Science
Button batteries pose deadly risks to children. Doctors want them to be made safer
The round batteries, small as buttons and shiny as coins, are prized for the energy they pack at their size. In households, they have become commonplace, powering remote controls, hearing aids, toys, electric tea lights, wristwatches, greeting cards that play music and other familiar items.
But doctors warn that such “button batteries” can maim and kill. Pop one into your mouth and swallow — as thousands of children do annually — and they can quickly cause devastating injuries.
A growing number of medical associations is pushing for battery manufacturers to head off the threat by making a new product: A button or “coin cell” battery that will not lead to catastrophic injuries when swallowed.
“The only real solution to the battery problem is to make the battery itself safer,” said Dr. Toby Litovitz, founder of the National Capital Poison Center.
When button batteries are lodged in the body, their electrical current breaks down water, driving up alkalinity to dangerous levels akin to bleach. Bodily tissues can begin to liquefy. Physicians say serious injury can happen within two hours, sometimes before a parent has even realized that a battery was swallowed.
As button batteries have proliferated in common items, the rate of pediatric emergency visits for battery-related injuries has more than doubled in recent decades, according to a study published in the journal Pediatrics. Some children have ended up relying on tubes to breathe or suffered massive hemorrhaging, doctors said.
“Unfortunately, these batteries cause such severe injuries so rapidly,” some of which are impossible for surgeons to repair, said Dr. Kris Jatana, surgical director of clinical outcomes at Nationwide Children’s Hospital in Ohio.
Jatana became alarmed by the risks after caring for a 2-year-old child who ended up needing a tracheostomy to breathe. “It was a moment that motivated me to try to see what we could do to prevent these injuries from happening in the first place.”
Button battery safety
Here are recommendations from Nationwide Children’s Hospital:
Some battery manufacturers have tried adding bitter coating or saliva-activated dye to tip off parents.
Reese’s Law, a federal statute named for a child who died of serious injuries after swallowing a button battery, now requires compartments for such batteries on consumer products to be harder to open and mandates child-resistant packaging for button batteries.
But advocates say more needs to be done. For instance, Litovitz said that harder-to-open packaging would not address the many injuries caused when children swallow batteries left sitting out or discarded. Among those pushing to develop safer batteries is biotech entrepreneur Bryan Laulicht.
“What makes them really great for devices is also what makes them so dangerous when you swallow them,” Laulicht said of button batteries. “They’re powerful enough to split water … which spikes the pH up to Drano levels in a matter of minutes.”
Doctors began raising alarms about the threat decades ago as more children began to suffer grave injuries. One study found that between 1985 and 2009, the percentage of button battery ingestions that led to serious or deadly injuries had risen more than sixfold.
Litovitz and other researchers pointed to the rising popularity of the 20-millimeter diameter lithium coin cell battery: Their analysis found that 12.6% of children under the age of 6 who ingested button batteries around that size suffered serious complications or death.
They’re “just the right size to get stuck in the esophagus of a small child, especially a child younger than four years,” Litovitz said in an email. “Further, these lithium coin cells have twice the voltage of other button cells.”
Doctors may not immediately recognize and diagnose the problem if no one realized a battery was swallowed, because the symptoms can initially look like those of other childhood ailments.
The problem has worsened over time: From 2010 through 2019, an average of more than 7,000 children and teens went to emergency rooms annually for injuries related to batteries, according to the Pediatrics study. The rate of such emergency visits had doubled compared with the period of 1990 to 2009.
Button batteries were implicated in the bulk of cases where the battery type was known. Researchers have tallied more than 70 deaths from ingesting button batteries over time, but Litovitz said the true number could be far higher because that figure only includes cases documented in medical research or the media or reported to the National Button Battery Ingestion Hotline, which stopped operating six years ago.
At Children’s Hospital Los Angeles, doctors see roughly one child a month who has been injured by a button battery, said Helen Arbogast, injury prevention program manager in its division of general pediatric surgery. Children are attracted to shiny things and pick up on the attention that adults pay to electronics, she said.
“Remote controls are really fascinating to them — the buttons, the colors — and part of their natural motor skill development is to learn how to open and close things,” Arbogast said.
She stressed that time is critical. “If a parent suspects their child having swallowed a button battery, it’s important to get them to a hospital right away.”
