Paeds · acute-care-resuscitation-and-toxicology
Button-battery and magnet ingestion
Also known as Button battery ingestion in children · Disc or lithium cell ingestion · High-powered magnet ingestion · Neodymium magnet ingestion · Oesophageal foreign body emergency
A fellowship approach to the child with suspected button-battery or magnet ingestion. Treat any oesophageal button battery as a time-critical emergency requiring endoscopic removal within two hours, recognise the mechanism of alkaline liquefaction at the negative pole and the risk of delayed life-threatening fistula and perforation, give honey or sucralfate as a bridge in the eligible child older than twelve months who can swallow while awaiting removal, manage two or more magnets as a high-risk situation because attracting magnets across bowel walls cause fistula, obstruction and perforation, and run safeguarding and prevention in parallel.
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Target exams
Red flags
- Any button battery lodged in the oesophagus is an emergency requiring endoscopic removal within two hours, even when the child is asymptomatic
- A child who can swallow honey or sucralfate as a bridge must still have the battery removed urgently; the adjunct never replaces endoscopy
- Drooling, dysphagia, chest pain, haematemesis, stridor or vomiting after a suspected ingestion places the battery in the oesophagus until proven otherwise
- Two or more magnets, or a magnet paired with a ferrous object, attract across bowel walls and cause fistula, perforation, obstruction, volvulus and ischaemia
- Massive haematemesis days to weeks after a battery ingestion signals an aorto-oesophageal or tracheo-oesophageal fistula and is usually fatal
- A single magnet that does not pass, or any battery still in the stomach at repeat imaging, needs removal
- Recurrent or unwitnessed ingestion, or easy access to unsecured batteries and magnets, must keep safeguarding and prevention open
Life stages
Care settings
Clinical exam formats
Board mappings
- Acute Care
- Current 2026 PREP curriculum — Learning Objective 2.2.1: Recognise, prioritise and manage an acutely ill infant, child or young person
- Current 2026 PREP curriculum — Learning Objective 2.4.4: Assess and manage infants, children and young people with potential cardiac, respiratory or neurological emergencies or acute sepsis
- Renewed curriculum for first-year trainees from 2027 — Learning goal 11: Acute care and procedures
- Clinical Applications
- Medical Sciences
- Long Cases
- Short Cases
- 4. Professional skills and knowledge: Patient management
- 7. Patient safety, including safe prescribing
- General Paediatrics: Resuscitates, stabilises and treats extremely unwell babies, children and young people, liaising with specialist teams, as necessary
- Foundation of Practice (FOP)
- Theory and Science (TAS)
- Applied Knowledge in Practice (AKP)
- Clinical
- History
- Communication
- General Pediatrics Content Outline — Domain 7: Emergency and Critical Care
- General Pediatrics Content Outline — Universal Task 3: Diagnosis
- General Pediatrics Content Outline — Universal Task 4: Management and Treatment
- General Pediatrics EPA 7: Recognizing a Severely Ill Patient, Providing Initial Management, and Mobilizing Resources Needed for Continued Care
- Patient Care 3: Organize and Prioritize Patient Care
- Patient Care 5: Patient Management
- Systems-Based Practice 1: Patient Safety
- Systems-Based Practice 6: Systems Navigation for Patient-Centered Care
- Medical Expert
- Pediatrics: Foundations EPA #1 — Recognizing deteriorating and/or critically ill patients and initiating stabilization and management
- Pediatrics: Core EPA #2 — Resuscitating and stabilizing critically ill patients
Overview & Definition
Button-battery and magnet ingestion describes the accidental, and occasionally intentional, swallowing of a disc or lithium cell battery, or of one or more small permanent magnets, by an infant or child. Both are common, both can be asymptomatic at first, and both can kill within hours of an event the family may not have witnessed. The shared message is that an innocent-looking household object, retained in the oesophagus or trapped between bowel loops, can inflict devastating injury long before the child looks unwell. [1] [3]
The two threats work through different mechanisms but share a single clinical discipline: act on the possibility, image early, and remove an oesophageal battery or attracting magnets before tissue is destroyed. A button battery trapped against the oesophageal mucosa generates hydroxide by electrolysis of tissue water at its negative pole, producing alkaline liquefaction necrosis that worsens by the minute and continues after the battery is removed. Two or more magnets, or a magnet and any ferrous object, attract one another across opposing bowel walls, trapping and ischaemia the intervening tissue until a fistula, perforation or volvulus forms. [1] [9]
[1] [2]The clinical approach runs inside the broader paediatric primary survey. Airway, breathing and circulation are supported first, because drooling, stridor, haematemesis or a child who cannot protect their airway may signal an oesophageal battery or a complication. The history seeks the object, the time of ingestion, the type and number if known, and any symptoms. A single radiograph confirms the location, distinguishes a battery from a coin, and counts magnets. The plan then divides sharply by location and object: oesophageal battery and attracting magnets are emergencies; a distal, asymptomatic single object can often be observed with planned repeat imaging. [2] [9]
The first hour of suspected battery or magnet ingestion
- 1
Suspect and confirm
Ask about ingestion time, object type and symptoms. Treat drooling, dysphagia, chest pain, haematemesis, stridor or vomiting as an oesophageal battery until proven otherwise.
