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Button battery interview

Recorded in Brisbane, Queensland on 3 November 2015 following release of the Coroner’s findings on the death of Summer Steer from swallowing a button battery.

I have asked ‘Are button batteries the most challenging product safety problem ever?’ This podcast explores the nature of the problem and contains advice for parents, carers and those in the medical profession.

Summer Steer

Summer Steer

In this 15 minute interview I speak to:

  • Dr Ruth Barker – Emergency Paediatric Specialist at Mater Children’s Hospital, Brisbane and Director of the Queensland Injury Surveillance UnitDr Barker assisted the Coroner in his investigation
  • Dr Kirsten Vallmuur – Associate Professor at Queensland University of Technology Centre for Accident Research and Road Safety (CARRS-Q)
  • Natalie Stewart– QUT CARRS-Q Honours student researching issues associated with button battery safety

 

Button batteries everywhere

I began by asking Ruth her experience of the button battery problem.

Ruth:               For parents it’s difficult for them to know which products contain batteries, which products have secure compartments, what a “secure” compartment means, what is the relative risk with different sized batteries, and how do they control it all.

What I’ve been encouraging parents is to try to minimise the risk in their own home by minimising the number of products that they buy that contain disk batteries, trying to select products that have alternative power sources, cylindrical batteries, or some other power source. And particularly to pay attention to the sorts of items that young kids will get access to and play with. And that’s not just specifically toys, it’s all sorts of products around the house that the kids might be able to get into, and as a parent you need to think very laterally about what kids might think is attractive and what they might get into.

This a really unique issue because the batteries are in so many different products, so it’s a problem to regulate it product by product.

Gail:                 It’s all too easy to swallow these things too.

Ruth:               It takes about a second. I once sat beside a family on a picnic blanket and saw a mother feed a child, not a battery, but a plum that had a little pip in it. I watched her feed this little ten-month old the plum, and the plum seed go down, and heard the little gulp.

And I knew that that family were going to have to be airlifted back to Brisbane to have that pip removed because it was going to be stuck in the child’s oesophagus.

So I’ve seen it happen with a different object but of a similar proportion, and it literally takes a second. If parents are lucky they might hear a little cough and a gag as the battery goes down, but kids can just swallow it with a simple gulp. Parents may never hear it and they may never know it’s down there.

How do the batteries cause injury?

Gail:                 And so can you tell us a little bit about what happens when a child does get a button battery stuck in their throat?

Ruth:               When they swallow it, it gets stuck in their oesophagus and it tends to lodge at a couple of different places in the oesophagus. Some kids it lodges high, and some kids it lodges right down at the bottom of the oesophagus. And the high ones the kids tend to present with more obstructive symptoms, so drooling and a bit more agitated; and the lower ones, the kids can actually just look quite normal. The battery, it’s shaped like a coin – it can cause a physical obstruction – but that physical obstruction doesn’t totally impede their ability to swallow liquids, to swallow soft food, and also to vomit back past it. So for a clinician trying to work out whether they’ve actually got a physical obstruction in the oesophagus, it becomes quite difficult when they’re still able to pass things both ways.

As the battery sits there within minutes, if there’s sufficient charge in the battery, it starts to produce hydroxide ions at the negative pole. It converts water in the environment to sodium hydroxide, and that eats through the tissue. It’s essentially the same as oven cleaner.

Even once you pull the battery out the sodium hydroxide can continue to eat through the tissue and you can have very late manifestations with – there’s a child in WA who had a bleed four weeks after the battery was removed.

Gail:                 Do you know whether the message has got through to the medical community now? GPs as well as hospitals?

Ruth:               I think there is a little bit of increased awareness, but the problem is that you’re looking for a needle in a haystack. You see heaps of children with very non-specific symptoms. It could be fever, it could be not eating so well, it could be irritability, and one in a thousand, one in ten thousand might have a battery down. And you don’t know which child you’re seeing.

