Button Batteries: What Parents Need to Know

Lynn Smith: There are things we all worry about as parents, and then there are lesser known dangers that really fly under the radar—batteries, specifically small round batteries called button batteries or lithium coin batteries. They tend to fall into that lesser known category. The smaller ones resemble small pieces of silver coated candy, while the larger versions are flatter and look like a nickel.

Both versions have become increasingly common in recent years and there's a strong chance several are in your home right now. They're an inexpensive way to power small toys and gadgets, and they're found in everything from household items like watches, key fobs and remotes to games, toys and even musical greeting cards that are so popular with kids. Laura Johnson, a mom of two boys, had recently seen an Instagram post about button batteries when her then 6 year old accidentally ingested one that had popped out of a remote control. On that day alone, her son was the third patient to arrive at our hospital after ingesting such a battery and then a fourth case came in shortly behind him. The swallowed battery wreaked havoc on her son's esophagus and resulted in a two-week stay in the hospital. Laura is sharing her family's story to pay it forward as a thank you to the family whose social media post may have helped save her son's life.

We're also joined by Dr. Matthew Santore, a pediatric surgeon who's treated more than 100 cases of ingested batteries. He serves as the Medical Director for Trauma Outcomes at Children's and will share insight into common scenarios that lead to swallowed batteries. This is an episode you'll want to share with anyone who provides gifts to your children or whose house your child might visit.

It's my honor to welcome Laura Johnson and Dr. Santori to the show. This is such an important topic. And Laura, I am right where you are as a mom, where you think that your child is out of the stage where this could happen and you're right there in the thick of it. I want to start with you. Your story is striking a chord with a lot of people because we can all see this happening in our households. Before we dive in to the day that landed you here on the podcast, can you tell me a little bit about your boys?

Laura Johnson: Yes, I have two wonderful little boys. Ford is 3 now and Beckett is 7. At the time of this, they were a little bit younger. They love to build. They love to create. They love being outside and doing things. So, you know, we're always watching what we have around the house, just making sure that we have things safe and trying to be conscious of that.

Lynn Smith: Take us back to that day where you got a call from your husband. You missed a few calls before that, I hear. Tell me exactly what happened.

Laura Johnson: I was out doing the normal Sunday things. We were grocery shopping. I had my youngest with me, and I was at the end of the grocery shop trying to load all the groceries into the car, trying to get him into the car—wrangling a 2 year old into a car seat. I missed some calls. We had just been all together. My husband and Beckett went home, and they were just relaxing at the house. So I wasn't really paying attention to my phone. When I did get the calls, it was my husband letting me know that they were on their way to the ER and that Beckett had ingested a button battery.

Lynn Smith: What's really remarkable is you had just shown your husband an Instagram post about swallowing batteries, and that's how he knew to go immediately to the ER. Tell me about that.

Laura Johnson: It was just something I saw while scrolling Instagram. Surprisingly, I decided to show my husband and point out, “Gosh, it's crazy how impactful these can be when ingested and just the harm that they can cause.” We had the casual conversation around it and noted Beck's getting older. We're in the safe zone there. We’ve got to watch out for it, but we're getting close to the end of that window. It was a passing conversation, but so glad that it happened, looking back now.

Lynn Smith: This is something that I hope everyone that's listening takes away from this—you have to act immediately. And you did. He took Beck right to the ER. We'll get to what happened a little bit later in the show, but I want to go back to this remote and what we need to look out for. What did the remote look like? And had this been on your radar, the type of battery that he swallowed?

Laura Johnson: The remote was about the size of a pack of gum. It was used to control some blinds that we had in our house that were motorized. It was not on our radar. Even after seeing the Instagram video, thinking about it and having the quick conversation about it, we didn't go around our house and catalog what had batteries and what type. This had a 2032 battery in it. It's about the size of a quarter. I think there are so many things lying around the house that have these batteries in them that we're not thinking about. We're not noticing on the day-to-day basis.

Beckett was watching TV in the back room. He was by himself, and we think he was just playing with the remote. There's a slot that the battery is inserted into. He’s casually watching TV and mindlessly putting the remote around his face, near his mouth. At some point, the remote opened and the battery came out. Then, Beckett swallowed it.

