James M. DeCou, MD
Pediatric Surgeon
Helen DeVos Children's Hospital 

Infants and toddlers are always putting things in their mouths. They probably ingest more objects than we suspect! If they are large enough, these objects tend to get stuck in the upper esophagus, the narrowest point of the journey between mouth and anus. My colleagues and I very frequently remove coins and other objects from kids' esophagi, but none are nearly as dangerous as disc batteries, also known as button or watch batteries.

Since May, we have operated on three children, ages 8 to 15 months, who swallowed the disc batteries that power so many of our devices these days. These batteries can be found in remote controls, watches, children's games and other devices. If swallowed, they tend to lodge in the upper esophagus, where the battery's electrical current produces an alkaline reaction, leading to a severe caustic erosive burn akin to swallowing a drain cleaner or other strong base. In two of our three patients, the burn led to a tracheoesophageal fistula, a hole from the esophagus into the trachea through which liquids could pass into the lungs, causing pneumonia. There have been reports from other hospitals of deaths from disc batteries eroding into major blood vessels. There is at least one report in the literature of lithium poisoning from a lithium button battery, while mercury poisoning is another danger.

These are surgeries we do not want to do!  That's why I'm writing this blog-to urge community physicians to counsel parents about the dangers of these batteries. A 2004 article in Pediatric Surgery International noted that "while batteries represent less than 2 percent of foreign bodies ingested by children, in the last two decades the frequency has continuously increased." The authors go on to urge more public education about the dangers of battery ingestion, specifically, that doctors include this information "as part of the routine guidelines for childproofing the home."

Children don't just swallow the batteries; the medical literature is also rife with reports of children sticking them in their noses and ears, causing liquefaction necrosis of adjacent tissues.

So please, remind parents of the dangers of leaving the batteries lying around.  They also need to keep remote controls and other devices away from infants and toddlers. Even if the battery no longer has enough charge to operate a device, it has enough to generate an electrical current in the esophagus or other body part. If a parent suspects a child has swallowed a button battery, it should be treated as an emergency and the child seen immediately. Even a few hours is too long to wait.

Feel free to post your own stories or questions here.

James M. DeCou, MD, FACS, FAAP, a board certified pediatric surgeon, is a partner in Pediatric Surgeons of West Michigan and the Pediatric Trauma Medical Director at Helen DeVos Children's Hospital.  He is a clinical assistant professor of surgery at Michigan State University College of Human Medicine.

William Stratbucker, MD
Pediatrician
Helen DeVos Children's Hospital

A couple of months ago, the US Preventive Services Task Force recommended that clinicians "screen children aged 6 years and older for obesity and offer them or refer them to comprehensive, intensive behavioral interventions to promote improvement in weight status." Just another item to check off during a well-child visit or something that could change the trajectory of obesity, diabetes and cardiovascular disease today's kids are following?

I submit the latter-which means we've come a long way, baby. Five years ago the same group "found insufficient evidence to recommend for or against" routine screening for overweight in children and adolescents because, basically, there wasn't any strong evidence that we could do anything meaningful if we found that the kid was overweight. But the committee's review on weight-management programs for children and adolescents changed that.

The review found that behavioral interventions, "particularly moderate- to high-intensity comprehensive programs," were "probably" safe in children ages 4 to 18, while combined pharmacologic/behavioral interventions were appropriate for obese adolescents. Moderate intensity programs involved 26 to 75 hours of contact, high intensity programs involved more than 75 hours.   

These programs, which fit into the American Academy of Pediatrics' definition of stage 2 and stage 3 obesity treatment, are not earth shattering in their focus. They help children and, usually, their families, change their diet and activity levels using cognitive behavioral therapy (CBT) and similar techniques so they can not only integrate such changes into their daily lives but sustain them over time.  

Here at Helen DeVos Children's Hospital we are opening just such a program next month. The Healthy Weight Center will be the first in the state of Michigan, capable of working with children as young as 6. Our staff includes a pediatric exercise physiologist, a registered dietician, pediatric-trained psychologist and masters-level social worker, two pediatricians and a premier researcher in the area of pediatric obesity. We will teach families and children how to become more active in safe and inexpensive ways and how to eat healthier no matter what their income or where they live. We will also teach physicians and office staff and connect them to resources that will allow them to be more efficient and effective at stage I treatment of childhood obesity within the medical home. 

It is our hope that through this center we can start changing the weight gain trajectory that more than a third of our children in west and north Michigan are on, enabling them to be fitter and live out a healthier and longer life.

Tell us about your efforts to work with overweight and obese kids in your practice. Do you screen for overweight? Do you refer to weight-control programs or practitioners? Do you think this country can make a difference when it comes to child and adolescent obesity?