Accidental ingestion of small objects such as magnets and batteries or caustic substances is potentially very dangerous for children, with long-term consequences in 20% of cases. The phenomenon is increasing, also due to the diffusion in homes of the so-called “silent killers”, the small button batteries present everywhere, from the remote control to video games to music tickets, which, often asymptomatically, burn the tissues generating fistulas between the esophagus and the trachea and between the esophagus and the arteries and thus giving rise to bleeding even serious and fatal. Mortality in this area is 18%. For this reason, the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition Sigenp, two years after the publication of a Consensus aimed at paediatricians for the management of these accidents, «addresses parents, grandparents, teachers and all those who are with children with a primary prevention partner, spreading the rules summarized in a flyer (available here) distributed in schools, hospitals and pharmacies» explained the president Sigenp, Claudio Romano of the University of Messina, ddirector of the unit in gastroenterology pediatric. The Sigenp campaign for the safety of children and parents» was wanted because «accidents are more and more frequent; today out of 100,000 pediatric accesses, 300 are due to the ingestion of objects or substances. Precisely to measure the phenomenon, the seriousness and the management of the cases, the Sigenp is working on a register ».
The rate of ingestion of foreign bodies, according to European and American data, increased by 91.5% in 15 years and almost doubled under 6 years of age. Coins are the objects most frequently ingested (62%), batteries (lithium micropiles) account for 7% of all cases. The ingestion of caustics, especially household cleaning products and detergents, accounts for one third of domestic accidents, responsible for about 1,000 hospitalizations a year. «Only the serious pathological situations resulting from the ingestion of disk batteries have increased sevenfold in the last twenty years. In the case of disk batteries, theirs too endoscopic removal can give rise to bleeding, for this l‘intervention it is performed by a multidisciplinary team,” he explains Paola De Angelis, head of digestive endoscopy of the Bambin Gesù and national coordinator of the SIGENP area of endoscopy and instrumental diagnostic investigations. «Then there are the small magnets which, if ingested, can join together and become blunt, causing damage. But also nails, screws, jewels. Finally, liquids: never transfer detergents or corrosive substances into smaller bottles. Endoscopy should be done as soon as possible, preferably within two hours of ingestion. Timing is very important. For this reason we have taken steps both to inform parents in the area in a capillary manner, and to train more endoscopists prepared for these emergencies, so that in the Centers there is always one available when needed, without harmful expectations”.
What to do? «In the presence of respiratory, gastrointestinal symptoms, burns of the oral cavity or lips or even non-specific symptoms but in any case if there is the suspicion of accidental ingestion of caustic substances or disk batteries, do not induce vomiting which would risk burning even more the esophagus. In the case of disk batteries, administer honey because it protects the mucous membranes and reduces damage to the esophagus» he says Filippo Torroni, head of endoscopy at the Bambino Gesù Pediatric Hospital in Rome. «Finally, go to the nearest emergency room as soon as possible, because the time factor is essential to minimize the risk of complications or long-term outcomes. A multidisciplinary team of endoscopists, surgeons, anesthesiologists, radiologists will take charge of the child and, if the hospital is small, will secure him for transfer to a reference centre”. Indeed, in third-level centres, pediatric endoscopists are present 24 hours a day and all the specialists capable of dealing with pediatric emergencies. «Unlike in the past, today the evaluation of the patient who has ingested an object or a substance is already carried out in the emergency room, with all the diagnostic tests present in the guidelines that we drafted in 2020 and the definition of the therapeutic path, including the need for endoscopy for diagnostic purposes but also for the execution of therapeutic interventions» dice Salvatore Oliva of the La Sapienza University, head of Pediatric Digestive Endoscopy at the Umberto I Policlinic, highlighting the persistence of strong inequalities on the Italian territory. Fortunately, in 80% of cases the objects ingested by children are evacuated spontaneously. Button batteries were also discussed last month at the congress of European paediatricians in Padua, where a well-known manufacturing company presented a child-proof package with batteries with a bitter taste, unattractive for children. Meanwhile, in Europe, producers are raising awareness of the risks: the European Portable Battery Association has decided to raise awareness of the risks of ingestion and what to do with a portal in which it illustrates to parents «What to do in case of involuntary ingestion?» ee to specialists “how to make the right diagnosis”. What would be really useful, however, would be to eliminate the danger, producing batteries that are safe even in the event of ingestion.