Lynn Smith: You pointed out he's 6 years old. I have a 6 year old. I would not think he would put random objects in his mouth. How did it happen?

Laura Johnson: It was completely unintentional. It really caught him off guard. Luckily, he immediately came out and notified my husband. It surprised him so much. He was so shocked that he even did it that he immediately notified us. Poor thing.

Lynn Smith: And it's such a good reminder that these batteries can pop out of things with just a little bit of play. There are some kids that play with items in their mouth like coins. This is so about awareness for parents. What happened once you got to the Emergency Department?

Laura Johnson: Right away when we got there, they took him back. They started giving him honey to coat the battery to help slow anything that's happening. While they were able to evaluate him, we got an X-ray and identified that it was stuck in his esophagus. The battery wasn't able to pass. That's also when we met Dr. Santore and started our conversations with him around what the next steps would be, which would be removing the battery surgically.

Lynn Smith: He was taken into surgery less than two hours after swallowing this. Do you know if any damage had been done right away?

Laura Johnson: Beckett was saying that his chest was burning. It felt like it was on fire. He was definitely feeling things happening. We're lucky that we live so close and were able to get there quickly. We're only 12 minutes away. My husband acted really fast and got them out of the house. In the Emergency room, everyone was moving very quickly. We were hoping that because it was removed so fast that there wouldn't be much damage. After they removed it, we were able to see the images, and there was quite a bit of damage that occurred.

Lynn Smith: We'll talk to Dr. Santore about that, but I wouldn't have thought of this. That's why I'm so glad we're doing this episode because I understand you learned you weren't the only family that was there because of batteries that day.

Laura Johnson: We learned that we were the third battery case of that day. While we were doing the post-op conversation, they were notified that another case had come in. I did not know how prevalent it was, how often this was happening to other people. After this incident, I'm surprised at how many people don't know that this is a concern. I think people figure it’s like swallowing a toy. It'll pass. Things will be okay. They don’t understand the dangers that can come with ingesting these types of batteries.

Lynn Smith: You spent two weeks in the hospital. Tell me about what happened during those two weeks. What were they watching for after the surgery and before?

Laura Johnson: That was a quite the post-op surprise to find out we were staying for two weeks in the hospital with these battery ingestions. The damage is just unknown. They need time to evaluate what's happening. There's a lot of swelling and if anything happens, it'll be catastrophic. Your child being in the hospital so hospital staff can react quickly is so important. Beck had a NG [nasogastric] tube for about a week trying to protect his esophagus and help him with swallowing and preparing to ingest food again. There's quite a process that you go through to get your body healed and to get back to where you were beforehand and make sure that everything is safe. Beck remained in the hospital really for observation, to make sure that everything was going well while we were healing.

Lynn Smith: Thank goodness he's safe now. This is a great time to bring in Dr. Santore. Listening to this, you might think it's just a freak accident. Maybe this is just a one-time type of thing. But I know that's not the case. You are dealing with this much more often than I anticipated. How often are you seeing something like this along with your colleagues?

Dr. Santore: This is a really important topic because as you described before, this is not known in the mass public that this is really a health problem and can cause devastating, catastrophic damage, even death in some patients. Unfortunately, we've seen a real uptick in the amount of ingestions from button batteries in the last decade. Part of that is the prevalence of the button batteries. They're basically in everything around your house. They're in watches, car fobs, thermostats, calculators, remotes—anything you can really think of that is electronic. Christmas cards and cars that have songs in them, they have button batteries. We've seen an uptick of button battery ingestions and severe injuries. Part of that is the strength of the button batteries. They’ve become stronger. These lithium batteries are now 3v, which is a fairly substantial amount of energy and can cause a pretty significant amount of damage.

Lynn Smith: I didn't realize that they were any different than your typical battery. Beck experienced how powerful the effects of it are. What were the clinical teams looking for over those two weeks once you got the battery out? Why were they still concerned about some of the effects that it had?

