{"hq_id":"hq-p-chd-000155","name":"Button and Coin Cell Battery Child Ingestion (Esophageal Burns, Reese's Law 2022, Bitter Coating)","category":{"primary":"children","secondary":"electronics","tags":["button battery","coin cell","child","ingestion","esophageal burn","Reese's Law","CR2032","lithium","bitter coating"]},"product_tier":"CHD","overall_risk_level":"critical","description":"Button and coin cell batteries (CR2032, CR2025, CR2016) are swallowed by children 3,500+ times per year in the US, resulting in 2,800+ ER visits and an average of 15 deaths annually. When a lithium coin cell lodges in the esophagus, it generates an electrical current that hydrolyzes tissue fluid, creating sodium hydroxide (lye) — causing severe chemical burns within 2 hours that can perforate the esophagus, erode into the aorta, and cause fatal hemorrhage. 90% of severe injuries and deaths involve 20mm lithium cells (CR2032). Children ages 6 months to 3 years are at highest risk. Reese's Law (HR 5313, signed August 2022) — named after 18-month-old Reese Hamsmith who died after swallowing a battery from a remote control — requires child-resistant battery compartments and warning labels on products containing button batteries and on battery packaging. Duracell and Energizer now apply bitter coating (denatonium benzoate) to coin cells to deter ingestion.","synthesis":{"derived_risk_level":"severe","synthesis_confidence":0.82,"synthesis_method":"compound_composition","context_used":"human_infant","context_source":"product_users","exposure_modifier":1,"vulnerability_escalated":false,"escalation_reason":null,"compounds_resolved":1,"compounds_total":1,"synthesis_date":"2026-03-27","synthesis_version":"1.0.0"},"hazard_summary":{"sensitive_populations":"children 6 months to 3 years (peak ingestion age), all children under 6","overall_risk":"critical","primary_concerns":["3,500+ button battery ingestions/year, 2,800+ ER visits, ~15 deaths/year in US","Chemical burns begin within 15 minutes of esophageal lodgment (NaOH generation)","90% of severe injuries from 20mm lithium cells (CR2032/CR2025)","Aorto-esophageal fistula: delayed fatal hemorrhage days after initial burn"],"exposure_routes":"Oral (ingestion of loose coin cell from unsecured battery compartment — esophageal tissue electrolysis)"},"exposure":{"routes":["oral"],"contact_types":["oral_direct"],"users":["infant","child"],"duration":"minutes_to_hours","frequency":"rare","scenarios":["Child swallows loose CR2032 coin cell from unsecured battery compartment","Battery lodges in esophagus: chemical burns begin within 15 minutes","Remote controls, key finders, flameless candles — accessible battery compartments","Post-ingestion: delayed hemorrhage days after initial burn (aorto-esophageal fistula)"],"notes":"National Capital Poison Center: 3,500+ button battery ingestions/year in children under 6. CPSC: 2,800+ ER visits/year. NCPC: 70+ reported deaths since 1977, 15/year average in recent years. 90% of severe outcomes involve 20mm lithium cells (CR2032, CR2025). Mechanism: 3V lithium cell in esophagus generates NaOH via electrolysis — pH >12 at tissue contact point within 15 min. Burns can progress to perforation, mediastinitis, aorto-esophageal fistula (fatal hemorrhage). Reese's Law (PL 117-171, Aug 2022): CPSC rule requires child-resistant battery compartments on consumer products, warning labels. Compliance deadline: manufacturers had 1-2 years to comply. Bitter coating: denatonium benzoate (most bitter substance known) applied to coin cells by Duracell (2020) and Energizer (2022) — reduces ingestion by deterring children from keeping battery in mouth. Honey: National Capital Poison Center recommends honey (10mL every 10 min) for children >1 year while en route to ER — creates pH buffer reducing burn severity."