This is particularly dangerous, Litovitz said, because the prolonged contact of the battery surface with the tissues of the esophagus creates an external current. The battery then can burn through the wall of the esophagus into whatever structure is next to it. The results can include damage to the windpipe or the aorta, which is the main blood vessel carrying blood from the heart to the rest of the body.
"Kids can bleed out," Litovitz said.
For this reason, it's important for doctors to identify the problem and, if one of these large button batteries is lodged in the esophagus, retrieve it quickly with endoscopy, a procedure using a lighted, flexible instrument.
The study authors recommend a goal of having the battery removed from the esophagus within two hours of ingestion. This can be tricky, especially if no one actually witnessed the child swallowing a battery. The symptoms of battery ingestion are not very specific, and they are often the same symptoms seen with potentially less serious ailments like croup or a stomach virus.
The study found that 61.8 percent of children younger than 6 who ingested the 20-millimeter lithium batteries got them directly from a product, like a remote control, toy, hearing aid, or personal digital assistant. In other cases, children picked up batteries lying loose or got them out of their original packaging. Of children younger than 6 who ingested large button batteries, 12.6 percent experienced serious problems or death.
"There are children that have died from this," said Susan Howard, "and I just can't even imagine our life without [Liam], and to think, a battery, really?"
The study's authors recommend several ways to prevent button battery ingestion in children. For one, they call on manufacturers of household devices to make battery compartments more secure.
"The little latches that are on remote controls now are really not adequate," Litovitz said. "Kids are defeating them all the time."
Dr. Mark Meredith, a pediatric emergency physician at the Monroe Carell Jr. Children's Hospital at Vanderbilt University, agreed. "There have been many different ways to try and secure these batteries in different devices over the years. If the manufacturers would treat all of these compartments like a child's toy that requires batteries and secure the compartment with a screw, I am willing to bet that the number of ingestions would decrease."
Another important piece of prevention, the study's authors say, is that parents must keep track of batteries and not leave them loose.
Dr. Dale Tylor, a pediatric ear, nose, and throat surgeon at Vanderbilt, has seen countless children with injuries to the inside of the nose from children putting batteries up a nostril.
She says that a big problem "is hearing aids, sometimes the child's own, sometimes an elderly family member's. Parents don't even think about it because nobody knows they're dangerous." Just as in the esophagus, a battery can burn a hole through the tissues of the nose.
The authors also recommend that battery manufacturers make packaging child resistant.
For physicians, the authors hope to get the word out that timely removal of batteries lodged in the esophagus is more important than ever.