Dr. Santore: I can't overemphasize the fact that if there's a witness or even a suspicion for a button battery ingestion, you come immediately to the Emergency room. The damage from a button battery in the esophagus can occur within two hours of ingestion. We can see different types of injuries—thermal injuries, which injure the lining. We call it the mucosa of the esophagus. That is more of a superficial burn. Those usually occur early, within an hour or two of the ingestion, to the point where you can have severe injuries—burning of the esophagus can cause different types of things, such as a perforation or hole in the esophagus, which can be catastrophic and lead to death.

Even connections between the airway and the esophagus and connections from the esophagus to the aorta. That's the main blood vessel in the body. We've had several patients with that instance, where there has been a connection between the esophagus and the aorta. There are other devastating injuries because of this. The reason we watch these patients for such a long period of time, for two weeks, is because what we know how these injuries occur is initially there's a burn. Even after you remove the button battery, you will continue to have this thermal damage to the esophagus, a burn in the esophagus. That continues to mature and develop. These long-term complications, such as the connection between the airway and the esophagus, don't present themselves into at least seven to 10 days, as well as the connection between the esophagus and the aorta. Watching these patients in the hospital is paramount to making sure that we're able to detect the injury and can intervene and not have any catastrophic events.

Lynn Smith: I want everyone to understand what these batteries are like, what to look for and how it differs from maybe swallowing a small toy or a coin. There's a really big increase in these cases because these batteries are in so many different household items. What are button batteries and lithium coin cell batteries.

Dr. Santore: They look like coins. They're circular. There are different sizes—9-millimeters up to 20-millimeters. Those are more common. They can get stuck in the very top part of the esophagus. If it gets lodged in the esophagus, the battery can discharge and cause that thermal injury. They look very similar to coins. Unlike say a AA battery or a AAA battery, which is long and thin. These are round circular objects that look like a coin and can be misled for an ingestion of a coin.

Lynn Smith: I think I'm going to have a conversation with my children tonight about this, educating them on what it can do. I'm also going to do a walk through of the house. Where would these batteries be especially? I mean as Laura described, this was in a tiny remote, the size of  a bubblegum pack.

Dr. Santore: They can be in watches, key fobs, calculators, scales, hearing aids, fake candles, remotes. They also could be loose. If you have a container of batteries near a kid, they could potentially get into that. As we all know, kids have a way of getting into everything and then putting everything in their mouths. Unfortunately, we're seeing more and more of it, almost weekly. When we saw Beck, we had three patients within a very short period of time come in with the same ingestion.

Lynn Smith: Are you seeing any kind of trend with all of these patients that come in?

Dr. Santore: I think the most common situation is the lack of knowledge or understanding among families of how serious ingestions are. Most families don't understand that this can be a potentially life-altering event.

Lynn Smith: I'd love to point out with all the holidays coming up, there are a lot of decorations that have these types of batteries. When children see something that's bright, they start playing with it. Have you had that happen?

Dr. Santore: That's another common scenario. The lights are going up and a lot of these lights that aren't connected to an outlet will have need some sort of battery pack. The smaller ones are going to use button batteries, most likely the 20-millimeter 3-volt lithium batteries, which are the most powerful ones. To your point, it's going to be more prevalent and as the devices get smaller and there's more of these types of devices, we're going to continue to see this. There's been a lot of advocacy around this, and even the button battery companies have taken notice. There are some new regulations and newer things that are happening. If you ever buy a button battery, you’ll notice they're hard to get out of the package. That's for a point. Also, there is now labeling on the button battery itself. It says, “Do not ingest.” Some of them are coated with a very foul-smelling taste so it discourages ingestion, or if it goes in the mouth, they'll spit it back out. There has been some advocacy within the industry, but it still hasn't really prevented all these significant injuries from the perspective of a surgeon.

Lynn Smith: Can you describe for us the damage that these batteries can do once it's swallowed? What happens and why is it so important to get treatment immediately?