In Texas, Reese Hamsmith awoke one morning in 2020 congested and wheezing. Her mother, Trista Hamsmith, took the toddler to the pediatrician, who suspected croup. It wasn’t until the next day, after a Halloween night when Reese had remained ill, that her mother realized a button battery was missing from their remote control.
Reese underwent emergency surgery, but the damage continued even after the battery had been removed, burning a hole through her esophagus and trachea, her mother said. In the weeks that followed, she underwent more surgeries, sedation and intubation. Less than two months after her injury, Reese died.
She was a year and a half old. After she died, “I held her again, and I promised to her that I would do everything I could that no kid would die this way again,” Trista Hamsmith said.
The Lubbock mother started a nonprofit, Reese’s Purpose, that successfully pushed for federal legislation that imposed new requirements for battery compartments, childproof packaging and warning labels. Hamsmith was glad to see those rules go into effect, but rued that such protections had not been put in place earlier.
“It shouldn’t have to take what we went through” to spur action, she said. “It definitely should not have to take someone like me screaming at the world.”
The group is also funding research into a medical device that could detect a swallowed battery without subjecting a child to radiation, which Hamsmith wants to see used whenever a child shows up with possible symptoms. And it worked with Energizer on safety features including a telltale dye that turns blue with saliva.
“The missing ingredient here … has been the ability to alert the caregiver that something has happened,” said Jeffrey Roth, Energizer’s global category leader for batteries and lights. “That’s really what ‘color alert’ does — it gives the caregiver notification that a child might have put something in their mouth that they shouldn’t have.”
Litovitz cautioned, however, that because not all batteries have the blue dye, doctors and parents should not assume that no battery was swallowed if they don’t see that color.
Roth said that in recent years, Energizer has spent tens of millions of dollars on research and other efforts surrounding button battery safety. “We believe that one day we will solve this,” he said. “But it certainly requires a breakthrough innovation.”
Laulicht, cofounder and chief executive of Landsdowne Labs, said his company has been testing an alternative battery with a different kind of casing, intended to shut down inside the body. Tests that involve sandwiching the battery between two pieces of ham do not show the kind of damage inflicted by commercially available button batteries, he said. (Ham is used as a readily available substitute for human gastrointestinal tissue, Laulicht explained.)
One of their challenges has been getting the same level of battery performance with those alterations, Laulicht said. But as a father of young children, “I would rather a battery that only lasted a year on the shelf … but didn’t kill my kid when they swallowed it.”
Science
Questions follow massive recall of California raw milk after bird flu testing
Less than a week after California health officers confirmed a finding of bird flu virus in store-bought raw milk, state agriculture officials descended on Mark McAfee’s Raw Farm dairy “like never before” Wednesday and began collecting samples from the farm’s two herds, creamery, bulk milk tanks and trucks, according to the owner.
The visit follows a recall of Raw Farm products, and also comes amid a growing series of H5N1 bird flu outbreaks in state dairy farms. Raw Farm maintains 1,800 head of cattle spread over two herds — one in Fresno, the other outside of Hanford, according to McAfee. The company also owns a Fowler-based creamery.
“I think they are on full attack mode,” he said, describing the search as thorough. In addition to milk, Raw Farm produces cheese and kefir.
As California Department of Food and Agriculture officials collected samples and conducted tests at the dairy Wednesday, some health experts raised questions and concerns about the recent positive test results.
Last week, public health officials in Santa Clara County detected bird flu virus in a store-bought sample of McAfee’s raw milk. Two days later, the California Department of Public Health confirmed the finding.
But when state agriculture officials tested cows at McAfee’s dairy farm on Monday, they failed to detect the virus.
The fact that none of the animals are known to be infected with the virus has puzzled and concerned public health experts. Generally, once the virus appears on a farm, it spreads and does not just disappear.
“The fact that all the supplemental testing is negative really bothers me,” said John Korslund, a retired U.S. Department of Agriculture veterinarian epidemiologist, in an email.
Officials from the CDFA could not be reached for comment Wednesday, but infectious disease experts told The Times that officials were likely reviewing testing procedures, as well as the actual origin of the sampled milk.
According to testing records, the initial sample of store-bought raw milk carried high levels of the virus, and was found to have a polymerase chain reaction cycle threshold — or Ct — of roughly 25.
