Parents (and grandparents) learn to think preventively when there is a toddler in the house. Cupboards with cleaning materials have to be secured from curious mitts and medication stored safely away from prying eyes.
Otherwise, small foreign bodies may find their way into a child’s ears and up their nostrils – or indeed swallowed, with potentially serious consequences.
In children, the most commonly ingested foreign bodies are coins, button batteries and toys. Although most ingested foreign bodies pass naturally out of the body, about 10 to 20 per cent of cases require endoscopic retrieval – and about 1 per cent need emergency surgery.
According to Adam Taylor, director of the Clinical Anatomy Centre at Lancaster University, button batteries are notoriously attractive to children. They’re small – only 5-25mm in diameter – round, shiny, and can be mistaken easily for a sweet. “The signs of button battery ingestion can be difficult to recognise until it’s too late,” he writes in The Conversation.
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Ingestion causes non-specific symptoms, including coughing, fever, difficulty swallowing, and vomiting. If the ingestion is not witnessed by anyone, these symptoms can be easily mistaken for other childhood illnesses. Once swallowed, batteries that are 20mm or more in width often become lodged in the oesophagus at a point where it narrows.
Within two hours, these batteries can begin to cause irreparable damage. Moist body tissues cause the battery to “complete a circuit” between the positive and negative poles. The resulting alkaline substance is highly corrosive and can burn the oesophageal lining in 15 minutes to an hour. It can pass through to neighbouring tissues in as little as four hours.
The more charge left in the battery, the quicker this occurs.
“Erosion of tissues can progress to neighbouring structures at the natural narrow points of the oesophagus,” Taylor says. “Batteries lodged at any of these sites – including the opening of the oesophagus, the point where the oesophagus crosses the aorta (the main artery of the body), the left main bronchus (the tube taking air to the left lung) and where the oesophagus enters the stomach – will cause burning and paralysis of the vocal cords, huge blood loss and potentially death.”
Alternatively, a tunnel can burn through to the trachea, creating a fistula between it and the gullet that may lead to respiratory distress and feeding difficulties.
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Batteries that make it to the acidic environment of the stomach pose less risk – unless they are stuck there for more than 48 hours. After this time, stomach acid may begin to corrode parts of the battery, causing the caustic contents to leak and lead to internal burning. And the more batteries are ingested, the higher the risk of becoming stuck in the stomach.
There is better news when it comes to the swallowing of coins, with recent research suggesting the rise of cashless payment methods has reduced the number of coins in everyday situations, and thereby the need for surgery to remove foreign bodies. The study, published in the Annals of the Royal College of Surgeons of England, found the total number of procedures to remove foreign bodies from the digestive tract in the UK fell from 2,405 in 2012 to 1,716 in 2022 – a 28 per cent reduction.
Contactless payments were first introduced in the UK in 2007 and cash payments declined from 2012, leading the authors to speculate there are fewer coins lying around in people’s houses. The study found there was no statistically significant increase or decrease in the number of foreign body removal procedures in Britain between 2000 and 2012, but a significant drop in the following 10 years.
Historically, coins have accounted for more than three quarters of objects swallowed by children under 6, but a limitation of the latest study is that it doesn’t specify the type of foreign body ingested.
But does this mean parents can relax?
The authors suggest not yet, and advise that we continue to make sure that dangerous items, “such as button batteries and magnets, are not within a child’s reach”.
