Button Battery Code: A Case Series of Button Battery Ingestions in Children at a Tertiary Referral Center and Proposed Management Protocol

Background: Button battery ingestion is a paediatric emergency associated with significant morbidity and mortality. Rapid recognition and removal are critical to prevent severe oesophageal and mediastinal complications. Methods: We report a case series of five patients with a mean age of 22.6 months (SD= 11.4 months) with confirmed button battery ingestion who were managed at a tertiary referral center. Results: Patients ranged from 13 to 41 months of age. Presentations varied from asymptomatic delayed presentation to acute respiratory distress. Endoscopic removal was required in all cases, with findings ranging from superficial mucosal erythema to severe grade 3 caustic necrosis. One child demonstrated features suggestive of an impending aortoesophageal fistula. Supportive care included parenteral nutrition, antibiotics, and proton pump inhibitors. Despite successful retrieval in most of the cases, long-term complications remain a concern. Conclusion: Button battery ingestion in children is unpredictable both in presentation and in outcome. Delays in recognition and failed initial removal attempts are associated with higher grades of oesophagal injury. Based on these findings, we propose the establishment of a “Button Battery Code” to standardise rapid response, expedite referral, and coordinate multidisciplinary management, similar to STEMI and stroke codes.