Pediatric emergency care · NCPC and NASPGHAN guidance

Button Battery Clock

An esophageal button battery burns through mucosa in 2 hours. This runs the pathway against that clock.

Time of ingestion not set

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Set time zero to start the 2-hour removal clock.

Elapsed

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Mitigation window

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Time zero, age, battery size and your answers are kept on this device only, so the clock survives a lock screen. Free-text notes are never kept. Reset clears everything.

Always on the page

Never

Never wait for symptoms. Nearly half of ingestions are unwitnessed and most children are initially asymptomatic.
Never delay removal or transfer for NPO status, for a mitigation agent, or for a second opinion.
Never induce emesis and never give cathartics — both are ineffective and add risk.
Never attempt blind or balloon-catheter retrieval — the mucosa has to be seen.
Never give honey or sucralfate under 12 months of age.
Never irrigate a battery in the ear or nose — liquid completes the circuit and accelerates the burn.

Return precautions after a battery passes the esophagus

Injury continues after the battery moves on, and the dangerous complications are delayed by days to weeks.

Return at once for: vomiting of blood or black material, blood in stool, chest or abdominal pain, fever, drooling, refusal to eat or drink, painful swallowing, new cough or noisy breathing, or voice change.

Any hematemesis is a surgical emergency — an aorto-esophageal fistula can produce a herald bleed weeks after the battery is gone.

Inspect stools for passage. If passage is not observed within 10–14 days, repeat the film.

Delayed complications to counsel and watch for

Esophageal perforation, mediastinitis, tracheo-esophageal fistula, aorto-esophageal fistula, esophageal stricture, vocal cord paralysis, tracheal stenosis or tracheomalacia, aspiration pneumonia, empyema, lung abscess, pneumothorax, spondylodiscitis.

Perforations and fistulas are characteristically delayed; strictures present weeks to months out.

Numbers

National Battery Ingestion Hotline — identification and treatment, 24 h800-498-8666

Poison Control1-800-222-1222

Keep this on your phone

Hospital wifi and a two-hour clock are a bad combination. Add this page to your home screen so it opens instantly:

iPhone: Share → Add to Home Screen. Android: menu → Add to Home screen.

The clock keeps running across a lock screen, an app switch and a reload — but it still needs the page to load at least once, so add it before your next shift, not during one.

Button Battery Clock — free bedside tool from Pedemy (pedemy.com). Report a mistake: contact@pedemy.com
Clinical content adapted from the National Capital Poison Center Button Battery Ingestion Triage and Treatment Guideline (rev. 6/2018) and the ESPGHAN/NASPGHAN position paper on button battery ingestion in childhood.
Version 2.1 · reviewed October 2026
Decision support only. It does not replace clinical judgment, your attending, or the receiving team.