Got Baby? Beware the Button Battery

Babies and Batteries Don’t Mix.

Got a thermometer? A digital camera? An entertainment remote? A battery-operated toy–or two or three or four? Nieces and nephews running around with newly holiday-gifted electronic games? That’s probable.

3-volt lithium button battery

If I can open this Apple TV remote, anyone can!

Size—of the Battery—Matters.

Be careful. Ingested button-type cell batteries, the kind used in all sorts of how-did-we-ever-live-without-these electronic gizmos, can cause life-threatening damage within 2 hours if they lodge in the esophagus. And lots of them do, in particular in children, and in particular batteries that are 20mm in size.   That’s critical to know.

A battery’s size can be determined by the number etched onto it: for cell batteries, in the case of a 4 digit designation, the first 2 numbers will reflect the diameter. CR 20xx batteries, which are 20mm across, are in common use. If numbers are missing or you can’t make them out, compare the battery to a coin: if it’s larger than a penny and smaller than a nickel, it’s probably 20mm.   According to an article in the International Journal of Pediatric Otorhinolaryngology 12.6% of children who ingested a 20mm battery had severe or fatal injuries.  That’s a big number.

Keep the Current in the Gizmo, not the Baby.

The battery in your baby’s esophagus is a problem because it can rapidly burn surrounding tissue. Many of the newer lithium cell batteries are very powerful at 3 volts, which is great when they’re in a device, but terribly dangerous when that current is stuck in the baby. Smaller and larger button batteries can also be problematic, so anytime ingestion is suspected an immediate X-ray is imperative. Again, if the battery is lodged, it has to come out within 2 hours of going in.  That’s fast.

Diagnosis is Difficult.

Perhaps most troublesome, the symptoms of battery ingestion are non-specific: vomiting, fever, lethargy, low appetite, trouble swallowing, cough, wheezing, irritability.   The worst battery ingestion outcomes are from events that weren’t witnessed. Diagnosis is often delayed. Looks like the flu, acts like the flu, might be a lodged something, and possibly worst of all, might be a lodged battery.  That’s scary.

You Can Avoid the Ingestion Risk.

And so you need to preclude any such risk. This isn’t complicated, but it can be tedious. First, figure out which of your household items are powered by a cell battery. In addition to what’s listed above, consider, for starters, key fobs, watches, kitchen scales, bathroom scales. If you have diabetes, look at your glucometer, and if you have a garage, check the remote door opener. Planning to use ‘safer’ flameless candles this year during the holidays? They’re likely powered by the exact size of lithium battery that could be the biggest risk. Hearing aid batteries often find their ways to noses and ears. That’s a lot of stuff.

Once you identify all of the items, ensure that they are always out of reach of your child and of visiting small folk. If the battery compartment doesn’t require a lot of experience, dexterity and specifically a tool to open, tape it closed with duct tape. In any case, keep it away from the baby, even under your supervision.  That’s common sense.

Finally, identify a single, completely inaccessible location in which to store extras. That’s imperative.

Don’t Let Your Holiday Gatherings Be a 2-Sided Coin (Battery).

Make sure any family you’re visiting over the holidays–or at any time of the year, does the same thing. In general, the greater the number of kids around, the more likely that at any given point the littlest ones aren’t being closely supervised. To repeat: the worst battery-ingestion outcomes were from events that were not witnessed. T hat’s avoidable.

Finders Can’t Be Keepers if the Finder is a Child.

If you drop a battery, FIND IT and re-insert it. If you were about to toss it in the trash when it slipped out of your hand, skip that, secure the battery, and when you have a chance, bring it to a Hazmat disposal site. That makes for safe floors and safe garbage containers.  That’s cumbersome (but necessary).

Know this Battery Hotline Number.

The number of the National Battery Ingestion Hotline is 202-625-3333. It should be posted in your house (and in your parents’) and in your phone as well.   Don’t hesitate to use it—immediately–if you have any suspicion that there’s battery in your child’s body.  That’s smart.

Review or Learn CPR.

And always, always, make sure anyone who is responsible for the baby knows and has recently practiced Relief of Choking as well as CPR, for infants and/or children. If the baby chokes on a battery, once it’s out, immediately call the Battery Ingestion Hotline to find out your next steps.

If you need to learn or review your skills, register for a class at











Don’t Let a Poisoning Poison Your Holiday Gathering

Over-the-Counter Medications Can Cause Over-the-Top Poisoning.

But what’s on Grandma’s night table?

You can almost taste it: the baby is having her early morning playtime-in-bed with grandma and grandpa, and you get to sleep for an extra hour.  You’d trade almost anything for some extra shut-eye, and this is a transaction with no downside.  Snuggles, giggles, inter-generational bonding.  Nothing could be better, unless the giggles end in terrified gasps and a trip to the emergency room!

