Abu Dhabi: Swallowing multiple magnets can cause serious complications, and parents and guardians need to be especially vigilant because there has been an exponential increase in cases over the last few years.
In Abu Dhabi, the number of multiple magnet ingestion cases reported to referral hospitals in the emirate grew from one in 2016 to 14 in 2019, with patients suffering from serious complications like obstructions, fistulas and even bowel gangrene, said Dr Nafea Alyasi, paediatric gastroenterology fellow at Sheikh Khalifa Medical City (SKMC).
“The good thing is that these are entirely preventable with awareness and caution,” Dr Alyasi said at a recent paediatric conference.
“Children tend to swallow things as they are curious. But we started to look into magnet ingestion because we noticed an increase in magnet ingestion. With foreign bodies, most of the ingestion happens among children younger than three years of age. But with magnets, we saw even a 13-year-old present to the emergency department, which indicates that even school-age children can be at risk [without proper awareness and actions],” he added.
The doctor said the first case of magnet ingestion was reported in North America in the early 2000, but that the number of cases increased sharply when magnets began to be marketed widely in 2011. Initially designed as desk ornaments, multiple magnet structures were repurposed as toys, and this had led to a sharp increase in cases of ingestion.
There is still no regional data on this, but Dr Alyasi said the tops are widely available in the UAE. He has been studying the risks of foreign-body ingestion for a while. He had told Gulf News in 2019 that magnet ingestion was a worrying trend.
“While coins make up the majority items ingested by children, more and more children are swallowing multiple magnets and this can lead to major internal injuries,” he had warned. He had also pointed out that button batteries were also particularly dangerous when swallowed.
The three-year study Dr Alyasi was referring to looked at cases of magnet ingestion at two referral hospitals in Abu Dhabi — SKMC and Tawam Hospital. There were a total of 68 recorded cases of magnet ingestion and 63 were confirmed by x-rays. “But cases can often be detected incidentally, and it can even be difficult to identify them radiologically as they present differently in imaging,” Dr Alyasi said.
He, therefore, urged guardians to be aware of symptoms, which can include coughing, a sensation of foreign body in the throat, abdominal pain, vomiting and poor feeding.
The risk is obviously greatest when children ingest multiple magnets at different times. During the study period in Abu Dhabi, there were 23 such cases, and 45 cases of single magnet ingestion. All the children who swallowed single magnets passed the foreign bodies spontaneously. This was, however, not the case among children who had swallowed more than one magnet.
“There were seven cases in which the patients had swallowed two magnets. One of these children required a surgical, laparoscopic removal of the foreign bodies. And among the 16 children who had swallowed more than two magnets, three needed endoscopic removal, and 12 needed surgical removals. Only one child who had swallowed multiple magnets was able to pass them spontaneously,” the doctor said.
The complications among these children were also severe.
“The majority of these patients had obstructions and fistulas (an abnormal connection between two parts of the body). Some had perforations, and one child had an adhesion that required a follow-up surgery. One child faced post-operation sepsis, and one patient ended up with bowel gangrene that required surgical resection of part of the colon,” Dr Alyasi said.
In terms of cost of treatment, the amount varied from Dh92 to more than Dh71,000 per child in the study.
“These are all preventable complications and cases. Luckily, all the patients with multiple magnet ingestion have healed so far but we need to [act before something worse happens],” the doctor urged.
He recommended greater awareness among guardians and children, and even a recall of multiple magnet toys.
Other foreign bodies
Numerous cases of children swallowing other foreign bodies have also been reported across the UAE.
In particular, Dr Alyasi told Gulf News that between 2016 and 2018, SKMC had seen 258 cases of children swallowing foreign bodies, of which 40 per cent were coins, 16 per cent were button batteries, and 0.05 per cent were magnets. There were also some cases of older girls ingesting scarf pins.
While coins and single magnets often pass through the digestive tract without intervention, any foreign body can cause obstructions, perforations and other complications.
Most commonly ingested foreign bodies:
— Coins, which often pass out of the body without the need for medical intervention.
— Button batteries that can leak and cause poisoning and infection.
— Magnets that can cause intestinal perforation if more than one is ingested at different times.
— Scarf pins.
What should you do?
Keep toys with small magnets away from children aged four months and older.
Store batteries away from children, and try to ensure that the battery chamber in toys does not open up easily.
If a child starts coughing or choking suddenly, think foreign body ingestion and check for it.
If you suspect that something has been swallowed, rush your child to the hospital without delay.
Caution older children against ingesting foreign objects as a dare.
If your child has swallowed a foreign object:
— Make sure he or she is not choking on it. Symptoms of choking include going blue in the face, having trouble breathing, swallowing or speaking.
— Find out what he or she swallowed and head to the hospital.
— Do not try to extract the foreign body by yourself.
— Observe the symptoms while on the way to the hospital. For instance, if a coin lodges in the oesophagus (food pipe), your child will exhibit signs of increased salivation, difficulty swallowing, vomiting, neck pain, chest pain or coughing.
Some recent cases:
September 2019: One-year-old Mohammad in Abu Dhabi swallowed seven toy magnetic balls and developed bowel perforations, as well as perforations in the stomach and small intestine. The toys belonged to an older sibling. They were surgically removed.
February 2020: Younis, a two-year-old boy in Ajman, swallowed five small toy magnets. These too belonged to his older sibling. They were removed by means of two procedures conducted over 48 hours.
June 2020: A three-year-old in Sharjah, Ayat, swallowed a 50-fil coin in Sharjah before her mother, who was watching her, could retrieve it. The coin was extracted through an emergency gastroscopy surgery.
December 2020: Salma, a one-year-old in Dubai, swallowed eight lentil-sized magnetic beads over a number of days and went into end-stage septic shock after sustaining damage to her bowels. Again, the beads had been a toy purchased for her older sibling. She had to undergo three surgeries over two months before recovering.
Magnet ingestion (SKMC study):
* 68 cases between 2016 and 2019: 45 single magnet ingestions, 23 multiple magnet ingestions.
* In 2016, 5 cases in total: 4 cases of single magnet ingestion, and 1 multiple magnet ingestion.
* In 2017, 17 cases in total: 15 cases of single magnet ingestion, and 2 of multiple magnet ingestion.
* In 2018, 14 cases in total: 8 cases of single magnet ingestion, and 6 of multiple magnet ingestion.
* In 2019, 28 cases in total: 14 cases of single magnet ingestion, and 14 of multiple magnet ingestion.
* 23 cases involving multiple magnets: 7 involving two magnets, 16 involving more than two magnets
Among the double magnet ingestions (7 cases): 5 patients passed the magnets spontaneously, 2 patients required surgical removal of the magnets
Among the multiple magnet ingestions (16 cases): 1 patient passed the magnets spontaneously, 3 patients needed endoscopic removal of the magnets, 12 patients needed surgical laparoscopic removal
In a previous study at SKMC (2016-2018), it was found that 258 foreign bodies had been swallowed by children. The breakdown of items swallowed shows:
— 40% coins
— 16% button batteries
— 0.05% magnets, but this number is on the rise.
— 7-8 cases of older girls ingesting scarf pins.