},"consumer_guidance":{"usage_warning":"CRITICAL: If you suspect a child has swallowed a button battery, call 911 immediately. For children >12 months: give 2 teaspoons (10mL) of honey every 10 minutes while en route to ER (creates pH buffer — do NOT give honey to children under 12 months due to botulism risk). Do NOT induce vomiting. Secure all battery compartments with screws — check remote controls, key finders, flameless candles, greeting cards, hearing aids, bathroom scales, car key fobs. Keep loose batteries locked away. Reese's Law requires child-resistant compartments on new products, but existing household items may not comply.","safer_alternatives":["Products with screw-secured battery compartments (Reese's Law compliant)","Bitter-coated coin cells (Duracell, Energizer — denatonium benzoate)","Rechargeable devices without removable coin cells","Battery compartment lockout tape (temporary child-proofing for existing devices)"]},"regulatory":{"applicable_regulations":[{"jurisdiction":"USA","regulation":"Reese's Law (PL 117-171) — Button Battery Safety + CPSC Enforcement","citation":"Public Law 117-171 (Reese's Law, Aug 16 2022); ANSI/UL 4200A","requirements":"Child-resistant battery compartments required on consumer products containing button/coin cell batteries. Warning labels required on products and battery packaging. ANSI/UL 4200A: performance standard for button battery accessibility. CPSC enforcement: mandatory compliance, recall authority for non-compliant products. IEC 62368-1: incorporates button battery child safety requirements.","compliance_status":null,"effective_date":"2022-08-16","enforcing_agency":"CPSC","penalties":"CPSA penalties: up to $100,000 per violation, $15M max","source_ref":null}],"certifications":[],"labeling":{"required_disclosures":[],"prop65_warning":{"required":null,"chemicals":[],"endpoint":null,"notes":null},"ghs_labeling":{"required":null,"signal_word":null,"pictograms":[],"hazard_statements":[],"notes":null},"hidden_ingredients":{"trade_secret_protected":null,"categories_hidden":[],"estimated_count":null,"known_concerns":null,"notes":null},"notes":null},"recalls":[],"regulatory_gap":null,"notes":null},"lifecycle":{"recyclable":true,"disposal_guidance":"Tape both sides of used coin cell batteries before disposal to prevent short-circuiting and to reduce ingestion risk if found by children. Recycle at Call2Recycle drop-offs or municipal battery recycling. Store spent batteries in a child-proof container until disposal.","hazardous_waste":true,"expected_lifespan":"1-5 years depending on device draw"},"formulation":{"form":"varies","key_ingredients":[],"certifications":[]},"materials":{"common":[],"concerning":[],"preferred":[]},"compound_composition":[{"hq_id":"hq-c-ino-000103","compound_name":null,"role":"active_material","typical_concentration":"lithium metal anode in coin cells"}],"identifiers":{"common_names":["button and coin cell battery child ingestion (esophageal burns, reese's law 2022, bitter coating)"],"aliases":[],"manufacturer":null,"brands":[]},"brand_examples":[{"brand":"Graco","manufacturer":"Newell Brands","market_position":"mass_market","notable":"Leading children's product brand"},{"brand":"Fisher-Price","manufacturer":"Mattel","market_position":"mass_market","notable":"Iconic children's product brand"},{"brand":"Safety 1st","manufacturer":"Dorel Industries","market_position":"mass_market","notable":"Children's safety products"}],"sources":[{"type":"expert_curation","name":"ALETHEIA Safety Database","date":"2026-03-25"},{"type":"regulation","title":"Reese's Law (PL 117-171) — Button Battery Safety + CPSC Enforcement (Public Law 117-171 (Reese's Law, Aug 16 2022); ANSI/UL 4200A)","jurisdiction":"USA","year":2022,"citation":"Public Law 117-171 (Reese's Law, Aug 16 2022); ANSI/UL 4200A","id":"src_02b1eb85"},{"id":"src_001","type":"database","title":"PubChem Compound CID 5462224","url":"https://pubchem.ncbi.nlm.nih.gov/compound/5462224","accessed":"2026-03-12","notes":"Chemical identity, properties, safety data","inherited_from_compound":"hq-c-ino-000103"},{"id":"src_002","type":"epa","title":"EPA CompTox Chemicals Dashboard — DTXSID0049658","url":"https://comptox.epa.gov/dashboard/chemical/details/DTXSID0049658","accessed":"2026-03-12","notes":"Hazard, exposure, and toxicity data","inherited_from_compound":"hq-c-ino-000103"}],"meta":{"schema_version":"4.0.0","last_updated":"2026-03-25","timestamp":"2026-05-01T19:50:55.993Z"}}