There are a few non-poison ingestions that I would like to address: button batteries, magnets, and superabsorbent polymers (i.e., water beads that expand). All are seemingly harmless, but can be very dangerous if ingested. While they can cause problems for anyone, the age group that is most often associated with swallowing these objects is infants and children between six months and three years of age. They cause problems in their own unique manner.
Button batteries are often found in common household electronics which may include toys, watches, cameras, games, hearing aids, and those cool musical or flashing greeting cards. They are so tantalizing for infants and young children. They come in a variety of sizes that are usually small enough for them to put into their mouths and swallow. Unfortunately, button batteries can cause severe damage.
Button batteries can get stuck in the esophagus, stomach, or intestines and it is the prolonged contact with the lining of the gastrointestinal tract that causes the problems. These problems can occur within two hours of swallowing a button battery, if they are stuck in one spot. There are three proposed mechanisms of injury to the tissue which include, “direct pressure on the mucous membrane (pressure necrosis), leakage of battery contents (chemical damage), and electrical current generated by contact of the battery poles against the mucus membrane in the esophagus (electrical damage)” or other gastrointestinal mucus membrane. The most common area of damage is in the esophagus.
The tissue damage in the esophagus, stomach, or intestines can cause a perforation or hole in the lining of the gastrointestinal tract and erode into surrounding structures, such as the aorta, the trachea, the area surrounding the heart, the nerves controlling the vocal cords, and other structures. The consequences can be life threatening and include bleeding, strictures of the esophagus with subsequent feeding problems, pneumonia, vocal cord paralysis, and others. An x-ray can be used to identify the batteries because they show up very well on x-ray and can have a distinctive halo appearance around the circumference of the battery. Usually being stuck in the esophagus or stomach, endoscopy is performed to pull out the button battery.
Magnets are items that are often found around the house, with the usual suspects being small ball magnets that are associated with games/toys or refrigerator magnets of various shapes. These small, but often high-power magnets, can be of serious concern if they are swallowed. But, one may not know that their infant or child has swallowed a magnet. So, it takes a high index of suspicion of the parent or the medical provider to identify that a magnet has been swallowed. Most children are asymptomatic. However, if complications occur, they can develop abdominal pain, vomiting, and fever which are common in children who have a viral gastroenteritis, the flu, or other intestinal infections. So, the presentation of symptoms without knowing that magnets were swallowed can lead to confusion and misdiagnosis.
Swallowing a single magnet is not concerning and no cause for alarm (as long as it is not too large). However, if two or more magnets are swallowed, that will get the attention of any medical provider. The reason that two or more magnets are concerning is because they attract each other. When they attract one another, they can trap intestinal tissue between them to cause damage to the intestine by creating a hole or perforation and even cause pinching of the intestines to cause a bowel obstruction. Once two or more magnets are identified, they need to be removed from the gastrointestinal tract by endoscopy or surgery (depending upon their location and the size or shape of the magnet). An x-ray can help diagnose the issue because magnets are seen very well on x-ray. However, one must make sure that they are accurately determining the number of magnets because two magnets can appear as one, if they are joined together and don’t have distinct shapes to identify them as separate magnets.
Superabsorbent polymer toys and beads are very common and kids love to play with them. It is fun to watch the objects grow in water, whether it is a cup of beads or a small animal toy. The material is able to absorb a significant amount of water and expand in size, with some able to expand to up to 400 times their original size. Most don’t cause issues and can pass through the intestines, but some can be problematic.
The concern is that as the superabsorbent polymer toy or bead grows in the intestinal tract, it can expand large enough to obstruct the intestines. In one study, the median size of the beads that were removed from obstructed intestines was 3 cm in diameter. Infants or children will present with abdominal pain and vomiting. If there is a true bowel obstruction, they may have bilious (green) vomiting. Once the bowels are obstructed by the beads or toys, they need to be removed surgically. If they are stuck in the esophagus or stomach, endoscopy can be attempted to remove the objects. Given composition of the material, these objects are not readily seen on x-ray. Abdominal ultrasound and CT scan seem to be better imaging methods to identify these superabsorbent polymer objects.
Clinical Presentation of Objects Stuck in the Gastrointestinal Tract
If an object is swallowed, some clinical symptoms can help give clues as to the location of the obstruction or injury. If an object gets stuck in the esophagus, the infant or child will likely not feed well and have drooling (more than normal). If it is stuck in the stomach, it may block the outlet portion of the stomach and cause vomiting with feeding. Once it gets down to the intestines and causes obstruction, vomiting will occur and appear dark green, the color of bile. The obstructed areas will generate pain or discomfort as well.
Button batteries, multiple magnets, and superabsorbent polymer beads or toys represent a real threat to infants and small children if they are ingested. It is a challenge to keep them out of their reach because they are commonly found in households and easy for adults to overlook because they have a non-threatening appearance and are small. Families need to be aware of them and keep them out of the hands and mouths of their extremely curious infants and young children. If these objects are ingested, prompt identification and evaluation for removal are the keys to reducing further injury. While button batteries, magnets, and superabsorbent polymer beads or toys are not poisonous, they can be equally as dangerous.
Were you aware of the problems that button batteries, magnets, and superabsorbent polymer beads or toys could cause?
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