Magnets Are Associated with an Alarming Increase in Pediatric Ingestion Injuries
(arrow) lodged in his esophagus.
Children's toys are potentially dangerous, and it's that time of the year to be especially mindful of this fact. Listen to our chief of pediatric surgery Christopher S. Muratore, MD, who in an interview on WSHU offers advice to parents and caregivers.
Foreign body ingestion by children represents a major challenge to the treating physicians and to the parents/guardians. Diagnosis can often be challenging because not all ingested objects can be seen by routine x-ray exams.
Only metallic objects can be seen by x-ray. Objects made out of plastic and glass can be easily missed. Diagnosis, therefore, is often made by direct observation with a history of choking, or new onset of certain symptoms.
Of the many ingestion injuries treated by our Pediatric Surgery Division, one involved a little boy who had sudden chest pain and was brought to our ER: he had swallowed a toy part that lodged in his esophagus (see x-ray at right).
Treatment of a swallowed or inhaled foreign body is dependent on the location and the type of the foreign body. In the digestive tract, if the object is stuck in the esophagus and fails to pass into the stomach, it must be removed using endoscopic techniques.
A foreign body that passes into the stomach can be observed without intervention, because it will usually pass through the intestine and exit with stool. Even sharp objects such as pins can pass without perforating the intestine. The passage into stool can take up to one to two weeks.
Certain types of ingested objects represent a major concern: button batteries and supermagnets (neodymium magnets; typically 10 to 20 times stronger than traditional magnets) are two of the most common types.
Button batteries can be easily swallowed, and these batteries release corrosive chemicals that can erode through the esophagus and intestine if they fail to move. Therefore, our Pediatric Surgery Division tries to remove all of such batteries when seen in the esophagus. Once a battery passes into the intestine, it can only be watched, with the hope it will pass out with the stool without damaging result.
| The majority (72%) of pediatric magnet ingestions occurred after the year 2010. ("Surgical Management and Morbidity of Pediatric Magnet Ingestions.") |
Magnets are another type of object that has been identified as especially dangerous. In recent years, many reports of ingested small magnets eroding through the bowel by magnetic force have appeared in the medical literature.
A 2015 study, titled "Surgical Management and Morbidity of Pediatric Magnet Ingestions," demonstrated "the increasing need for magnet regulations and public awareness to prevent potentially serious complications.
Another recent study, titled "Pediatric Magnet Ingestions: The Dark Side of the Force," published in the American Journal of Surgery, found that injuries caused by children ingesting magnets are increasing. The authors conclude that "magnet safety standards are needed to decrease risk to children."
Stony Brook Children's is the only hospital in Suffolk County with board-certified pediatric surgeons who treat children with toys ingested into the airway and digestive tract.
Magnets that are swallowed can clump together on opposite sides of the intestinal wall, and their pinching action can be so tight that holes are made in the intestine, thus creating a dangerous problem.
The current standard of care for children who have more than one magnet is to consider performing emergency abdominal surgery.
A foreign body inhaled into the airway by children is a surgical emergency. Many objects have been identified as high risk for inhalation by young children. These include popcorn seeds, peanuts, latex balloons, etc. Unusual inhaled objects seen at Stony Brook Children's include a broken Monopoly piece and a screw.
Observing choking with an object in the mouth may be the only history. Sometimes, it is a child with new onset wheezing. Chest x-ray may not necessarily make the diagnosis. Rigid bronchoscopy is the utilized for both diagnosis and treatment.
During the holiday season, children's gifts need to be age appropriate for many reasons. Prevention of foreign body aerodigestive ingestion is one of them. However, this is a problem seen throughout the entire year at Stony Brook Children's Hospital.
Stony Brook Children's is the only hospital in Suffolk County with a team of fellowship-trained pediatric surgeons who treat children with toys ingested into the airway and digestive tract. We also have specialists from our pediatric emergency department who can make the diagnosis, and pediatric otolarygologists who can perform all of the above procedures in children.
Foreign body ingestion injuries related to toys often happen when parents overestimate their child’s level of development and make the mistake of buying a toy beyond the suggested age range: toys designed for older children may contain parts that are choking hazards.
A compelling recent study of foreign body ingestion injuries in children ("Toys in the Upper Aerodigestive Tract") found that despite the adoption of preventive strategies, including product modification by manufacturers, which have decreased the mortality rate due to choking, preventive strategies imposing regulations on industrial production, even if fundamental, are not sufficient.
In addition to these strategies, it was concluded that what's needed is other preventive intervention aimed at improving parents' awareness of foreign body ingestion injuries and at increasing their watchfulness of their children.
Harmful If Swallowed
Here's a very partial list of toy types/parts that young children have swallowed and that have sent them to the emergency room:
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| ALERT: Children under the age of 3 should not play with toys that could fit inside a toilet paper roll. Read magnets safety alert of U.S. Consumer Product Safety Commission. Check to make sure your children's toys are not recalled products. |
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