We have been trying to work on raising awareness such that if parents say their children might have swallowed a battery or had been seen playing with a battery that those children are expedited to get an x-ray to see whether the battery is actually there, particularly if it’s a two centimetre battery.

I think that might potentially catch some kids, but the big danger and the children who have really severe injuries and fatalities are the ones who swallow a battery, nobody knows about it, the parents don’t notice the battery’s missing, they didn’t witness it, no other member of the family witnessed it, and they present with very, very non-specific symptoms and they’re incredibly difficult to pick.

Gail:                 I guess so long as the medical professionals know that it’s a possibility and that if it is a chance then they’re aware of it. Because I think in the past they weren’t aware that it was a problem at all.

Ruth:               I think it’s still not broadly well understood.

I think that the other thing that is perhaps not so well understood is the long-term consequences. Both the very delayed impact of the injury, the potential for significant bleeds, the need for a prolonged stay in hospital, children being nil by mouth for prolonged periods of time.

That’s really why we need to try to concentrate management of these kids in a specialist environment where they understand the long-term complications associated with this issue.

Unfortunately the Paediatric Gastroenterology Department here in Brisbane has got quite a bit of experience managing kids. We’ve had three severe cases this year.

They’re still refining their processes about how best to go about managing these kids. When is it safe just to go in and pull the battery out? When do you need some CT imaging prior to going in? How long do you keep them nil by mouth? How can you be guided by that? These are really complex questions.

Gail:                 And I suppose that what they’re learning will be able to be shared around the rest of Australia and elsewhere.

Ruth:               Well I think there are various units around Australia who have a significant amount of experience with this as well, and I think this is something for the Paediatric Gastroenterology and also the Paediatric ENT and the Paediatric Surgical community to discuss, as to how best to approach these patients.

Gail:                 Well it’s good to know there’s people on the case anyway.

Dr Ruth Barker with button battery

Dr Ruth Barker outside the coroners court. Photo from Herald Sun*.

Awareness strategies

Kirsten, can you tell me a little bit about your involvement with this issue?

Kirsten:          What we’re looking at doing to support some of the work that’s already going on is to get a better understanding of what parents’ awareness is about the risks of button batteries.

We’re doing a survey with parents to look at the kinds of awareness they have and the kinds of behaviours that they show in relation to button batteries. In the survey what we’re doing is looking at what their purchasing behaviours are of products, whether or not they look for safety as one of the issues when they purchase products, and what types of products they would look for safety as one of the areas . . . compared to children’s products, household products, that kind of thing, to get a better understanding of whether they have some awareness of the issues related to all sorts of products, not just toys for children under three, which is traditionally where people would focus their attention.

So . . . looking at purchasing behaviours, looking at what they do when the product gets into the house, whether they store the product in a safe manner and keep it out of reach of children, whether or not they’re aware of having a secure compartment related to button batteries, what they do in relation to if they suspect a child might have swallowed a button battery and what hazards they perceive there to be with the children, and what their responses to that are. So it’s a fairly broad survey to look at really putting ourselves in the shoes of parents and understanding what their mindset is and where some of the issues and gaps are for parents in relation to button batteries. We’re doing this pre- and post- the social medial campaign.

We’ve done an initial survey with parents and we managed to get around five hundred parents from across Australia to complete the survey.

And, there’s a social media blitz we’ve got coming up to really pull some of the messages out of what we learnt from the survey, as well as incorporating the messages from the various different groups that have been involved in button battery safety along the path. Put that out to parents, try and get the message as broad-reaching as we can, through social media largely but also drawing on traditional media that’s generated from the coronial inquest.

And then doing a survey after the event as well, a couple of weeks after this, to see whether or not we’ve managed to actually reach some parents and see some changes in their kinds of recognition of safety and responses to button batteries.

So what we did in the first survey was ask for permission to follow up the same people, so we can do a head to head comparison of the same individual to see whether or not they saw the campaign, what messages they drew from the campaign, and also whether they’ve changed any behaviours as part of that.

