Early and frequent ingestion of honey + sucralfate may reduce esophageal injury in children after accidental button battery ingestion, according to a new study published in The Laryngoscope.

Noting that infants and children who ingest button batteries can experience esophageal damage leading to significant morbidity and death in as little as 2 hours, researchers from the Children’s Hospital of Philadelphia and Nationwide Children’s Hospital aimed to identify effective options for mitigating these effects by testing common weakly acidic household beverages, viscous liquids, and sucralfate (Carafate).

The study authors first tested apple juice, orange juice, Gatorade, Powerade, pure honey, pure maple syrup, and sucralfate using a 3-volt lithium (3 V-CR2032) button battery on cadaveric porcine esophagus. From there, the most promising agents were compared against a saline control in live piglet models with battery placement on the posterior wall of the proximal esophagus for 1 hour. The animals received 10mL irrigations every 10 minutes starting from the 5-minute timepoint. 

Histologic and gross assessments showed that honey and sucralfate conferred the most protection in vitro and in vivo. Both agents neutralized the increased pH of the tissue and “created more localized and superficial injuries.” A decrease in both full-thickness injury and outward extension of injury was also noted (P <.05). 

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“Our recommendation would be for parents and caregivers to give honey at regular intervals before a child is able to reach a hospital, while clinicians in a hospital setting can use sucralfate before removing the battery,” stated co-principal investigator Ian N. Jacobs, MD. “Safely ingesting any amount of these liquids prior to battery removal is better than doing nothing.” 

The authors note that more studies are needed to establish the right amount and frequency of treatment. They also caution against the use of these substances in children who have suspected sepsis, esophageal perforation, known severe allergy to honey or sucralfate, or in children under 1 year of age due to a risk of botulism.

For more information visit wiley.com.