How can we be sure that the toys we buy for our children are safe?  What sorts of guidelines can we use to minimize risks?  The following article will discuss a few current products that could be present a risk of more than minor harm and provide some guidance on minimizing the risk of harm from toys and foreign objects in general.

For information on the chemical risks of toys click here.

Toys are a part of a child’s environment whether in their own home, the home of a relative or babysitter, or a school or daycare.  We provide toys to our children for fun and education with the assumption that the products are safe for them to use.   Clearly no one wants to bring toys into a child’s environment unless the toys are safe for children to use both during normal play and if the toys break.  However, every year, many children are injured, and some are killed, as a result of their normal interactions with toys we, as parents, have given them.

In recent years, we have seen children injured after interactions with items as seemingly harmless as common balloons.  New products entering the market may present unexpected new risks.  For example an award winning new children’s toy released a few years ago was coated with a solvent that the body converts into a date rape drug.  After the problem came to light, this product was rapidly removed from the market and reformulated.

The US Consumer Product Safety Commission (CPSC) is charged with the responsibility of protecting the public from unreasonable risks of injury associated with the use of consumer products under the agency’s jurisdiction.   The CPSC works to ensure the safety of a range of consumer products including everything from toys to household chemicals.  For example, the CPSC has been at the forefront of efforts to insure that children’s toys are not painted with lead based paint.  As a result of CPSC’s work, federal limits for lead in paint on children’s toys was reduced to 90 parts per million, which is among the lowest in the world.   For further information on the CPSC you can go to their website.  http://www.cpsc.gov/about/about.html.

Foreign objects 

Children exploring their environment often put things into their mouth as part of the process.  Older children and patients with disabilities like autism and psychiatric disorders may also be at increased risk. Sharp foreign objects like open safety pins and shards of glass are inherently dangerous if ingested. Foreign objects can get stuck at any point in the digestive tract.  Fortunately, foreign objects that don’t get stuck in the throat normally pass through the digestive system uneventfully.  Foreign objects that get stuck in the esophagus must be treated as a medical emergency.  Small objects of all sorts can present a choking risk which can be an immediate life threat, but other less obvious risks may also be present. Objects that get stuck in the esophagus can wear through the thin tissue of this organ. This can lead to breathing problems, life threatening blood loss and serious infections. Some of these so called foreign objects can present additional risks even if they are not poisonous. Button batteries and newer strong magnets are particularly concerning foreign objects.  Other newer products marketed to kids can present a risk of obstruction to the digestive tract even if a child swallows them without difficulty. Many parents may not be aware of the risks associated with foreign objects.

Magnets

Manufacturers have found a number of interesting uses for powerful new magnets.  This broad utility is likely to make them increasingly available in our homes as consumer product innovators find new uses.  Some current consumer products include jewelry meant to simulate piercings, refrigerator magnets and toys.  Toy building sets that contain strong magnets are fun and educational for appropriate aged children and adults, but can be dangerous in younger children.

Magnets cause problems when they stick to each other or other magnetic metal objects across body tissues. This can occur in the digestive tract or other body parts.  A case report in the medical literature describes perforation of the nasal septum in an 11 year old that used magnet-backed earrings in both sides of the nose to mimic nose piercings.   When the child removed the outside part of the jewelry, the magnets in the patient’s nose stuck to each other across the nasal septum so tightly that he could not remove them.  The patient left them in place for two days before seeing a doctor.  Doctors needed to remove the magnets surgically and repair the damage they caused.

Like any foreign object, there is a risk that a magnet could get stuck at some point in the digestive system.  Generally, a single magnet that passes into the stomach will move through the digestive tract normally and pass with bowel movements within a day or two.  When a child eats two or more magnets or a magnet and a metal object they can attract each other so strongly that blood flow to the tissue between the magnets is cut off.  This can cause death of the tissue between the magnets.  The magnets can also hold together parts of the intestines that normally would normally slide by each other freely.  These effects can cause is can cause the formation of holes in the intestines where the magnets are joined and disrupt normal movement the bowels.  Holes in the intestines and intestinal blockage can lead to dangerous infections if fecal matter leaks out of the intestines.

Button Batteries  

Button batteries are becoming more common in children’s environments as the small electronic devices they power become more popular.  Children less than 5 years of age are at highest risk of swallowing button batteries.  Most current button batteries are small enough that they should pass through the digestive tract easily. However, like magnets, button batteries have the potential to cause injury beyond what would be expected based on their size alone.  Case reports in the medical literature describe serious injuries in children after they swallowed a button battery or put one into their nose or ear canal.

