Commentary: Button Batteries in Fidget Spinners

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Excerpt

No matter how hard parents try, it is almost impossible to completely prevent children from harming themselves. Children can trip down stairs, choke on a piece of food, put foreign objects up their nose, or get hit by a car while riding their bicycle. In the modern era, public health interventions have, however, been implemented to improve child safety. Sometimes, this involves developing a safety feature, such as a seat belt, infant seat, bike helmet, or “childproof cap” on medications. Other times, however, limiting consumer access to unsafe products can reduce morbidity and mortality in children. Three such products that have been limited or banned by federal or state agencies include firecrackers, heavy metal “lawn darts,” and most recently high-powered neodymium magnets. The ban on neodymium magnets was the result of targeted focus of a strong effort by North American Society for Pediatric Gastroenteroloy, Hepatalogy, and Nutrition (NASPGHAN) and the American Academy of Pediatrics to prevent ingestion of these products that led to endoscopies, bowel damage, and intestinal surgeries in hundreds of children in the United States and across the world (1,2). Recent evidence shows that the magnet recall has reduced the number of patients coming to emergency departments for magnet ingestions, though pediatric gastroenterologists continue to be called emergently to remove these objects (3).
For every hazard that is reduced however, another hazard may enter the marketplace. The important series of papers in this month's Journal of Pediatric Gastroenterology and Nutrition describe cases of button battery ingestion, where the button battery was hidden inside a “fidget spinner” that was broken open by a child, and the battery swallowed (4–6). Children underwent emergent evaluation and were found to have significant esophageal or gastric ulceration that required endoscopy, imaging, and medical management. Fortunately, the most feared complications of button battery ingestion (esophageal perforation or aorto esophageal fistula) did not occur with any of these children. As is well known, button battery ingestion can, however, lead to these life-threatening complications. According to the authors, these “fidget spinners” did not have any warning label that they contained button batteries, nor did they discuss the potential life-threatening complications of battery ingestion. Having an unlabeled button battery in a toy or product that children can handle and break poses a potential danger to children.
Which should a pediatrician or other provider do when faced with such a hazard to children? A provider who simply treats the individual child and ignores advocating on a public health level is doing our community a dis-service. This is one clear area where public advocacy can be beneficial. The first step an physician in the United States should take when coming across such a hazard is to notify the United States Consumer Product Safety Commission at their website (www.cpsc.gov) by clicking on the link on the right side of the screen: “report an unsafe product.” Details on the ingestion can then be provided to the regulatory agency. This is the primary tool through which the Commission identifies potential hazards. It is unlikely that the commission will react if a single case is noted. Multiple cases will, however, often get their attention, as we learned from the high-powered magnet advocacy effort of a few years ago. In addition, we would suggest contacting your local NASPGHAN counselor or advocacy committee member because our NASPGHAN advocate often meets with other groups that may be central to the effort, including the Consumers Union and the American Academy of Pediatrics.
Once a regulatory authority is notified of a potential hazard, they have a number of options. The first option is to take no action.
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