“A herd should not be immediately negative after a reading of 25 if it is truly milk from the same herd, IMO,” Korslund wrote in an email.
Richard Webby, director of the World Health Organization’s Collaborating Center for Studies on the Ecology of Influenza in Animals and Birds, and a researcher in the department of Infectious Diseases at St. Jude’s Children’s Research Hospital in Memphis, Tenn., agreed.
“OK, that’s not a weak positive … and definitely not on the borderline where some tests would be positive and others negative,” he said after reviewing the test records.
Webby, Korslund and other experts say the test that was used only looks for the H5 part of the H5N1 virus, and it can’t determine if the virus is inactive, or alive. A second test — one called a virus isolation test — needs to be done to confirm the sample is H5N1 and that it is active.
State and federal health officials say the H5N1 bird flu virus poses a low risk to the public. However, they have urged people not to drink raw, unpasteurized milk. There has been no reported outbreak in consumers associated with the bird flu in contaminated raw milk.
The milk was bottled on Nov. 9. Raw Farm LLC has recalled all products associated with the positive sample. McAfee estimates the recall involved roughly 2,000 gallons of half- and quarter-gallon “cream top” whole milk products.
Since the beginning of the outbreak, 461 herds have been infected in California — including herds in Fresno and Kings County, where McAfee’s herds are located.
Early in the H5N1 dairy outbreak, federal health officials tested pasteurized milk samples and found virus in 20% of the samples collected from retail shelves. However, when further testing was conducted — virus isolation — they were able to show it was inactivated virus that had been denatured by heat.
So, why then would a raw milk sample test highly for virus and a dairy herd not test positive?
Korslund acknowledged that testing and sampling can sometimes be compromised, but he was not inclined to doubt the tests in this instance. He said the Ct value — and the lack of subsequent positive tests — suggests a “product integrity issue rather than a herd infection.”
“What if somewhere in the bottling process, pasteurized shelf milk was spiked into the raw milk to meet inadequate supply demands? In such a scenario, we don’t have a testing issue; rather it’s a product integrity issue that normally would be undetectable,” he said.
This is why virus isolation testing is critical, Korslund said. It would help determine whether the virus in the sample collected was alive or not.
A spokesman for the state’s health department said testing on the sample was complete. He did not say whether viral isolation had been completed, but noted the positive result has been confirmed by state and now federal laboratories.
McAfee said he does not think the virus is present in his herd. The tests that the state’s agriculture department have been regularly conducting — twice a week — on his bulk milk have been negative. In addition, he noted, a test taken on Monday also showed no virus.
In addition, he said, he monitors each cow at his farms with a high-tech device — made by the Austrian company smaXtec — which sits in a cow’s udder and sends real-time information about the animal’s body temperature, milk acidity, etc.
He said there are no indications that virus is moving through his herd based on that data.
He also said all his equipment — from his trucks, to his bulk tanks and bottling plant — are closed to outside farms and milk; they are used only by Raw Farm, LLC.
He said he’s worried state officials are determined “to find something.”
Science
Another recall of California raw milk after second batch tests positive for bird flu virus
California health officials announced Wednesday that another batch of raw milk from Fresno-based Raw Farm has tested positive for bird flu virus, as dairy farms throughout the state continue to struggle with a widening number of outbreaks.
For the second time in roughly the span of a week, Santa Clara County Department of Public Health officials tested store-bought raw milk and found evidence of the virus. The sample was collected and tested on Tuesday.
Raw Farm is voluntarily recalling a batch of “cream top” whole milk half-gallon-size products, lot No. 20231119, expiration date Dec. 7.
According to Mark McAfee, the owner of Raw Farm, the state’s Department of Food and Agriculture has requested that he “hold delivery of further products” until Friday.
On Wednesday, state agriculture officials visited his farms in Fresno and Hanford, as well as his creamery in Fowler, and tested finished and unfinished products, as well as his trucks, bulk tanks and bottling facility.
He said the investigation was carried out with a thoroughness “like never before.”
There have been no reported illnesses associated with either this second recall or the first. The first recall also involved Raw Farm and was limited to a batch that was bottled on Nov. 9.
State and federal health officials say the H5N1 bird flu virus poses a low risk to the public. However, they have urged people not to drink raw, unpasteurized milk.
