Clinical guideline on the management of a child with suspected retained button battery

  • Houston R & al.
  • Arch Dis Child
  • 10 Feb 2020

  • curated by Dawn O'Shea
  • UK Medical News
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The British Association of Otorhinolaryngology and Head and Neck Surgery (ENT UK) has published guidelines on managing a child suspected of retaining a button battery (RBB).

The guidelines state the following:

  • Common sites where RBBs become lodged include:
  1. Cricopharyngus (C5),
  2. Mid-oesophagus (T5),
  3. Gastro-oesophageal junction (T10) and
  4. Duodeno-jejunal flexure (L2).
  • At triage, monitor for the following symptoms:
  1. Airway: epistaxis, nasal discharge, coughing, choking, drooling and chest pain.
  2. Systemic: irritability, acute refusal to eat and altered consciousness.
  3. Gastrointestinal: nausea and vomiting, abdominal pain, haematemesis and bloody stools.
  • Request an X-ray of the chest, abdomen and lateral soft tissue neck.
  • Monitor for erosion into the trachea and aorta.
  • Contact the National Poisons Information Service on 0344 892 0111 for assistance on battery identification and treatment.
  • If the battery is in the airway, make an emergency call to ENT and anaesthetics.
  • If the battery is in the nose or ear, the patient should be urgently referred to ENT for removal.
  • If in the oesophagus, refer to ENT or paediatric surgery for removal.
  • If the RBB is below the diaphragm and the patient is symptomatic, make an emergency referral to paediatric surgery for endoscopy.
  • If the RBB is below the diaphragm and the patient is not symptomatic, the guidance is as follows:
    • If the battery has passed the pyloris, discharge with a safety net.
    • If it has not passed the pyloris, admit, monitor and repeat imaging.
  • Note: gut wall necrosis, perforation and fistulation can occur up to 28 days after the event.

The guidelines are available as a single-page algorithm here.