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We are not doing enough to make button batteries safe

The Australian Competition & Consumer Commission (ACCC) is working with manufacturers and the industry to improve battery safety after the recent death of a toddler who swallowed a lithium button battery…

It is estimated that five Australian children are taken to emergency rooms every week after swallowing button batteries. Shutterstock

The Australian Competition & Consumer Commission (ACCC) is working with manufacturers and the industry to improve battery safety after the recent death of a toddler who swallowed a lithium button battery.

Whether repackaging button batteries and re-educating consumers on their potential dangers will be an adequate is debatable because as soon as the batteries are out of the packaging, children can access them as they do now.

A long history

Summer Steer was only four years old when she swallowed a lithium button battery and died as a result. She is just one of the five Australian children taken to emergency rooms every week after swallowing such batteries. And this has been happening for a long time.

In 1984, a nine-month-old girl was presented to Westmead Hospital in Sydney with copious bleeding from the bowel. I was the paediatric surgeon on call for the day. As she was not too unwell, I booked her for an anaesthetic and examination of the lower bowel the next morning.

Her mother said that she had developed a croupy cough several days before, but we did not think that this was related to the blood in her bowel motions.

Overnight her condition deteriorated and she started to have trouble breathing. A chest X-ray showed a button battery lodged in her gullet. We took her urgently to the theatre, and the anaesthetist just managed to squeeze in an airway tube as she had almost stopped breathing.

I extracted the button battery out of her gullet where it was firmly wedged, causing inflammation and bleeding. Two days later, she coughed up a cube of tissue about the size of a game dice.

It soon became apparent that the battery had eroded a hole between her gullet and windpipe, so that food could go into her lungs and air into her stomach.

Many operations to feed her, stop infections, allow the hole to heal, and stretch up the narrowing of the gullet followed. Eventually, the child was discharged and made a recovery.

We retrospectively concluded that the battery probably came from an open, used battery discard container, under the counter of a camera shop where her mother worked and which the daughter had visited several days before the bleeding started.

With some colleagues, I wrote a paper for the Medical Journal of Australia to highlight this problem. That was in 1986.

While researching the paper, we noted a 1983 report in the Journal of the American Medical Association that reported 56 such cases, including several deaths. Through Kidsafe, we alerted government agencies of this and other foreign body problems in children.

The size of the button battery is just right to lodge in the windpipe. Shutterstock

An international issue

In 2012, I attended a workshop in Wellington, New Zealand, on the problem of button batteries. The speakers were impressive, especially the engineers. They understood that the button batteries had three essential problems made them a potentially lethal product.

The first was the size: the narrowest part of the gut is just above the junction into the stomach. The next narrowest is halfway down the gullet, just adjacent to the windpipe and just above where it divides into right and left side.

The button battery is precisely the correct size to lodge in this part of the windpipe. Any smaller and it would pass into the stomach, from where it will pass through the entire gut and be passed in the stool without any problems occurring.

The second problem is the relationship between the anode (the terminal where current flows in from outside) and cathode (the terminal where current flows out). They are close and the chemicals result in a high current passing through the adjacent salty tissues (causing tissue damage within 20 minutes under laboratory conditions).

The third problem is that the battery will still cause damage when “flat”. The battery will stop working at about 1.1 volts but still cause tissue destruction when it is below one volt.

The engineers were confident that they could design a battery that was safe. Their suggestions included altering battery size, changing the way the anode and cathode were arranged and having a cover over the electrical points when the battery was removed from its appliance.

At the Wellington workshop, it was reported that a worldwide registrar had been set up in Italy, that showed thousands of cases reported, hundreds of serious injuries and many deaths. Representatives of battery company assured us that they were aware of the problem and were working hard to rectify it.

Back to the beginning

With the recent death of Summer Steer in Queensland and the serious injury of Mackayla O’Connor in Sydney, I reviewed our experience in the last 12 years at The Children’s Hospital at Westmead. In this time, we have had 34 admissions for button battery injuries.

Based on our experience, the ACCC initiative to ensure child safe packaging would not solve the problem. Most of the time, we remain uncertain how and when the battery was ingested, but it does not seem that the child removed it from a package.

The problem seems to be the battery has become dislodged from a product, or has been discarded. The best solution is an engineering solution to make the product intrinsically safe.

My mind returns to the infant girl I treated 29 years ago. Although I have lost contact with her family, I hope she has remained well.

She is probably old enough to have had children. I am saddened to think that any children she has still face the same risks that she did, 29 years ago.

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5 Comments sorted by

  1. Riddley Walker

    .

    This is a terrible story, that seems to have only surfaced recently. Thank you for republishing and raising proposals to fix it. Should be easy to legislate an engineering fix and an education campaign.

    But I guess there's not a lot of profit in it.

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  2. John Kelmar

    Small Business Consultant

    All button batteries I have ever bought are sealed in a cardboard and strong plastic cover, which no child could break. Parents need to take greater care where they store these batteries.

    If the batteries were in toys when children played, then the manufacturer should ensure that the lock is child-proof.

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  3. Ruth Barker

    Paediatrician

    This is a very unusual injury problem; a ubiquitous and innocuous looking item, accessible, attractive to and readily swallowed by young children, causing oesophageal obstruction instantly, and severe injury or death in hours to days.
    As an emergency paediatrician and a mother, I am acutely aware that parental supervision can only go so far. Disc batteries are hazardous throughout their lifespan in the home. Packaging and child-resistant battery compartments only address part of that journey. The data we have would suggest that only a fraction of batteries causing injury are purchased for toys. Toys are the only product required to have a secured battery compartment.
    Danny has clearly articulated the lag between recognition of an issue and design solutions to prevent the issue (about 30 years). What is required is closer collaboration between those with injury data and those with the power to design out the hazard.

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    1. Mike Jubow

      forestry nurseryman

      In reply to Ruth Barker

      Going by the article, it seems to be the discarded batteries that are causing the trouble. Newly purchased batteries are less attractive for a child to put in their mouth because of the packaging.

      "The third problem is that the battery will still cause damage when “flat”. The battery will stop working at about 1.1 volts but still cause tissue destruction when it is below one volt."

      As a suggestion, would it be feasible for the battery manufacturers design and pack the batteries in new childproof plastic packages that can be reused by the consumer when the battery has lost its charge? For extra security, if there could be a small metal frame that is inserted into the package that, when it is closed on the used battery, has two prongs that make contact with both the - & + sides thereby ensuring that it is flattened completely.

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  4. Ruth Barker

    Paediatrician

    Just to clarify the above comment, the batteries are hazardous at both ends of their life, as Danny says, they will still cause damage when they are 'flat'. Our data suggests that children have accessed them loose (probably both 'flat' ones coming out of products and new ones going in), from packaging (not all packaging is so robust) and possibly from products themselves. Add to this the fact that batteries can be purchased loose from a variety of stores. This is an inexact science, as unless they are caught in the act, it is speculation as to how they accessed it (many are too young to tell what they have done).
    Certain children are voracious predators when it comes to swallowing things, and the act itself takes seconds. If the parent is observant, they may notice the item is missing (coin, tablets, battery).......or the evidence trail (the chair moved closer to the table).

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