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Updates: Oral administration of honey or sucralfate after button battery ingestion in children

" For asymptomatic children with acute button battery ingestions (eg, witnessed or likely to have occurred within one to two hours) who are older than one year of age, we suggest one oral dose of pure honey (eg, 5 to 10 mL) as soon as possible after ingestion (Grade 2C). "

Guidelines for the management of button battery ingestion previously recommended no oral intake before timely radiographic localization and emergency endoscopic removal of esophageal button batteries. A recent study using in vitro and in vivo animal models of esophageal battery impaction suggests that early and repeated oral administration of either honey or sucralfate until the battery is removed may reduce the severity of esophageal burns. For asymptomatic children with acute button battery ingestions (eg, witnessed or likely to have occurred within one to two hours) who are older than one year of age and who have no allergies to honey or its components, we suggest one oral dose of pure honey (eg, 5 to 10 mL) as soon as possible after ingestion. Once in the emergency department, the child may receive another dose of honey or a single dose of sucralfate 500 mg prior to confirmation of esophageal impaction and emergency battery removal. Although this approach runs counter to the usual approach of no oral intake until operative removal, the benefit of neutralization and reduction in burn injury to the esophagus appears to outweigh the potential increased risk of aspiration. 


pH-neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury. Anfang RR, Jatana KR, Linn RL, Rhoades K, Fry J, Jacobs IN. Laryngoscope. 2018;  PMID 29889306. Division of Otolaryngology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.