AAPA: When Kids Swallow Dangerous Objects

PHILADELPHIA, June 5 -- Magnets and batteries may cause serious harm if swallowed, necessitating endoscopic or surgical removal.

One swallowed magnet is usually not dangerous, but if more than one is swallowed the situation can become extremely hazardous, said Marsha Kay, M.D., of the Cleveland Clinic Foundation, at the American Academy of Physician Assistants meeting here.

That's because the magnets can attract each other, even through tissue, and that can quickly lead to perforations and fistulas, Dr. Kay said.

Localizing the multiple magnets via radiography and prompt endoscopic removal is important to avoid such injuries. If the magnets are beyond the reach of an endoscope, consider surgery, Dr. Kay advised.

Magnets have become increasingly ubiquitous in toys, jewelry, and other household objects, and reports of children swallowing them have been on the rise, she said.

Another object being increasingly ingested by children are batteries-not just the tiny button-type batteries but the larger cylindrical batteries as well. The source of the battery is frequently a child's own hearing aid, Dr. Kay said.

Batteries contain concentrated solutions of sodium or potassium hydroxide. If leaked into the esophagus or airway, these substances could cause severe tissue burns, said Dr. Kay. She advised that an immediate X-ray to locate the battery is essential in every case.

Some batteries contain lithium, she added, but no cases of lithium poisoning associated with swallowing batteries have so far been reported.

All batteries that lodge in the esophagus should be removed as soon as possible, Dr. Kay said. Even though symptoms are uncommon following ingestion, batteries as small as 8 mm in diameter can cause perforations in as little as six hours.

They may also cause fistulas and, if left in place for 10 hours or more, lead to esophageal stricture and even death, she said. The danger increases with the size of the battery, she added.

Once a battery reaches the stomach, however, observation is usually the best strategy, Dr. Kay said. More than 80% will traverse the GI tract without harm within 48 hours. For 5% of patients, the battery may take a week to pass, she added.

Parents should be told to strain the stool to find the battery, she said.

If a child has symptoms, such as abdominal pain, however, immediate endoscopic removal is advisable, Dr. Kay said.

Coins are one of the objects most commonly swallowed by children. They accounted for about 21,000 pediatric visits to U.S. emergency rooms in 1997, Dr. Kay said. Coins commonly lodge in the esophagus, but about one-third will pass into the stomach, she said.

If the swallowed coin does not pass to the stomach within 12 to 24 hours, it should be endoscopically removed, lest fistulas or esophageal stricture result, Dr. Kay said.

However, if the patient can't swallow or is experiencing acute respiratory symptoms, the coin should be removed immediately, she said.

Coins in the stomach will usually pass harmlessly in four to six days. Endoscopic removal is not recommended unless the coin is retained for several weeks or the patient has symptoms such as abdominal pain.

Parents should be advised to search the stool for the passed coin, but evidence suggests that parents will miss it about 40% of the time, Dr. Kay said.