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Small Button Batteries Pose a Danger to Children

By Marcella Bothwell, M.D.

Why do kids put things up their nose? It can be baffling to parents, but the short answer is that children are naturally curious and like to explore their surroundings, especially when they begin to crawl or walk. Putting objects in the ear, nose and throat is not limited to children but, as you might suspect, children between six months and five years old are most likely to put objects where they don’t belong. As kids gain mobility, they have access to a larger variety of shiny objects. And yes, boys do insert more objects up their nose: 60 percent compared to 40 percent for girls.

The most common site for insertion of small objects is the nose, then the ear, and finally the mouth, which often leads to swallowing the foreign body. Sometimes these objects are found incidentally during a pediatric well child exam. Some parents discover a nasal foreign body after detecting a foul odor emanating from one side of their child’s nose. The foreign bodies removed are a reflection of our culture and time. Japan reports a larger number of fish bones removed. Coins have replaced safety pins for swallowing since most parents no longer use cloth diapers requiring safety pins. Beads, nuts, carrots, beans, pins and BBs are just some of the other fascinating array of objects doctors have discovered.

More recently, cases of children swallowing button batteries have increasing significantly. These are the small, coin sized batteries commonly found in toys and games, hearing aids, watches and calculators. Recently, the number of flashlights and remote controls using button batteries has increased. The shiny objects seem innocent enough, but they can be deadly. A 2012 study published in an issue of Pediatrics found that the rate of battery injuries has almost doubled in the 20-year period from 1990 to 2010. There is a child admitted to the emergency room almost every three hours in the United States for a button battery injury. Eighty-four percent of those batteries were button batteries; only 16 percent were cylindrical.

Button batteries can cause significant permanent damage within a few hours if placed in the nose, mouth or ear. All sizes of the battery are dangerous, but the large diameter 20mm or greater cells cause the most damage in the esophagus because they can get stuck, potentially causing erosion into major vessels of the chest or nerve damage that can harm the voice box or larynx resulting in lifelong breathing tube dependence. Smaller button batteries can cause holes in the nasal septum and nasal scarring, or perforation of the eardrum and ear canal with resultant hearing loss.

Caregivers should ensure that batteries are stored out of reach of children and discarded properly. In 62 percent of button battery ingestion cases, the child obtained the battery directly from the product. That’s why, until manufacturers require child resistant mechanisms on their products, caregivers should tape shut battery compartments.

While we may never be able to prevent kids from sticking objects up their nose, making their environment as safe as possible means we don’t have to stifle their natural curiosity.

Dr. Marcella Bothwell is a pediatric otolaryngologist at Rady Children’s Hospital-San Diego and a clinical professor in the department of surgery at UC San Diego. She can be reached at