It was a perfect Saturday. Great weather. The smells of barbecue wafting through the air. The joyful sounds of children playing. Even at only 21 months of age, little Isabella loved barbecue. The family had invited friends over, and they had gathered in the living room to enjoy dinner. The younger children were toddling in and out of the adjacent playroom where the adults could see them.
But when Isabella’s dad, Marco, suddenly saw his baby girl acting strangely, the conversation stopped. She had begun to stagger, her eyes were big and round, and she was clutching her throat. She gave one cry, and then went silent. Marco raced over and scooped up Isabella, turned her over on his lap and slapped her back between her shoulder blades to try to expel whatever she may have swallowed. But nothing came out of her mouth.
A family friend helped rush Isabella to a hospital in Naples. The X-ray revealed a small round object, possibly metallic.
“When I saw the X-ray, I said, ‘Oh, my goodness. It’s a coin!’” said Isabella’s mom, Vivianne. But the doctor said he wasn’t so sure. He was concerned that it may be one of those little button batteries found in an increasing number of children’s toys and gadgets.
A button battery can do exceedingly more damage than a coin, which often makes its way to the stomach and is eventually eliminated naturally. Sometimes a button battery can also wind up in the stomach, and is generally left alone. But if the battery gets lodged in the esophagus, it’s a true emergency, and can be lethal.
“The big difference with button batteries is that the acid leaking from the battery mixes with saliva in your esophagus and it can eat right through your esophagus,” says pediatric emergency medicine physician, Joseph Perno, M.D.
Perno says emergency centers are seeing more of these cases, where children swallow the candy-sized batteries, with dangerous effects. The damage can be rapid and deep. It can erode all the way through the esophagus, and into the trachea. It can even erode into the aorta and cause a child to bleed to death.
“Younger children, usually under age 3, the way they explore their world is with their mouths. They’re not trying to be trouble-makers. That’s just what they do,” Perno explains.
Unfortunately, time was not on Isabella’s side. The family had to wait on an ambulance to transport her to a children’s hospital in Fort Myers, where she was taken to the operating room. But after several attempts at removing the battery, doctors shared some bad news with the parents. They were unable to successfully remove the object. By this time several hours had gone by since Isabella had swallowed the battery. It was time to put in a call to Johns Hopkins All Children’s Hospital.
Pediatric surgeon David Kays, M.D., was attending a holiday party on a Saturday night when he got the call. A child had swallowed a button battery, and another institution was unable to get it out. It was late in the evening.
“My response was, ‘Let’s get the child here as fast as we can. I asked to send a helicopter for her, and to have her taken directly to the operating room upon arrival,” says Kays, also professor of surgery at the Johns Hopkins University School of Medicine.
Once in the operating room at Johns Hopkins All Children’s, Kays used a rigid tube that allows the surgical team to see down into the esophagus. The battery was lodged just above the aorta. Kays was able to grasp the battery and pull it out within a few minutes.
He also was able to see extensive injury in and around the esophagus. The damage was “full thickness,” meaning it went all the way through the lining and the muscles of the esophagus into the surrounding tissue. It had created a fistula, or hole, resulting in injury to the trachea. It appeared to also have damaged the nerves that come down one side of Isabella’s vocal cord.
Isabella spent 40 days in Johns Hopkins All Children’s Hospital. She was able to go home for one day, before her mother noticed she was having difficulty breathing. So she came back to the hospital for another long stay.
She has a feeding tube for now because the scarring to the esophagus prevents her from being able to swallow food. Her parents remain in awe of the damage a tiny toy part could do.
“You just don’t think that something somebody sells to make your child happy can be so dangerous,” Vivianne says.
Kays may be seeing Isabella in the operating room in the coming months to delicately dilate the stricture in her esophagus. Recovery may take six months.
“She’s going to be OK, but what we don’t know is if this is going to heal on its own in the coming weeks, or are we going to have to go in and surgically separate the esophagus from the trachea,” Kays says.
The family will never look at a toy the same way again. Still, they have their baby girl.
“My daughter is alive. She’s alive,” Vivianne says. “We are so grateful.”
Learn more about choosing toys that can keep kids safe.