- 2
Resuscitate
Secure airway and breathing, give oxygen, establish access, and keep the child nil by mouth. Protect the airway aggressively if there is stridor or haematemesis.
- 3
Localise and count
Take one radiograph from nasopharynx to anus in AP and lateral views. Identify the halo or double-ring sign of a battery, confirm oesophageal versus gastric position, and count magnets.
- 4
Bridge if eligible
For an oesophageal battery in a child older than twelve months who can swallow safely, give honey 10 millilitres every ten minutes up to six doses while awaiting removal. It never replaces endoscopy.
- 5
Remove or observe
Oesophageal battery and two or more magnets get emergency removal within two hours. A distal asymptomatic single object is observed with planned repeat imaging.
- 6
Reassess and protect
Watch for delayed perforation, fistula and stricture after removal. Run safeguarding and prevention education in parallel, and give a clear safety net.
References12ShowHide
- [1]Mubarak A, Benninga MA, Broekaert I, et al. Diagnosis, Management, and Prevention of Button Battery Ingestion in Childhood: A European Society for Paediatric Gastroenterology Hepatology and Nutrition Position Paper Journal of pediatric gastroenterology and nutrition, 2021.PMID 33555169
- [2]Kramer RE, Lerner DG, Lin T, et al. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee Journal of pediatric gastroenterology and nutrition, 2015.PMID 25611037
- [3]Eliason MJ, Ricca RL, Gallagher TQ Button battery ingestion in children Current opinion in otolaryngology and head and neck surgery, 2017.PMID 28858893
- [4]Funk EM, Eck JB Button Battery Ingestion in Children: An Educational Review for Perioperative Nursing Journal of perianesthesia nursing, 2025.PMID 38878031
- [5]Goh S, Siu JM, Philteos J, et al. Pediatric Esophageal Button Battery Protocol Reduces Time From Presentation to Removal The Laryngoscope, 2024.PMID 38934450
- [6]Schmidt YM, Muensterer O, Wendling-Keim D The use of honey in button battery ingestions: a systematic review Frontiers in pediatrics, 2023.PMID 37842023
- [7]Chiew AL, Lin CS, Nguyen DT, et al. Home Therapies to Neutralize Button Battery Injury in a Porcine Esophageal Model Annals of emergency medicine, 2024.PMID 37725021
- [8]Eck JB, Ames WA Anesthetic Implications of Button Battery Ingestion in Children Anesthesiology, 2020.PMID 32011339
- [9]Altokhais T Magnet Ingestion in Children Management Guidelines and Prevention Frontiers in pediatrics, 2021.PMID 34422734
- [10]Seguier-Lipszyc E, Samuk I, Almog A, et al. Multiple magnet ingestion in children: A problem on the rise Journal of paediatrics and child health, 2022.PMID 35841278
- [11]Middelberg LK, Leonard JC, Shi J, et al. Warning Labels and High-Powered Magnet Exposures Pediatrics, 2022.PMID 36189482
- [12]Han Y, Youn JK, Oh C, et al. Ingestion of multiple magnets in children Journal of pediatric surgery, 2020.PMID 31937446