Friday, November 6, 2015

Parents warned of button battery danger after Summer Steer death inquest

Paediatrician Dr Ruth Barker holding a button battery outside the Brisbane Magistrates Court during the inquest into death of Summer Steer.
NO ONE knows where little Summer Steer found the battery that killed her.
The three-year-old from the Sunshine Coast became the first child to die in Australia from swallowing a lithium battery, also known as a button battery, in 2013.

A coronial inquest into Summer’s death, which concluded this week, found the toddler had died as a result of the battery becoming lodged in her oesophagus, which caused her to haemorrhage.
Chillingly, one day after the coroner handed down his findings, a little girl in Sydney was rushed back to hospital with ongoing complications from swallowing the same kind of battery as Summer.
The two-year-old girl had the battery surgically removed from her oesophagus two weeks ago, but yesterday she was back with Dr John Curotta, Head of Department of Ear Nose and Throat Surgery at The Children’s Hospital at Westmead, struggling to swallow.
Her parents didn’t know where she had first found the battery either.
“Where the battery lodged, it had started to pierce through her gullet (oesophagus), and as it’s healing it’s started to scar up, so we’ve had to stretch the gullet to help her swallow,” Dr Curotta told
“We don’t know how many times we’ll have to do that. She’s only two.
“It was a week or so before it was diagnosed, even though she’d been to the doctor.
“That’s the problem with button batteries. Nobody knew she’d swallowed it. This is the issue. You don’t know.”
Dr Curotta is among a growing number of health professionals trying to warn parents of the dangers of button batteries.
Summer Steer, 4, died after swallowing a lithium battery.
Summer Steer, 4, died after swallowing a lithium battery.Source:Supplied
He says about four children a year present at hospital in NSW after swallowing one, and while it’s a small number, the risks to these children are grave.
Button batteries are being increasingly used in everyday household items and, comparable in shape to a 10 cent coin, are the perfect size to become lodged in a child’s oesophagus if swallowed.
And that’s precisely where the danger lies.
Of all batteries, the really dangerous ones are lithium-ion or button batteries, such as CR2025 and CR2032 batteries. Those are 2cm wide and 2.5mm or 3.2mm thick, and similar to a 10 cent coin.
Button batteries are increasingly being used in toys and games, remote controls (including for car doors), scales and calculators, watches, torches and laser lights, flameless candles, hearing aids, reading lights and musical greeting cards.
Dr Curotta said children could shove them in nostrils and even in lower orifices, but they were commonly swallowed.
“With one (swallowing case) last year, the battery came out of grandma’s kitchen scales,” Dr Curotta said.
“There was one this year where it came out of the thermometer the parents bought for the new baby.
“The rules are, in Australia, children’s toys have to have a secure battery compartment — but other things don’t, necessarily. So the kids get stuff from anywhere.
“They get swallowed, they get stuck there, and they don’t tell anybody — the older ones are too embarrassed to speak up and the younger ones don’t know.”
Dr Curotta said another danger with button batteries was how powerful they were.
“These lithium-ion (button) batteries are three volt batteries,” he said.
“Your old, cylinder, C or D batteries — the standard ones — are only 1.5 volts. So when they’re worn out and won’t work anymore ... they’re a bit under one volt.
“With these (button batteries), usually when they’re no longer working they’ve gone from three to a bit over two volts, so they’re still stronger than the old batteries. A lot stronger.”
His advice was, simply, to keep button batteries out of reach of children.
“If they’re in a toy or in kitchen scales or remote controls at home they must be secure,” he said.
“Once they’re used, get rid of them from the house — put them in the garbage or put them in a recycling system (safe environmental deposit system).
“But get rid of them, don’t save them.”
Dr Curotta said more often than not, when ingested, the battery will become lodged in the child’s oesophagus, where it will generally lead to alkali burns.
He said the saliva in the oesophagus allowed the remaining power in the battery to generate alkali, and this caustic substance then burns through the oesophagus.
“The danger is that it will erode through to the aorta or it will erode through to another part of the chest, and cause chronic infection and inflammation — and that will kill them, too, because it’s all around the heart,” he said.
“It’s like swallowing (drain de-clogging chemical) Drano. The battery creates its own little bit of Drano in pellets around it and eats through the gullet.
