Kris R. Jatana, MD, discusses a new protective button battery that may reduce injury

A new titanium-based lithium coin-cell battery designed to reduce injury after accidental ingestion may represent an important advance in child safety, but it should not change how pediatricians evaluate or manage suspected battery ingestions, according to new research published in OTO Open.¹

The study evaluated the first commercially available lithium coin-cell battery marketed with esophageal injury protection claims. Although investigators found substantially less tissue damage than with traditional lithium coin-cell batteries, the protective battery continued to generate alkaline hydroxide capable of injuring the esophagus. As a result, established diagnostic and treatment recommendations remain appropriate.

Does the new battery technology reduce esophageal injury?

According to lead investigator Kris R. Jatana, MD, FAAP, FACS, the answer is yes.

"One of the most important findings in this study is that we confirm that the esophageal protective features of a titanium-based battery technology do work compared to traditional coin cell batteries," said Jatana, professor of otolaryngology-head and neck surgery at Nationwide Children's Hospital and The Ohio State University.

"There is a substantial reduction in injury in our esophageal tissue model, at both one hour and also at 24 hours of exposure time, and this is going to reduce the severe esophageal injuries and deaths in many children who accidentally ingest these batteries."

Using a porcine esophageal model, investigators compared the titanium-based battery with conventional lithium coin-cell batteries. Traditional batteries rapidly produced highly alkaline tissue conditions and extensive tissue necrosis, whereas the protective battery produced markedly less visible injury while maintaining its characteristic lithium coin-cell appearance on radiographs.

Should pediatricians change how they manage battery ingestions?

Despite the improved safety profile, Jatana stressed that the study reinforces rather than replaces current clinical practice.

One goal of the research was to determine whether existing recommendations from the National Capital Poison Center remain appropriate now that protective batteries have entered the consumer market.

"I think one of the things that we confirmed is that these types of mitigation strategies that are part of our National Capital Poison Center management guidelines should still be followed," Jatana said.

"...using those current protocols does not take away from the safety mechanism of the titanium-based lithium coin cell battery to protect the esophagus against severe injury."

The study showed that protective batteries still generated hydroxide at the tissue surface despite producing substantially less injury than traditional batteries. Honey and sucralfate continued to effectively neutralize tissue pH before battery removal, and postremoval irrigation with 0.25% sterile acetic acid remained effective in neutralizing residual hydroxide. Investigators concluded that prompt removal of any battery lodged in the esophagus should continue regardless of battery type.

Jatana emphasized that the practical message for pediatricians, emergency physicians, and urgent care clinicians is straightforward.

"We know that the diagnosis is still going to be the same based on X-ray findings. We know that there still is hydroxide formation at the tissue level, even with the protective batteries, although it is significantly less based on our observations compared to a traditional coin cell battery."

"...the diagnosis and management based on our current treatment protocols should not change for those healthcare professionals that are in urgent cares, emergency departments, or pediatricians' offices."

What should pediatricians tell families before emergency evaluation?

Jatana said early first aid remains an important component of care for children with suspected battery ingestion before arrival at the emergency department.

"Our current guidelines from the National Capital Poison Center recommend two teaspoons or 10 milliliters of honey every 10 minutes, essentially for suspected or witnessed ingestions in the home until that child can get to an emergency department and get an X-ray to confirm the location of the battery."

He noted that batteries passing into the stomach often do not require the same intervention, but those lodged in the esophagus remain a medical emergency because tissue injury begins rapidly.

"Sometimes they can pass, and sometimes they do become lodged in the esophagus, and it's the ones that get lodged in the esophagus that are at greatest risk for having severe injury and complications."

Why are neutralization strategies still important?

Although the titanium-based battery reduced voltage loss and visible tissue injury, it continued to generate enough hydroxide to justify maintaining current mitigation strategies before and after removal.

"We know that this battery, even though this new protective esophageal protective battery... still does produce some hydroxide," Jatana said.

"The protocols that we have to neutralize before and after removal should still be employed until we have data to suggest otherwise."

The laboratory study confirmed that preremoval honey and sucralfate did not interfere with the battery's protective mechanism while continuing to neutralize tissue pH. Likewise, post-removal irrigation with 0.25% sterile acetic acid remained effective after battery extraction.

Could this technology reshape pediatric injury prevention?

Although Jatana cautioned that additional clinical data are needed, he believes the new technology represents an important step toward reducing severe pediatric battery injuries.

"We really need to continue to collect data on ingestions of these new protective lithium coin cell batteries," he said.

"The significance of this will hopefully drive other manufacturers to adopt a similar titanium-based technology that can either meet or exceed the new bar that Energizer has set."

The authors concluded that widespread adoption of advanced battery safety technologies by battery and electronics manufacturers could further reduce severe esophageal injuries and deaths while allowing clinicians to continue relying on familiar diagnostic and treatment protocols.

Reference

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