Increase in swallowing foreign objects

Coins, small toys and, most alarmingly, batteries – the number of children popping objects such as these into their mouths and swallowing them has more than doubled from 1995 to 2015, according to a new US study in the journal Pediatrics.

Researchers from the Nationwide Children’s Hospital, in Columbus, Ohio, analysed data from the National Electronic Injury Surveillance System (NEISS), which collects data on consumer product-related injuries occurring in the US, and found that for children under the age of six, the rate of “foreign body ingestions” rose by about 92% during the 21-year study period.

The NEISS data revealed that during that time, more than 759,000 children under six were treated in emergency departments because they’d swallowed a foreign body. The rate of foreign body ingestions per 10,000 children increased from 9.5 in 1995 to 18 in 2015. The number of estimated cases among children in that age range nearly doubled, from about 22,000, or about 61 per day, in 1995, to nearly 43,000, or 118 per day, in 2015.

“The dramatic increase in foreign body injuries over the 21-year study period, coupled with the sheer number and profundity of injuries, is cause for concern,” says lead author Danielle Orsagh-Yentis.

“Continued advocacy and product regulations are needed to keep children safe, and the data shows that vigilance, advocacy and regulations are effective,” she says.

Coins were the most frequent type of objects ingested (comprising 62% of the total), followed by toys (10%), jewellery (7%), and batteries (7%). The most frequently ingested coin was a one-cent piece.

Children from one to three years old were most likely to swallow a foreign body. Boys accounted for just over half of all cases, and 89.7% of children were able to be discharged after their suspected ingestion.

The researchers noted that although they represented a small percentage of all cases, battery ingestions increased 150-fold over the study period. This is particularly alarming because batteries can do considerable damage when swallowed.

Button batteries, found in everyday items such as toys, key fobs and greeting cards, represented 86% of battery ingestions.

The US Consumer Product Safety Commission (CPSC) cites a study by Toby Litovitz, of the National Capital Poison Centre, which said button-battery-related incidents “resulting in severe injury and fatality have increased sevenfold since 1985”.

The CPSC says most of reported incidents involve three-volt batteries with a diameter of 20 millimetres or larger. 

“Occasionally, a swallowed battery will pass through the intestine,” it says. “Most often, however, batteries that become lodged in the throat or intestine can generate and release hydroxide, resulting in dangerous chemical burns.”

The National Capital Poison Centre (NCPC) advises that “while most button battery ingestions are benign, passing through the gut without a problem, in recent years the number of debilitating or fatal battery ingestions has dramatically increased”.

If a child swallows a battery or places it in their ear or nose prompt action is critical. 

“Don’t wait for symptoms to develop,” the NCPC advises. “If the battery was swallowed, don’t eat or drink until an x-ray shows the battery is beyond the oesophagus. Batteries stuck in the oesophagus must be removed as quickly as possible as severe damage can occur in just two hours. Batteries in the nose or ear also must be removed immediately to avoid permanent damage.”