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Diagnosis, management and prevention of button battery ingestion in childhood: a European Society for Paediatric Gastroenterology Hepatology and Nutrition position paper
  1. Joseph Machta1,
  2. Warren Hyer2
  1. 1 Paediatric Gastroenterology, The Royal London Hospital, Barts Health NHS Foundation Trust, London, UK
  2. 2 Paediatric Gastroenterology, Chelsea and Westminster Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Joseph Machta, Paediatric Gastroenterology, The Royal London Hospital, London, London, UK; joseph.machta{at}

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Button battery (BB) ingestions are a serious risk in the paediatric population, the complications of which involve gastrointestinal (GI), respiratory and vascular structures, and include perforation, stenosis, inflammation and fistulation.1 While information on UK incidence is presently unknown, child death due to BB ingestion has been the focus of a recent Healthcare Safety Investigations Branch (HSIB) inquiry2 and an NHS National Patient Safety Alert,3 both highlighting the significant risk this poses to children worldwide. In 2019, the US National Poison Centre reported 3467 cases of BB ingestion (10.47 per million), the majority of which affected children below the age of 6 years, including three deaths.4

Information about the current guideline

In July 2021, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) task force for BB ingestions published the ESPGHAN position paper on BB ingestion.5 The guideline focuses on the diagnosis, management and prevention of BB ingestion in children and highlights differences between their position and that of the North American Society for Paediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) guideline published in 2015.

Previous guideline

In 2015, the NASPGHAN endoscopy committee published their guidance on ingested foreign bodies in children, which included guidance on BB ingestion, as well as magnets, pointed objects and food bolus impaction.6


  • Full guideline:

  • Poster—advice and guideline summary:

  • Poster—the dangers of button batteries patient information:

Key issues

Pathophysiology and complications

Severe damage to the mucosa can take place within 2 hours of a BB remaining in the oesophagus, including transmural oesophageal damage, which can lead to fistulisation with surrounding tissues. The risk is significantly increased in children aged less than 6 years, and with batteries larger than 20 mm diameter. Furthermore, BBs lodged in the mid-oesophagus are most concerning due to the risk of aorto-oesphageal fistula formation.7

Multiple mechanisms of injury have been suggested in BB ingestion. …

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  • Contributors JM wrote the manuscript. WH advised on and edited the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.