In addition, every waste site tested in California by WastewaterScan — an infectious-disease monitoring network led by researchers at Stanford and Emory University, with lab testing partner Verily, Alphabet Inc.’s life sciences organization — has tested positive for bird flu in the last two weeks.
The Los Angeles County Department of Public Health issued a statement late Wednesday expanding the list of stores that may have sold bird-flu-contaminated raw milk.
They include:
- Back Door Bakery, 8349 Foothill Blvd., Sunland, CA 91040
- Bristol Farms, 7880 Sunset Blvd., Los Angeles, CA 90046
- Eataly, 10250 Santa Monica Blvd., Los Angeles, CA 90067
- Erewhon Market, 475 S. Lake Ave., Pasadena, CA 91101
- Erewhon Market, 26767 Agoura Road, Calabasas, CA 91302
- Erewhon Market, 4121 Santa Monica Blvd., Los Angeles, CA 90029
- Erewhon Market, 7660 Beverly Blvd., Los Angeles, CA 90036
- Lassen’s Natural Foods, 1631 W. Sunset Blvd., Los Angeles, CA 90026
- Lassen’s Natural Foods, 2080 Hillhurst Ave., Los Angeles, CA 90027
- Lassen’s Natural Foods, 710 S. La Brea Ave., Los Angeles, CA 90036
- Lazy Acres, 1841 N. Western Ave., Los Angeles, CA 90027
- Lazy Acres, 2510 Pacific Coast Highway, Hermosa Beach, CA 90254
- Mothers Market & Kitchen, 6677 W. Santa Monica Blvd., Los Angeles, CA 90038
- Mothers Market & Kitchen, 2475 Cherry Ave., Signal Hill, CA 90755
- Sprouts Farmers Market, 1302 S. La Brea Ave., Los Angeles CA 90019
- Sprouts Farmers Market, 1751 Westwood Blvd., Los Angeles CA 90024
- Sprouts Farmers Market, 8985 Venice Blvd., Los Angeles CA 90034
- Sprouts Farmers Market, 915 N. La Brea Ave., Los Angeles, CA 90038
- Sprouts Farmers Market, 2245 Yosemite Drive, Eagle Rock, 90041
- Sprouts Farmers Market, 7925 Atlantic Ave., Cudahy CA, 90201
- Sprouts Farmers Market, 5660 Sepulveda Blvd., Culver City CA, 90230
- Sprouts Farmers Market, 12060 Lakewood Blvd., Downey, CA 90242
- Sprouts Farmers Market, 14411 Hawthorne Blvd., Lawndale, CA 90260
- Sprouts Farmers Market, 1515 Hawthorne Blvd., Redondo Beach, CA 90278
- Sprouts Farmers Market, 4230 Pacific Coast Highway, Torrance CA, 90505
- Sprouts Farmers Market, 15801 Whittier Blvd., Whittier, CA 90603
- Sprouts Farmers Market, 11522 Alondra Blvd., Norwalk, CA 90650
- Sprouts Farmers Market, 11900 South St., Cerritos, CA 90703
- Sprouts Farmers Market, 4253 Woodruff Ave., Lakewood, CA 90713
- Sprouts Farmers Market, 820 N. Western Ave., San Pedro, CA 90732
- Sprouts Farmers Market, 4600 E. Pacific Coast Highway, Long Beach, CA 90804
- Sprouts Farmers Market, 920 Foothill Blvd., La Cañada Flintridge, CA 91011
- Sprouts Farmers Market, 400 W. Huntington Drive, Monrovia, CA 91016
- Sprouts Farmers Market, 39 N. Rosemead Blvd., Pasadena, CA 91107
- Sprouts Farmers Market, 6607 Fallbrook Ave., West Hills, CA 91307
- Sprouts Farmers Market, 10821 N. Zelzah Ave., Granada Hills, CA 91344
- Sprouts Farmers Market, 24285 Magic Mountain Pkwy., Valencia, CA 91355
- Sprouts Farmers Market, 21821 Ventura Blvd., Woodland Hills, CA 91364
- Sprouts Farmers Market, 1011 N. San Fernando Blvd., Burbank, CA 91504
- Sprouts Farmers Market, 11315 Ventura Blvd., Studio City, CA 91604
- Sprouts Farmers Market, 835 W. Foothill Blvd., Claremont, CA 91711
- Sprouts Farmers Market, 655 S Grand Ave., Glendora, CA 91740
- Sprouts Farmers Market, 1375 Foothill Blvd., La Verne, CA 91750
- Sprouts Farmers Market, 239 S. Diamond Bar Blvd., Diamond Bar, CA 91765
- Sprouts Farmers Market, 2630 E. Workman Ave., West Covina, CA 91791
- Sprouts Farmers Market, 150 E Main St., Alhambra, CA 91801
- Vitamin City LB, 6247 E. Spring St., Long Beach, CA 90808
- Vitamin City, 642 W. Arrow Highway, San Dimas, CA 91773
- Whole Wheatery, 44264 10th W., Lancaster, CA 93534
Science
A “yoga pill” to end anxiety? Neuroscientists discover a brain circuit that instantly deflates stress
Your heart is racing, your arms are tingling and your breathing is shallow. You’re having an anxiety attack. And you’re in a public place, to boot. A crowded restaurant, say, or at the office. Not a space where you can comfortably lay on the ground and do some deep breathing exercises to calm yourself.