The X-ray of a 14-month-old boy who swallowed a button battery and had to have it surgically removed.
The X-ray of a 14-month-old boy who swallowed a button battery and had to have it surgically removed.Source:News Corp Australia
“And this baby (Summer) who died in Queensland, she died because this chemical eroded from the gullet into the aorta and she bled to death. Basically it lodged in the back of the heart, and it wore through into the aorta and she just bled into her gullet and she died.”
In 2010 in Queensland, a baby boy who swallowed a button battery ended up with extensive destruction of three vertebra, which severely weakened his spine. Five years on, his parents are pursuing legal action against two hospitals over delays in the removal of the battery.
Here’s the scary thing. Many cases of button battery ingestion, such as with Summer Steer, go undiagnosed for days.
The symptoms can be vague, but they can be there, Dr Curotta said.
“Sometimes they (the child) will swallow fluids but they won’t swallow food, so they might start spitting out food or refusing it,” he said.
“When they’re coughing or spitting there may be a bit of blood, and this might go on for a few days and weeks. The blood might be swallowed down and then start coming out black in poo.
“They might be just generally unwell and get a fever and spit up and cough up more. They’re the main things.
“The seriousness is when there is any suggestion of blood coming up or going through and you can’t really explain it.”
He said the challenge — for both parents and medical staff — was detecting the battery as early as possible.
“If there’s any child who chokes we have to assume they’ve choked on a battery until we’re proven otherwise,” he said.
“Most of them won’t — 99 out of 100 won’t — but every so often they will, and they’re so damaging that we have to check all the kids to be sure.”
If a child swallows a button battery, it is considered an emergency. It can take as little as an hour for an ingested battery to begin the chemical reaction.
“Button batteries are urgent. We have to drop everything, clear the operating theatre and get them out as fast as we can,” Dr Curotta said.
He said in some cases, the battery might end up in the child’s stomach, and while it still needed urgent removal there might be a little bit more time.
Parents should get their child to an emergency department immediately if they suspect they have swallowed a battery.
Children should not be given any food or drink and vomiting should not be induced.
Removing the battery removes the immediate danger. But as Dr Curotta saw with his tiny patient this week, that may not be the end of the story.
“If (the battery) comes out and they get a scar, the scars always tend to get smaller as time goes on; they tighten, like an elastic band,” he said.
“So they have to be dilated or there may be some swallowing troubles as time goes on.”
An X-ray of a child who got a button battery stuck up his nose.
An X-ray of a child who got a button battery stuck up his nose.Source:Supplied
Tiny watch batteries can also be a concern, but less so than button batteries.
Dr Curotta said if ingested, watch batteries were generally small enough to pass through into a child’s stomach, and wouldn’t cause the same oesophageal damage as their larger counterparts.
But he also said children have been known shove watch batteries into ears and nostrils, where they can still be dangerous.
“They’ll burn if they’re stuck in nostrils — we’ve had children who got a hole through their septum, a bit like a cocaine addict, because it’s worn through,” he said.
Cylindrical AAA and AA batteries were less of a risk to kids, he added.
Handing down his findings into Summer Steer’s death on Wednesday, Coroner John Hutton recommended more safety measures be pursued to make button batteries less dangerous to kids.
Kidsafe Queensland updated the coroner of two international initiatives that appeared promising — US research is underway into a battery coating to prevent the chemical reaction from occurring, while in New Zealand, researchers are looking into a colourant that would turn saliva a bright colour if ingested.
But Dr Hutton said these developments were many years away. Dr Curotta agreed.
“We can congratulate Eveready, Energizer, who are doing a lot of work along these lines, as well as Kidsafe,” he said.
“But having said that, it’s going to take years for these to be introduced and we don’t know how many parallel imports from cheap manufacturers we’re going to have coming in anyway.
“So yes, it’s a great idea but it’s certainly going to take a long time and there are a lot of substitutions. If they’re more expensive people will go for the cheaper option.
“It will be helpful but it won’t be the answer.”

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