If It’s Not Food, Don’t Let the Baby Eat It.

That liniment mom is using on her shoulder so she can lift your daughter without pain? Make sure she moves it from the night table to the medicine chest.  Dad’s eye drops?  They, too, need to relocate from bedside to a high, closed cabinet, and ideally all the enclosures are both lockable and kept locked. It’s not just prescription medications that can be dangerous to the baby.

 Out-of-Sight + Out-of-Mind = Out-of-Trouble

Treat over-the-counter medications the same as you do ones requiring prescriptions: out-of-sight and out-of-reach at all times.  This dictum might make your parents skeptical, but you can rout the raised eyebrow with the following examples:

1)   a swallowed quarter teaspoon of camphor rub can end in neurological problems and sometimes death, and

2)   ingesting as little as 6 ml of eye drops or a nasal spray can lead to coma.

Further, it can sometimes take hours before toxic effects are noticeable, depending on the medication, and in such circumstances it can be exceedingly difficult to determine what the problem might be

Mimicry and Medication are a Bad Mix.

No medication should ever be taken in front of a young child. Imitation is the sincerest form of flattery, yes, but flattery that ends in an E.R. visit, well, not so much.   Not only do we love the baby to imitate us, but we teach him to do so, and we exclaim with glee when he succeeds. Such displays of brilliance with regard to medications too often lead to unintended, and sometimes tragic, consequences.   Pills and potions should become private matters once there’s a baby in the house!

 Be Ready to Phone for Help.

If somehow, despite your best efforts, you know or you think that your baby has ingested, inhaled or had his skin exposed to a poison, you should phone the Poison Control Center. There are 56 such centers across the country, and they are open and staffed 24×7 by experts who provide confidential, free information.

The National Hotline Number is 1-800-222-1222, and your call will be routed to your local center via area code or satellite. This number should be committed to memory, posted in everyone’s home and stored in your phone.  Routing works very well with traditional landline phones, but occasionally, if calling via VoIP phone or from a cell, you might encounter a busy signal. Keep in mind the easily-remembered direct number for New York City’s center: 212-POISONS, which, presumably, you can dial from anywhere.

Know CPR!

It’s imperative that you and your family are up-to-date on your CPR and Choking skills. If you’ve never taken a class, you can sign up for a session at If you haven’t reviewed your skills in the past month, please do it right away!



Backyard Pools: Know Your Risks!

blog edge of pool“Mom, Aunt Joan, watch me!”  Your 10 year old is perfecting her dive, and your eyes are on her.  She’s excited, you’re excited.  Your 3-year-old-nephew picks this moment to bump himself silently down the pool’s wide entry steps.  By the time you turn back to him after the dive, he’s underwater.  And the fun stops.  You need to be able to start CPR.

Nothing Makes Less Noise Than Drowning

Drowning can occur in seconds, and it’s silent. There’s no shouting, because submersion effectively shuts down the ability to make sounds; if you can’t breathe, you can’t yell.  Even if a drowning child bobs up, her instinctual priority, for those brief seconds, is to inhale; she can’t yell for help and take in air at the same time. And there’s no wild, communicative splashing: she’s busy drowning. A child will instinctively position her arms in a way that might help raise her up, and while she’s doing this, she can’t also wave madly for help. Rather, before fully and finally submerging, she will likely be still, with her head tilted back and low in the water and her body upright. Unless your eyes and attention are on the pool, this can be easy to miss. And unless you’re scanning beneath the surface the water, too, you’ll miss the child who has gone under and stayed under.  In short, while the outcome of drowning is dramatic, the process is anything but. Watch, don’t listen.

Watch the Watchers

Who should be supervising?  Once the water is 4’ deep or greater, the person in charge needs to be a confident, competent swimmer.  Teenagers who are certified lifeguards are fine; otherwise, a fully-attentive, sober, water-confident adult is required.  This means that before leaving your friend in charge while you dash into the kitchen for something, you need to ensure that he knows what it means to supervise kids at the pool: eyes, not ears.  At public pools or swim clubs, consider the hired lifeguards to be supervising adjuncts to you, and don’t depend on them entirely. They’re great back ups, but I wouldn’t put 100% of the responsibility in their hands.

Crowd Size is a Safety Challenge

Bigger pools often mean bigger crowds.  More kids are trickier to supervise than fewer, and if they’re of a horsing-around age, they’re more likely to get into trouble.  More adults on deck means more socializing opportunities, often less careful supervision and sometimes less sobriety.  Which is a lot more fun, of course, but not so great for the kids.  At larger gatherings with multiple families, parents tend not to continuously watch their own children in the water; too much else is going on.  If you’re hosting a pool party, consider hiring a lifeguard whose sole responsibility is to watch the pool, maximizing the chance that at least one set of eyes is on it at all times.  Be sure to give the lifeguard plenty of breaks, too, in order to ensure that boredom and complacency don’t set in.