What if there were a pill that would instead induce that kind of calm breathing for you? That scenario might be possible after a new scientific breakthrough.
Neuroscientists at the Salk Institute for Biological Studies in La Jolla have identified a brain pathway that instantly deflates anxiety. The new study, which published earlier this week in the scientific journal Nature Neuroscience, lays out how the aforementioned brain circuit regulates voluntary breathing — meaning conscious breathing as opposed to automatic breathing that happens without your having to think about it — allowing us to slow our breath and calm our mind.
The discovery opens up the potential for the creation of new drugs that would mimic the relaxed state common during breath work, meditation or yoga. Sung Han, senior author of the study, says he’d like to one day see a “yoga pill,” as he calls it, on the market to ease anxiety. It would likely be useful for the more than 40 million adults in the U.S, who, according to the National Alliance on Mental Illness, suffer from an anxiety disorder.
Han says the new discovery is a real scientific breakthrough.
“As a scientist, finding something never known before is always exciting,” he told the Los Angeles Times. “This top-down breathing circuit has been a longstanding question in the neuroscience field. It’s exciting to find the neural mechanism to explain how the slowing down of breathing can control negative emotions, like anxiety and fear.”
We’ve long known that we can control our breathing patterns to alter our state of mind — when we get stressed, we might take a deep, slow breath to feel calmer. But scientists didn’t understand how that worked — which parts of the brain were actually slowing our breath and why that activity makes us calmer. Now they know that there is a group of cells in the cortex, the higher part of the brain responsible for more conscious, complex thought, that send messages to the brain stem, which in turn sends information to the lungs. That’s the aforementioned “circuit.”
The discovery validates soothing behavioral practices such as yoga, mindfulness and even “box breathing” — the latter a technique that involves repeatedly breathing in, then holding your breath, for four-second counts in order to relieve stress — because it grounds these behavioral practices in science.
But the practical applications is what makes the Salk discovery so important, Han says.
“It can, potentially, create a whole new class of drugs that can more specifically target anxiety disorder,” he says.
These would differ from common anti-anxiety medications by more specifically targeting areas of the brain. Common anti-anxiety drugs like Xanax and Lexapro target multiple areas of the brain that control multiple brain processes and behaviors. It’s why these drugs don’t work for everyone in the same way and may create unwanted side effects. More precisely targeting an individual brain circuit makes a medication more effective and reduces potential side effects. And, in extreme cases, such a pill might be more efficient for targeting anxiety than doing breathing exercises.
“If you’re in panic, breathing techniques alone may not be sufficient to suppress anxiety,” Han says.
Han’s team is now trying to find the opposite circuit — a fast breathing circuit — that increases anxiety.
“To target the slow breathing circuit, we need to understand the opposite circuit, so we can avoid targeting it,” Han says. “To relieve the anxiety.”
While Han hopes his findings will lead to a “yoga pill,” that’s likely a long ways off. The research, and ensuing clinical trials, could take as much as 10 years, he says. And nothing is for certain.
“I cannot say that this discovery is directly connected to the discovery of the new medication,” Han says. “But I can say it’s a stepping stone. We now know the pathway. That’s exciting. That is the first step.”
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