Child-protective button battery reduces tissue injury but does not change emergency management

A newly marketed lithium coin-cell battery designed to reduce severe injury after accidental ingestion may represent an important advance in child safety, but pediatric clinicians should continue to follow existing emergency management guidelines for button battery ingestion.¹

In a study published in OTO Open, investigators evaluated the first commercially available lithium coin-cell battery marketed with ingestion burn protection claims. Researchers found that the titanium-based Energizer Ultimate Child Shield battery substantially reduced visible esophageal tissue injury compared with traditional lithium coin-cell batteries in a porcine esophageal model. However, the battery still generated alkaline hydroxide capable of causing tissue damage, supporting continued adherence to established treatment protocols.²

Button battery ingestion remains a significant pediatric safety concern. According to the study authors, children in the United States present to emergency departments with battery-related complaints approximately every 75 minutes, and serious injury can occur within 2 hours when a battery becomes lodged in the esophagus. The National Capital Poison Center has documented hundreds of severe injuries and dozens of deaths related to button battery ingestion.

“Far too many children have experienced life-altering or life-threatening injuries due to accidental ingestions in the home. With esophageal-protective batteries now commercially available, we expect to see meaningful improvements in patient outcomes,” said study author Kris Jatana, MD, surgical director of clinical outcomes and professor of otolaryngology–head and neck surgery at Nationwide Children’s Hospital and The Ohio State University.

How does the new child-protective battery work?

The investigators evaluated several questions relevant to clinical practice, including whether the new battery could still be identified radiographically, whether it produced tissue injury, and whether currently recommended mitigation strategies remained effective. Using a cadaveric porcine esophageal model, the team compared traditional and protective lithium coin-cell batteries and assessed tissue pH, visible injury, and the effects of honey, sucralfate, and acetic acid irrigation.

The protective battery uses a titanium-based design intended to reduce the electrochemical reaction responsible for generating caustic hydroxide ions when a battery becomes lodged in the esophagus. Researchers assessed the battery within current clinical management paradigms to determine whether its protective features altered treatment recommendations.

Can clinicians identify the protective battery on imaging?

Importantly, all protective batteries continued to demonstrate the characteristic double-ring or halo sign on radiographs, allowing clinicians to identify them as button batteries. However, investigators found that protective and traditional batteries could not be reliably distinguished on imaging alone.

Because clinicians are unlikely to know whether an ingested battery contains protective technology, the authors noted that standard emergency evaluation and treatment should continue for all suspected button battery ingestions.

Does the new battery eliminate the risk of esophageal injury?

Compared with traditional batteries, the protective batteries produced substantially less visible tissue injury and showed no obvious tissue necrosis during the study period. Nevertheless, localized tissue pH still increased into a highly alkaline range of 12 to 13, indicating continued hydroxide production. Honey and sucralfate effectively neutralized this alkalinity, while post-removal irrigation with 0.25% acetic acid remained effective at neutralization.

Although the findings suggest the new battery may reduce injury severity, the authors emphasized that it does not eliminate the risk of tissue damage. Additional studies are needed to evaluate longer exposure times and determine whether reduced injury in laboratory models translates to improved outcomes in children.

Should pediatric battery ingestion management change?

Based on these findings, the authors concluded that current clinical management should not change. Emergent removal remains necessary for batteries lodged in the esophagus, and clinicians should continue to administer honey or sucralfate before removal when appropriate and perform post-removal acetic acid irrigation according to established guidelines.

The American Academy of Otolaryngology–Head and Neck Surgery echoed that message in its accompanying statement, urging families to keep batteries out of children's reach, secure battery compartments, and seek immediate medical attention if ingestion is suspected.

“This is smart safety innovation with real potential to spare children from serious harm,” said Rahul K. Shah, MD, MBA, chief executive officer of the American Academy of Otolaryngology–Head and Neck Surgery. “That is worth celebrating, even as we keep treating every swallowed battery like the emergency it is.”

The study authors also encouraged clinicians managing foreign body ingestions to contribute cases to injury surveillance registries to strengthen understanding of battery-related injuries and prevention strategies.

What do these findings mean for pediatricians?

For pediatricians, the findings suggest that advances in battery design may help reduce the severity of injuries associated with accidental ingestion. The availability of commercially marketed esophageal-protective batteries represents a potentially important step toward injury prevention, particularly as battery-related emergency department visits continue to increase.

Until additional clinical data become available, however, prompt recognition, urgent referral, and adherence to established management protocols remain essential for all suspected button battery ingestions. Pediatricians should continue to counsel families on battery safety, emphasize secure storage of battery-powered products, and reinforce the need for immediate emergency evaluation when ingestion is suspected.

References

1. American Academy of Otolaryngology - Head and Neck Surgery. New Button Battery Technology Shows Promise, but Swallowing Remains an Emergency. Newswise. June 23, 2026. Accessed June 23, 2026. https://www.newswise.com/articles/new-button-battery-technology-shows-promise-but-swallowing-remains-an-emergency/?sc=dwrecomm&xy=10069478&wt=dw_r_23062026

2. Jatana KR, Rhoades K, Litovitz T, et al. Evaluation of an esophageal-protective lithium coin-cell battery within current management paradigms. OTO Open. 2026;10(2):e70266. doi:10.1002/oto2.70266