and Assessment Centre. In addition to poisoning by chemical substances and poisonous plants, these reports also include the ingestion of button cells and the associated risk of chemical burns. An amendment to the German Chemicals Act passed this year also provides for a national poisoning register to be set up at the BfR starting in 2026. This will allow information on cases of poisoning throughout Germany to be collected centrally for the first time. This should make a significant contribution to the early detection of risks and the initiation of risk minimisation measures.

The free BfR app "Poisoning accidents among children" provides tips on preventing poisoning and advice on first aid:
https://www.bfr.bund.de/de/apps_vergiftungsunfaelle.html

Link to the consumer monitor:
https://www.bfr.bund.de/cm/350/bfr-verbrauchermonitor-08-2023.pdf

Safe toys: Giving toys responsibly at Christmas:
https://www.bmuv.de/meldung/sicheres-spielzeug-spielzeug-in-der-weihnachtszeit-verantwortungsvoll-verschenken

About the BfR

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

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