Dr. Santore: What happens is the battery starts to discharge and basically has this hydrolysis reaction that causes a cooking of the tissue--cauterization that then progresses over time. The longer that the battery's in, the longer it has time for this discharge and this injury to occur. Most of the time, we see this dark scar when we take out the button battery. It looks like black dead tissue. That can progress to the tracheoesophageal fistula. That is when you have a fistula, or connection, between the esophagus and the airway. The problem with that is when you breathe, the air should go into your lungs and not into your esophagus. That connection can be devastating because you're no longer just breathing into your lungs, but the air is going into your GI tract, your esophagus and your stomach. These types of patients will have respiratory events, and potentially, if it's not treated quickly, can have catastrophic events. As the esophagus begins to heal, it will scar and tighten, which creates an obstruction. The most devastating one is when we've had a connection between the esophagus and then that aorta, which is the main blood vessel, where then the blood can then bleed into the esophagus and the patient ultimately will bleed out and die from hemorrhage.

Lynn Smith: Just hearing you describe that, I know, Laura, you must be just thinking to yourself, “What if?” Beck was so lucky that he's safe and healthy now. He had that battery lodged in his esophagus. Is it different? What if it makes its way to the stomach?

Dr. Santore: That's a great question. We've studied this at Children's. We have found that even if it goes into the stomach, even the small amount of time that button battery is in the esophagus, you can still see damage. If it is in the stomach, a lot of times we will remove them. If they pass through beyond the stomach, we’ll let them pass naturally. Once it gets into the stomach, there's enough fluid and such that it doesn't connect to the wall of the intestine like it does in the esophagus; so it doesn't discharge the same way. Eventually the patients will pass it. Even if it goes in the stomach, you still can have injury to the esophagus.

Lynn Smith: Is it different in how it affects children if they are younger versus an older child?

Dr. Santore: The big difference is the younger kids have a higher rate of complications because it's usually unwitnessed. They find this button battery. They put in their mouth, and no one's seen it. Then, the patient starts developing symptoms such as coughing, gagging, drooling, not able to eat or swallow, maybe some spit ups. They look very uncomfortable and maybe point to their chest and point to some discomfort. That usually prompts the families to bring the patient to the Emergency room. And then ultimately you have a diagnosis of an ingestion. However, because it is not witnessed, there's a longer exposure—sometimes even for hours or days. Those types of exposures can make it hard to remove the button battery. However, because of these more complicated complications that occur in younger patients, older patients (like in Beck's situation) will say, “Hey, I was putting this thing in my mouth and I swallowed it.” They will probably own up to it more and tell the family that this happened.

Lynn Smith: How much time do you have? I know it's go to the ED immediately, but when is it too long that you've waited?

Dr. Santore: I would say you don't want to wait at all. If you're hesitant and you make the decision not to go and say, “Oh, we'll just go in the morning.” You've waited too long. This is really an emergency in the sense that you need to get to the Emergency room as fast as you can. Now, there's a lot of families that live very far away—hours away from Children's. The important thing is to go to the closest facility. Children's deals with all this all the time, So if you're close to Children's, that's probably the best place to go. However, a lot of the families live far away, and a lot of the outside institutions have the ability to remove the button battery, and then they'll transfer the patient here for further management. We see a lot of that as well. If there's a button ingestion in a community hospital that's two or three hours away, eventually they get transferred here for management of after the ingestion and the removal.

Lynn Smith: I was surprised to learn this honey is something that you use to treat this immediately before you have a medical intervention. Tell me about the effects of honey.

Dr. Santore: You never think that household things like that would be of help, but it is. Children’s has developed guidelines from the removal all the way through taking care of the patient to going home. Honey has been shown to decrease the rate of complications and the extent of the injury. The reason for that is that the honey coats the lining of the esophagus. It's thick, and it prevents that contact from the battery to the esophagus. You don't have the same level of damage when you are drinking honey. Now, you can't give honey to kids that are less than a year of age. Any patient that is less than a year of age should not get honey. But for anybody older than 1 year, the more the better. That's part of our protocol in the Emergency room. As soon as they hit the door, if we know it's a button battery, the nurses are giving honey to the patient before they go into the Operating Room.

Lynn Smith: In Beck's case, Laura, you described he was able to tell dad what happened.  Tere are a lot of kids that are not going to be able to because they're younger and don't communicate so well. Can you tell us what parents might need to look out for if a child has ingested a battery? What kind of symptoms you described?

