Swallowed magnets in children need quick evaluation and treatment

Developed by an NASPGHAN expert panel, the algorithm provides doctors with a recommended, step-by-step approach to managing children who have swallowed these powerful magnets. "The algorithm is a concise guide to the evaluation and treatment of magnet ingestions meant to reduce the gastrointestinal complications in children," commented lead author Dr R. Adam Noel of Children's Hospital of New Orleans.

Informal Survey Identified More Than 80 Cases

"Neodymium or rare earth magnets are not our grandfather's magnets," Dr Noel and coauthors write. "Composed of iron, boron & neodymium, they are at least five to ten times more powerful than traditional magnets." Used in many industrial products, the powerful magnets are also marketed as "desk toys" or "stress relievers" for adults.

Because of their "formidable" attractive force, neodymium magnets pose a serious health hazard if swallowed. That's because ingested magnets can "find each other" even if they are in different areas of the digestive system. "The magnets can therefore cause two pieces of bowel to stick together with great strength and do not separate," the authors explain. This can result in gastrointestinal perforation or obstruction, sometimes requiring surgery.

An informal survey of NASPGHAN members highlighted the frequency and seriousness of the problem. Pediatric gastroenterology specialists responding to the survey reported more than 80 children with magnet ingestion. Most patients required endoscopy to remove the magnets or surgery to repair damage to the bowels. Twenty-six children had bowel perforation; three needed major surgery to remove a section of damaged intestine.

Emphasis on Rapid Medical Evaluation of Swallowed Magnets

In response, a NASPGHAN task force was formed to develop a new algorithm for evaluation and management of ingested neodymium magnets. X-rays are needed to confirm that the child has swallowed magnets and to show their location. Because the magnets are usually small, there may be no or only mild symptoms.

A critical step is determining how many magnets the child has swallowed. A single magnet will likely pass through without causing any harm. However, if two or more magnets have been swallowed (or a magnet with another piece of metal), attraction between them may result in serious complications. Because magnets may overlap, multiple x-rays from different angles are needed.

Rapid evaluation is critical, as complications appear more common if the child is not seen within twelve hours. The algorithm recommends removal of the magnets using an endoscope, if possible -- although this can be difficult because the magnets can get stuck on the sides of the removal instrument. Surgery may be needed if medical care is delayed, if the magnets pass out of the stomach, or if complications occur.

While the new article was being prepared for publication, the U.S. Consumer Products Safety Commission (CPSC) took action to ban the sale of neodymium magnets as toys. But Dr Noel notes that the CPSC action affects only the small magnets that make up adult magnet toys and that the biggest company selling the toys is resisting. In addition, the ban won't apply to magnets used in other products, such as children's toys and tools.

"Therefore there will be a significant exposure to the extremely small powerful magnet for the foreseeable future," commented Dr Noel. "I hope for our children's sake that the CPSC action will stick. But even so, the magnets that are already in our environment are a clear and present danger."

Coauthor Dr Mark Gilger of Texas Children's Hospital agrees, suggesting that cases of magnet ingestion in children may even increase over the short term. He added, "If one used a risk/benefit analysis on neodymium magnet desk toys, it's quite simple: the risk of injury to children is high and the population benefit is little or none. Do we need this toy, really?"