Button Battery Ingestion (Pediatric) Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Battery location
   Battery location? (esophagus vs past the esophagus) (Pediatric emergency (mostly <3 years). Esophageal impaction causes electrochemical burn within hours (local alkaline pH 10–13 at the negative pole → liquefactive necrosis, injury within 2 hours, progresses even after removal); complications: esophageal perforation, tracheo-/aorto-esophageal fistula (massive bleeding), stricture. Symptoms can be subtle (mimics a viral illness), vomiting/dysphagia/drooling, early brown frothy secretions are characteristic. Diagnosis: AP and lateral X-ray — AP double-ring/halo sign, lateral step-off sign (distinguishes from a coin).)
   • In the esophagus (impacted) → In the esophagus → immediate endoscopic removal
   • Past the esophagus into the stomach, asymptomatic → Past the esophagus · observe
2. [End] Past the esophagus · observe
   Past the esophagus into the stomach, asymptomatic: usually observe for passage (gastric/intestinal complications uncommon); periodic X-ray tracking, if not passed/symptoms/co-ingested magnet/large battery → endoscopic removal; nasal/ear canal batteries also need urgent removal.
3. [End] In the esophagus → immediate endoscopic removal
   A battery in the esophagus = absolute emergency → immediate endoscopic removal (ideally <2 h), do not delay (do not follow routine fasting rules); before removal give honey or sucralfate to mitigate (10 mL every 10 minutes x3, only if >12 months, battery in place <12 h, able to swallow; honey carries infant botulism risk), do not let this delay transport/removal; irrigate with acetic acid intraoperatively to neutralize. >12 h/impacted → CT first for vascular injury, involve thoracic surgery early (to prevent aorto-esophageal fistula).

Source guidelines & references

• Button battery ingestion (ESPGHAN; NCPC/Poison Control guidance)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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