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patient name: Nora Fraver

age: 3-years-old

condition: battery button ingestion

seen in: emergency department, pediatric surgery

provider: Dr. Anne Mackow

Casey was at home with her three-year-old daughter, Nora, when their evening took an unexpected turn. Nora had been quietly playing with toys, but suddenly turned to her mom and confessed that she had swallowed a coin. Casey waited to see if her daughter was behaving differently or was experiencing any distress from swallowing the coin. Nora complained of a sore throat, which made Casey uneasy. Just before bed, Nora threw up after having a snack.

Growing more worried, Casey called Nora’s pediatrician to see what she should do. Their pediatrician told Casey to line up a series of coins and ask Nora to point to the one she swallowed. She pointed to the quarter.

Knowing that she had swallowed such a large object that it would unlikely pass without assistance, Casey knew she had to get Nora to the hospital. Casey and her husband, Kyle, drove to Dayton Children’s Hospital’s emergency department and Level 1 trauma center.

care from the Level 1 trauma team

Given the urgent nature of Nora’s condition, she was brought back immediately for X-rays. As soon as the scans came through, Casey and Nora were joined by Anne Mackow, MD, pediatric surgeon at Dayton Children’s and trauma surgeon on-call that evening, to review the results. Based on the scans, it appeared that Nora had swallowed a button battery and it was stuck in her esophagus. She would need to have surgery immediately to remove it.

At almost 1 a.m., Nora went back for an-hour long surgery to remove the battery and assess for any damage. During surgery, Dr. Mackow found that the battery had badly burned the lining of the upper part of her esophagus.  Because of this, Nora was admitted to the hospital to recover and for further evaluation.

The next day, Nora was again put under anesthesia to assess her esophagus and airway for damage due to the extent of damage seen on her first endoscopy. The pediatric surgery and ENT teams wanted to make sure there wasn’t any additional damage from the battery.

Finding none, they took Nora for additional imaging to check the vessels around her heart. Luckily, there was no additional damage.

battery button ingestion becoming more common

According to Dr. Mackow, battery button ingestions are not that uncommon during young childhood. “3,300 battery button ingestions occur in the United States each year and almost 7 out of every 10 occur in children less than 6 years old. Ingestions peak in kids who are 1 to 3 years of age,” she says.

Dr. Mackow says that button batteries tend to get lodged in the upper part of the esophagus, because that’s the narrowest part of our gastrointestinal tract.  Because the esophagus collapses around a flat disc like a battery, a closed circuit can be created that allows the battery to discharge and burn of the surrounding tissue.

“The upper part of the esophagus is right next to the airway, as well as the aorta, which is the largest blood vessel in the body.  The longer the battery stays in, the more damage it causes,” says Dr. Mackow.  This damage can lead to the development of a connection between the esophagus and the airway or the esophagus and the aorta, both of which can have significant and life-threatening consequences.

After being discharged from the hospital, Nora later followed up with pediatric surgery to address narrowing of her esophagus that was seen on a follow up study. To help expand her esophagus, she had to have a procedure, done under anesthesia, that used a balloon to help widen the narrowed areas of her throat. She will have ongoing follow up to see if she needs to repeat this procedure in a few months if there hasn’t been sufficient expansion. Beyond that, Dr. Mackow has no major concerns about Nora’s recovery and is thankful that her parents brought her in quickly for evaluation.

“Nora had found a spare battery that came with a new toy she got for her birthday. Thankfully, Nora was a good communicator and let me know that something was wrong,” said Casey. “Those little batteries can do so much damage, so quickly. It can be damage that can end their life or affect them deeply for the rest of their lives.”

If you are concerned that your child might have swallowed a round silver object, like a button battery or coin, visit the emergency department right away so the team can see what it looks like with an X-ray.  If you have any concern that it was a button battery, giving your child honey to swallow, while you’re waiting to be evaluated, can help coat the battery to prevent injury to the esophagus.