Dr. Santore: The immediate symptoms the older kids will feel is discomfort in their chest. They may feel a fullness. Over time, that turns into more than just discomfort--more pain, also gagging, coughing, drooling. If it's in there for long periods of time, you can have fevers and you can look unwell. You can look like you're very sick because of severe damage to the esophagus. The initial symptoms are that they'll complain about some discomfort, pain, gagging, not able to eat, vomiting, spit ups. Those are your initial symptoms.

Lynn Smith: Is there anything that parents can do if they notice these symptoms and they're on their way to the Emergency Department?

Dr. Santore: Get there as fast as you can and give your child honey if they're older than a year. That is probably the only thing that the family can do. Don't allow your child to drink or eat. Don't force them to vomit. There are all these wives’ tales of how you get foreign objects out of the esophagus. Some families try to induce vomiting. They try to force it down by drinking or eating. That is not advised. What is advised is to get to the hospital as fast as you can and give honey. Don't stop at the store to buy honey. Just come as fast as you can.

Lynn Smith: Laura, just hearing all of these, just scenarios that could have happened, what's going through your mind? What do you want people to remember?

Laura Johnson: Hearing Beck's story, we're entering a busy holiday season where we've talked about all the toys and all the decor and all these items around your house that can have [button batteries]. Be aware of what you already have in your house, what you're bringing into your house, what are you gifting to others. Also with the holiday season, people are traveling around a lot and you're at other people's houses. Educate those that you're around, that your children are around, just to make sure that they understand the impact of this. as well. If they're not aware, they may be leaving batteries that they swapped out and left on the counter because they need to throw it away and didn't quite get there, yet.

Lynn Smith: Laura, what would you say was most surprising about this experience post-surgery?

Laura Johnson: When they came out and notified us of the damage, we were talking about what treatment was going to look like and understanding we were going to be admitted and that the stay was going to be a minimum of two weeks. [Children’s] has this extensively designed protocol that really focuses on protecting the children and making sure that they are safe and cared for. We were going to be there for two weeks. Beck was fed through a tube through his nose for a week. We then had to do studies on his esophagus, swallow studies, introducing food slowly to make sure that his body was healing, it was protected and it's safe. He was a 6-year-old little boy at the time, so very active. While he had so much damage internally, he was also really well. It was interesting to manage this healthy little boy bouncing around a hospital trying to keep him safe and trying to let his body heal at the same time.

Lynn Smith: And how's Beck doing now?

Laura Johnson: He is wonderful. We're about a year later, and he is doing really well. We are really lucky. There were no post complications. After our stay, he has continued to heal and develop well.

Lynn Smith: Amazing. I'm so happy for you, Laura, and the team at Children's Healthcare of Atlanta, like Dr. Santore. You are a dad to two girls, ages 6 and 1. Based on everything that you've experienced, what do you want the listeners to remember here about some of the preventative actions you take in your own home?

Dr. Santore: Being a father puts you on the other side of things. All those musical cards, I throw them out right away. We don't buy any of those things—those widgets. I really don't let my kids play with anything with a button battery. We keep our button batteries in a locked cabinet, which is at the very top and the kids would never be able to get to it.  The other thing we do is keep them in sealed containers like the button batteries come in.

Lynn Smith: I learned so much and I'm so grateful to you Dr. Santore and everyone at Children's who is just fighting to make sure everybody knows the dangers that can be associated with this. Laura, thanks for sharing Beck's story. We're so happy he's doing well. Thank you both.

In closing, I want to thank Laura and Dr. Santore again for the eye-opening insights shared today. As we head into gifting season, sharing this information with loved ones just might help keep a child out of the hospital. We hope you never need to use this information, but our three emergency departments at Arthur M. Blank Hospital, Hughes Spalding and Scottish Rite are open 24/7 for emergencies every day of the year. For more information and for content you can share on your own channels to spread the word about the importance of prompt treatment, visit For more information about what we discussed today, head to choa.org podcasts. I'm Lynn Smith and this has been Hope and Will, a parenting podcast from Children's Healthcare of Atlanta.

This podcast is for general informational and educational purposes only. It is not to be considered medical advice for any particular patient. Clinicians must rely on their own informed clinical judgments when making recommendations for their patients. Patients in need of medical or behavioral advice should consult their family healthcare providers.