Pathway for the Evaluation/Treatment of the Child with Foreign Body Ingestion
Button Battery Ingestion Confirmed By X-Ray
Main Pathway
Foreign Body
Ingestion Pathway
Foreign Body
Ingestion Pathway
Esophageal Batteries
Emergent Endoscopic Removal
Emergent Endoscopic Removal
- Activate Button Battery Notification
- Cluster notification to ENT, GI, Gen Surgery and OR to prepare for patient
- Transfer to OR immediately
- Irrigate esophagus with 50-100 mL of 0.25% acetic acid upon battery removal
- Consider Antibiotic Prophylaxis for children with severe esophageal injury, perforation, or fever
- Poison Help
- Button Battery Ingestion Triage and Treatment Guideline
Stomach/Beyond Stomach
- Pre-hospital Recommendations
- Children ≥ 1 yrs, ingestion in prior 12 hrs,
- Consider giving honey:
- 10 mL every 10 min
- Proceed to ED immediately
- Bring Battery Information, if Possible
Consult GI
Evaluate Symptoms
Evaluate Symptoms
- Anorexia, vomiting
- Abdominal pain
- Fever
- Magnet co-ingestion
No Symptoms
Single battery
No magnet co-ingestion
Single battery
No magnet co-ingestion
Symptoms
Multiple batteries
Magnet co-ingestion
Multiple batteries
Magnet co-ingestion
Battery ≥ 15 mm
Battery < 15 mm
Admit GI
Evaluation of Esophagus
Esophagram
Urgent Endoscopic Removal
Surgical consult if object not within reach
Surgical consult if object not within reach
Abnormal
Normal
Admit GI
Discharge
Discharge
- Confirm ability to PO
- Repeat X-ray every 2-3 days until battery passed (PCP or GI)
- Return to ED if symptomatic
- Repeat X-ray in 10-14 days if not passed
(PCP or GI) - Return to ED if symptomatic
Esophageal Batteries
- Serious burns can occur within 2 hrs of ingestion
- Symptoms may be delayed
- If mucosal injury is present after removal, observe for delayed complications (esophageal perforation, TEF, vocal cord paralysis, tracheal stenosis, mediastinitis, aspiration pneumonia, perforation into a large vessel)
- Complications may be delayed weeks, months
Risk Factors for Severe Esophageal Injury Include:
- Ingested batteries ≥ 20 mm in diameter
- Children < 6 yrs of age
- Multiple battery ingestions
- Esophageal exposure time > 2 hrs
Battery Facts
- Lithium cell batteries are most frequently involved in esophageal injuries
- Determination of battery diameter prior to removal or passage is unlikely in at least 40% of cases
- Assume hearing aid batteries are < 12 mm
- X-ray overestimates the diameter