Out of the Water ≠ Out of Trouble

Sometimes the child who drowns is one who wasn’t, at least in theory, in the water at all.  This is to say that a child playing poolside, or in the yard, may deliberately or accidentally end up in the drink, even when we think we’re sort of watching them. A friend of mine, when he was 3, rolled, in his Little Tikes truck, into the deep-end of his parents’ backyard pool.  He was submerged for a bit before anyone noticed, but someone eventually did and pulled him out.   Another party guest did CPR, and my friend is now a healthy 37-year-old guy.  Is the moral of that story ‘no Little Tikes trucks poolside?’ Or maybe, ‘no pets or rolling toys after which a toddler might chase?’  Sure, in part.  Another definite take-away is that a watchful adult, with hands in reach, would have been able to prevent that submersion to begin with.  And if the determined young trucker still managed to drive into the pool, his retrieval would in any case have been quicker.  She who starts out on dry land doesn’t necessarily stay on dry land, so keep your eyes on her and your hands nearby.

Block That Pool!

Ruling out the possibility of unsupervised water access is paramount.  Drowning tragedies often occur when we think the kids are inside, nowhere near the pool.  In more than 40% of backyard drownings, the child was in the care of one or both parents and was last seen in the house. In almost a quarter of cases, the child was last seen outside but not in the pool.

A Scalable Fence Doesn’t Count

Every in-ground pool should be surrounded by a fence or wall that is at least 4’ high, without space to crawl under or squeeze through, and with nothing nearby from which a determined youngster can launch herself over the fence’s top.  The fence gate should swing outward, and it should self-close and self-latch. The latch should either be on the inside of the gate at least 3” below the top, or no lower than 54” from the base.  In at least some states, including New York, a wall of your home can , in certain cases, replace one side of the fence.  Having heard too many tragic stories, however,  I strongly recommend that the pool not be directly accessible from the house.  By definition, the most restrictive recommendations are the safest, and they’re the ones you want to follow.

In-Ground Pools Create a False Sense of Security

Don’t be fooled into thinking that the walls of an above-ground pool are a sufficient barrier in and of themselves.   If the top of the pool is 4’ from the ground and can’t be scaled, if the ladder is itself gated or fenced and all other possible scaffolding is out of reach, then these pools can be considered protected.  Alternatively, you can install a fence around the rim.

Know Your Address for EMS

In the cell-phone era, it pretty much goes without saying that we have phones poolside, which we need–as long as we’re not on them instead of supervising the kids.  We don’t necessarily know, however, the actual address of the friend whom we’re visiting.  Satellite positioning systems aren’t 100% reliable, and the more rural the location and the further apart towers are, the less they work accurately.  Know the street number and road of where you are.  If there’s a drowning, you need to be able to tell EMS where to come  Ideally, you’ll already have commenced CPR, but you still need them.

Learn, Re-Learn and Practice CPR

Because nothing is more important if your child drowns. CPR needs to be the first thing you do, and you need to do it well. Your confidence will drive your competence, and continual practice and review is what makes you confident.  No kidding.

If you’re not 100% confident of your CPR skills, register for a class at  You could save a life.

7 Reasons Your Child is Still Not Safe at the Wading Pool

You’ve filled up the kiddie pool, settled down in the hammock with an Arnold Palmer and let your mind take a trip to the island of much needed peace and tranquility. What you’re not hearing might feel like relief, but it’s also the hidden danger around that few gallons of water- filled fun. Here’s why:

1. You Think You’re Paying Attention at the Pool, But You’re Not

Pool Safety NYCIf to drown or not to drown were the question, the answer would surely be not to.  Drowning is often fatal, almost always very problematic, totally avoidable, and far, far too frequently occurring, particularly among infants and toddlers. The World Health Organization recently re-specified the term to mean “the process of experiencing respiratory impairment from submersion/immersion in liquids;” and it now also covers what we used to think of as near-drowning. Drowning can resolve in a variety of ways: we can drown and recover fully; we can drown and end up moderately or severely disabled; we might end up in a coma or brain dead; we might end up deceased. Except for the possibility of full recovery, which requires fast response and Infant or Child CPR, all of the outcomes are bad. None of them is what we’d choose for our kids, and yet there are more drowning deaths among 1-4 year olds than of children in any other age range. And for every one of those deaths, there are many, many emergency room visits and numerous hospital stays. We’re not choosing for these tragedies to occur, but we’re not paying enough attention to prevent them, either. No child should ever drown, plain and simple. So what gives, and how do we change the narrative?

