Paediatric battery ingestion

True battery ingestions can lead to significant damage to the GI tract. After initial clinical assessment and PEWS charting, the next step is imaging.

Low dose (fluoroscopy or low-dose x-ray) imaging of the neck, chest, abdomen and pelvis should be the first option to assess position. If these are not available, a CXR and AXR may be required and consider other imaging and intervention depending on symptoms and information / clinical assessment).

Management depends on position of the battery:

• Above the sternal notch - refer to ENT on-call
• Below the sternal notch - refer to RHCYP surgical registrar

If referring to the surgical team, you can refer in the following order:

• RHCYP surgical registrar - bleep 9103 (see the contact page as this is a different paging system) or via switchboard
• RHCYP surgical consultant if registrar unavailable
• If surgical team is unavailable, you can discuss 0900-1630h with GI registrar (bleep 9434) or GI consultant (via switchboard)

• Assess the patient using ABC. ANY WORRYING SYMPTOMS?
• Alert the family this will require emergency endoscopic removal. Get in touch with the RHCYP team (as detailed).
• Obtain IV access and give intravenous hyoscine butylbromide (buscopan) – see section below
• If a battery can be moved into the stomach it is safer and less urgent or may avoid further intervention – this can be decided later.
• Get the family to check which battery type and for size comparison. Get as much information as soon as possible on what the FB was if in doubt. Measure the battery on the x-ray.
• If you have taken a call from home, management (only in those over age 12 months) is:
  • HONEY – DOSE IS 10MLS (2 TSPS) EVERY 10 MINUTES FOR 6 DOSES and for the family to attend ED as soon as possible. Honey is also an option in the ED.
  • In the ED /ward setting, SUCRALFATE should be administered and should be available in hospital ED or paediatric ward. SUCRALFATE SUSPENSION DOSE IS 1g EVERY 20 MINUTES FOR 3 DOSES

Hyoscine butylbromide (Buscopan) is an antimuscarinic that can help relieve gastric smooth muscle spasm, and help move the battery to a safer place in the GI tract.

The does in children (from the BNF) are as follows:

• For intravenous injection, may be diluted with Glucose 5% or Sodium Chloride 0.9%; give over at least 1 minute.
• For Child 1 month–4 years 300–500 micrograms/kg 3–4 times a day (max. per dose 5 mg).
• For Child 5–11 years 5–10 mg 3–4 times a day.
• For Child 12–17 years 10–20 mg 3–4 times a day.