The hope with that is that we can learn from this as well in terms of other kinds of education campaigns. You know, what are some of the effective ways to reach parents knowing that parents may not be watching the six o’clock news, but they may well be on Facebook or on Twitter or one of the other social media avenues. And then can we get an effective message across in a really brief way, and that parents can readily recall.

Gail:                 One of the interesting recommendations from the coroner was to come up with a disposal container that you would have in your home, like a parallel with the sharps container that you find in toilets and things for needles. Any thoughts on that? It sounds like a good idea.

Kirsten:          That was certainly something that came out, and Natalie might want to jump in with some of the responses with that too. So Natalie is our Honours student at QUT doing work on this project . . .

When we were asking about how people dispose of it, largely people were just saying they threw it in the bin and weren’t really sure that that was the right thing to do.

Natalie:           So, and there have been some suggestions I think within the industry, of maybe creating little mini wheelie type bins that are completely safe, that children can’t get into, that parents can just dispose the batteries into and then keep them in a safe place until they dispose them.

Gail:                 Are they (the batteries) recyclable?

Ruth:               They are, but I think you need specialised equipment to do it.

Kirsten:          And it’s not really clear, a lot of people can’t answer that question. We’ve still got that question as to where do you take them if you want to dispose of them, you know?

Gail:                 Does Officeworks have a repository? I think they might have.

Kirsten:          We don’t know. We don’t know, yeah. So it is something that would be interesting to see, yeah.

Gail:                 There’s one council in Melbourne that does recycling of just about everything, but I have to gather up all my stuff until I’m going all the way over to Collingwood to do that, and it works well enough, but yeah, it’s not convenient.

Kirsten:          No. Parents are time poor, and I think it’s having something that is easy to do that they are quite willing to do, and that might even be led by children as well. Something that their parents would make sure that they use the device might also raise children’s awareness as well as parent’s awareness.

Gail:                 And so long as it’s locked.

Natalie:           And the children can’t access it . . .

Gail:                 . . . then that could work. Yeah, I like that idea.

Kirsten:          I think what we’re recognising through all of this is how complicated the issue is, and it really does need to be tackled from multiple areas.

So there’s the regulatory response, there’s the manufacturers and suppliers and button battery designers type responses that we need to look at.

Gail:                 We’re all barracking for the button battery designers to come up with a really good solution that’ll get around it. And they are working on it. They’ve been working on it for quite some time, and if they can come up with something then that’ll save all of the other people having to rely on everybody else to get involved . . .

Kirsten:          And in the meantime I think knowing that those solutions are longer term solutions, really working at the end of parents’ awareness and clinical staff’s awareness of the issue, hopefully prevention at the start then getting people, as Ruth mentioned, not buying the kinds of products that they don’t need in the house and being vigilant and knowing what products do contain button batteries in their house, and having a safe strategy around those.

Whether they do or don’t have young children of their own, potentially there may be young children come into the house.

And they may even be pets. I mean there’s been circumstances of pets swallowing button batteries and having similar kinds of responses as well, so you know, there are risk to anyone that consumes them.

Dogs at risk with button batteries

Gail:                 I guess so. I hadn’t stopped to think about pets. But they’re prone to swallowing all sorts of things. Especially dogs.

Kirsten:          Yes in the veterinary literature there’s been a few cases that have been reported.

Gail:                 Well, thank you Kirsten and Natalie and Ruth for your contribution.

 

You can read more on this topic in my two blog articles Button batteries everywhere;  and Button batteries: the most challenging product safety problem ever? in The Maze.

Advice on button battery injury prevention and treatment is available on the Western Australian Health website and there is also information available on keeping pets safe.

Visit the Summer’s Day website for more information on button battery awareness.

Dr Barker also appears in a furniture safety video in the The Maze blog article Furniture tip-overs – safety strategy

 

* Photo source: The Herald Sun article Parents warned of button battery danger after Summer Steer death inquest, 5 November 2015