The main problem with button batteries occurs when they discharge while in contact with body parts.  This causes both thermal and chemical burns to the exposed tissue.  Newer batteries produce about twice the voltage of older batteries increasing the risk of harm.  Batteries that have stopped working in their application still have a residual charge and can still cause tissue damage.

The most worrisome problems with button batteries occur if they stick to the wall of the esophagus (the tube that goes from the mouth to the stomach).  They can cause burns and breakdown of the esophageal wall and nearby organs resulting in serious infections, breathing problems and even massive blood loss.  Continuous contact for as little as 2 hour is all that is needed to produce a potentially dangerous injury.

Rarely, button batteries break apart in the digestive tract.  Older button batteries contained dangerous heavy metals like mercury and an alkaline solution make the battery work. Newer batteries use lithium and a safer electrolyte solution.

Expandable Polymer Gel Products 

Recently some newer toys have been introduced that have the potential to cause obstruction of the digestive tract .  These products  are made of a super absorbent polymer substance that expands greatly in size when put into water.  The products are sold under several brand names including Orbees, Mega Moon Crystals and Water Balz. This product listing is arranged by the size of the expanded product from smallest to largest.  The un-expanded products range in size from about 3 -10 millimeters.   After soaking in water for several hours the largest of the products can expand to roughly the size of a racquetball.  Once expanded, the products are probably reasonably safe, but children eating the unexpanded products could develop a blockage in their digestive tracts as the products absorb water and expand inside them.  A recent report published in the journal Pediatrics detailed the experience of an infant who ate one of the larger un-expanded beads.  The product expanded in the child’s gut and had to be surgically removed.

Prevention for foreign objects. 

• +  READ the label and always choose age appropriate toys for your children.
• +  Children less than 5 years of age and patients with disabilities like autism or psychiatric disorders are at particular risk for foreign object ingestion.
• +  Children can swallow small objects very quickly.
• +  Keep strong magnets, button batteries and items that present a choking risk away from small children.
• +  Any product containing small parts is a potential choking risk.

Initial first aid for foreign objects

• +  If a child eats a single magnet it should pass through the digestive tract with minimal problems.
• +  A child who eats more than one magnet or a magnet and an additional metal object can be at risk of severe medical consequences and needs to be evaluated in an emergency room as soon as possible.
• +  Children may not tell their parents if they have swallowed magnets and initial symptoms may be vague and seemingly minor in nature.
• +  Children with disabilities like autism who present to emergency rooms with vague abdominal complaints should have an x-ray of their abdomen to rule out ingested magnets.
• +  Children who swallow a button battery should be taken to the emergency room for an x-ray to make sure the battery is not stuck in the child’s esophagus.
• +  If the battery has passed into the stomach, it will usually pass through the digestive tract without difficulty.  However, some physicians may opt to use an endoscope to remove batteries that are still in stomach to prevent injury farther down in the digestive tract

Author

Robert Goetz, Pharm. D.
The Cincinnati Drug and Poison Information Center

References

Magnets
George AT, Motiwale, S. Magnets, children and the bowel: A dangerous attraction? World J Gastroenterol 2012 October 14; 18(38): 5324-5328

Shermetaro,C, Charnesky M: Pediatric nasal septal perforationsecondary to magnet misuse:
A case report ENT-Ear, Nose & Throat Journal  2007 86(11): 675-767

Rahman,N, Featherstone,NC, DeCaluwe, D:  Spider-Man, Magnets,
and Urethral-cutaneous Fistula.  UROLOGY 2010 76 (1): 162-163

Oestreich,AE : Worldwide survey of damage from swallowing multiple magnets Pediatr Radiol (2009) 39:142–147

Button Batteries

Sharpe SJ, Rochette LM Smith, GA:  Pediatric Battery-Related Emergency Department Visits in the United States, 1990 -2009 PEDIATRICS 2012 June 129, (6) 1111-1117

Kimball SJ,  Park AH,  Rollins MD, Grimmer JF, Muntz H: A Review of Esophageal Disc Battery Ingestions and a Protocol for Management. Archives of  Otolaryngology,  Head and  Neck Surgery 2010 September  /VOL 136 (NO. 9) 866-871

Litovitz TL: Battery Ingestions: Product Accessibility and Clinical CoursePediatrics 1985;75;469-476

Litowitz TL, Schmitz BF, Soloway RA: Ghost Blasting With Button Batteries Pediatrics 1990 Vol. 85 No. 3Vol. 3