2. Momentary Lapses Have Long-Term Consequences

What gives is that we don’t pay sufficient attention. ‘Sufficient attention’, when we’re talking water, turns out to be synonymous with ‘100% attention’. Attention that’s continuous, without even a single momentary lapse, that’s given with our eyes and not with our ears. For younger children, our hands need to be within reach as well. Drowning is silent and takes only seconds. If our eye is on the phone or the newspaper then it’s not on the baby, and in case she accidentally submerges, we might not realize it quickly enough. And if we’re out of arm’s reach, we may not be able to retrieve her as fast as we need to.

Effectively, there’s an inverse relationship between the pleasure that our babies take in pools and the responsibility that accrues to the adults in charge. We have to be more engaged than we are when we’re in the house; water, unlike our living rooms, can’t be baby-proofed. And unlike, for the most part, in living room situations, at the pool a brief break from watching can result in tragedy.

3. Little Pools = Big Risks

Don’t confuse a little pool with a small risk. While the numbers of drownings aren’t as staggering as they are in above- and in-ground pools, the results of such an event are no less traumatic. Once there’s as little as an inch or two of water, let alone the foot or two usually found in a wading pool, there’s the possibility of accidental submersion. This means that even the seemingly innocuous $20 kiddie pool is potentially a hazard for the little ones. They can slip, tip, crawl, toddle, run or climb into the water and end up face-down. This can happen on your terrace, at your parents’ house, in a friend’s yard, at a public park. It can happen regardless of your baby’s age. It can happen in an inflatable pool, in one with rigid or soft sides, in a pool with a slippery bottom, in a pool with a non-slip bottom. (Choose non-slip if you can!) It can happen on a sunny or on a cloudy day. But it can’t happen if you’re physically present and fully attending. If the baby slips or tips and you’re right there, within reach and watching, you’ll pull him out instantly.

4. Water Can’t Be Baby-Proofed

We don’t, of course, spend every waking moment outside in the summer, and we pretty much never sleep there. The tricky part about that truth, and one that is easily but not often enough accounted for, is that usually the water stays in the wading pool even when we’re in the house. The reason there are stringent regulations about fencing in- and above-ground pools is that children often wander outside without our realizing it–including when we think they’re safe in their rooms napping or tucked in for the night. Or maybe we’re with them in the driveway (think country, not city!) and they meander around to the back to get something. An un-gated pool is a major hazard, easy as it is accidentally to fall into, and inviting as it may be to enter deliberately. And so we fence them.

5. Pools Are Like Guns, Never ASSUME They’re Empty

Kiddie pools can’t really be fenced, so we need to empty and store them upside down each time play time is over. This is an imperative, fail-safe and simple practice: if there’s no water, there’s no drowning. The statistics tell us that pool safety needs to be on your mind even when you’re in the house. Your toddler may not be likely to wander out alone onto the deck, but if she does, and if she makes her way into a wading pool that wasn’t emptied or that has become a repository for rain, she may drown.

6. The Pool You Don’t Know About Shouldn’t Exist

In a certain way, kiddie pools can present even greater hazards than larger ones, because they’re casually purchased and too often casually regarded. If a friend or a relative has an in- or above-ground pool we generally know it, and we can confirm that barriers and supervision are in place before letting our young child visit on her own. A wading pool (and sometimes even an above-ground pool) may well come onto the scene without our being aware, and consequently we don’t suss out what safety precautions are in place. Grandparents who take the baby for a weekend may decide that a wading pool will add tons of fun. But do Grandma and Grandpa understand the imperative of not being distracted while the baby is in or near the water? Are they themselves within reach of the baby at all times when the water is accessible? Do they know to empty the pool after each use? If we don’t know they’re going to purchase the pool we won’t have a chance to review the rules, and the baby is at risk. Make a practice of asking if there’s a pool on premises any time you visit anyone with outdoor space–at least if the weather is warm enough that water might be in it.

7. Infant and Child CPR Is Your Second Line of Defense

If your baby drowns (remember: we’re defining this as submersion that interferes with respiration), immediate, high-quality CPR is your best response. This means that anyone who is in charge of a splashing or swimming baby needs to be well-trained in these skills and needs to have reviewed them recently—Infant CPR if you’re supervising a infant, and Child CPR if your baby is over the age of 1. In principle, anyone who is ever alone with your baby needs to have these skills in hand, summer or winter, pool or not. The grave risks that come with swimming, or rather, with unsuccessful swimming, tell us that there’s not a moment to waste if you need to learn or to re-learn. Airplanes have 3 backup systems for every safety device. Baby safety depends on having backup as well, and that’s CPR training.

Register for a class now, if you need one  at