Montefiore in the News

A one and a half-year-old child swallowed 65 ... [+] beads of garland. The child started crying continuously and started vomiting. After being examined by the doctors, they saw the magnets sticking together and then they operated and saved the child's life. The pediatric team at Acadis private hospital in Gomtinagar Vishalkhand led by Dr. Saima Khan investigated the baby and multiple bead-like structures were seen in the intestine on X-ray, even though no history of any such ingestion was given. Doctor Sunil Kanaujia, who performed the emergency surgery, said that when the incision was made in the stomach, the equipment started sticking in it. There was a hole in the small intestine and the posterior part of the stomach. After five hours of operation, it was successful in removing all the beads of the magnet. Doctors claim that the child is now fully healthy.- PHOTOGRAPH BY Rare Shot / Barcroft Studios / Future Publishing (Photo credit should read Rare Shot/Barcroft Media via Getty Images)

The old saying, that an ounce of prevention is worth a pound of cure, could never be more relevant in regards to a study that was published online earlier this week in the Journal of Pediatrics describing an alarming spike in visits to pediatric emergency departments for ingested high-powered magnets after a U.S. sales ban was lifted in 2016.

As an ER doctor, prevention is something we preach. Certainly life happens and accidents occur—but in this case, the spike in injuries from ingested high-powered magnets, which children often put in their mouths and swallow, is something that was foreseeable and preventable in relation to lifting of this particular sales ban.

For this discussion, we are talking about tiny (<5 mm in diameter) rare earth, high-powered shiny spherical neodymium magnets (the size of a bb pellet)—up to 30 times stronger than standard “refrigerator” magnets that form a nearly inpenetrable bond to one another after more than one is swallowed, potentially leading to bowel injuries, bowel obstructions, death of tissue, sepsis, and even death.

It is estimated that “thousands of injuries have been recorded since the high-powered magnets entered the U.S market in the early 2000s in children’s toys, with the vast majority occurring after high-powered magnet sets were first introduced as desk toys in 2009,” the authors of the study write.

Because the magnets attract one another so strongly across tissues, they can cut off the blood supply, leading to tissue necrosis (death of tissue). The magnets, all manufactured in China, come in sets of 72, 216, and up to 1,728, significantly increasing the risk of injury.

“Toy magnets are perfectly designed to create a danger to children, they are small, shiny, handle just like finger foods and most importantly are easily swallowed,” said Al Sacchetti, MD, FACEP, Director of Clinical Services in Emergency Medicine at Virtua Our Lady of Lourdes Medical Center, Camden, New Jersey.

“The strong attraction of these [magnet] balls to each other is where the real danger lies. If a piece of intestine is caught between two magnets, it can be compressed to the point of dying and eventually rupturing,” added Sacchetti.  

In fact, in 2012, as a result of these serious risks, the U.S. Consumer Product Safety Commission (CPSC) stopped the sale of such high-powered magnet sets and then issued a recall, followed by a federal rule that essentially banned the sale of these products.

This rule, however, was overturned by the U.S. Court of Appeals in December, 2016. And this is where we are now—with a spike in ER visits due to these dangerous magnets, detailed in the study published online earlier this week.

“This isn't surprising, but it is really sad and frustrating,” Ali S. Raja, MD, MBA, MPH, FACEP, Professor and Executive Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School.  “This is an example of great injury prevention legislation being enacted and then reversed...and it's not surprising that there were significant health consequences.”

The study, a collaboration between researchers at the Center for Injury Research and Policy (Department of Emergency Medicine), the Central Ohio Poison Center at Nationwide Children's Hospital and the Children's Hospital at Montefiore (CHAM) evaluated calls to U.S. poison centers for magnet exposures in children 19 years and younger from 2008 through October 2019 to analyze the effect of the CPSC rule followed by the lift of the ban.

The study found that the average number of cases per year decreased by 33% from 2012 to 2017 after high-powered magnet sets were removed from the market. When the ban was lifted and high-powered magnet sets re-entered the market, the average number of cases per year then increased 444%. In addition, was also a 355% increase in the number of cases that required treatment in the emergency department. What’s also important to understand is that cases from 2018 and 2019 increased across all age groups and accounted for nearly 40% of magnet cases since 2008.

"Regulations on these products were effective, and the dramatic increase in the number of high-powered magnet related injuries since the ban was lifted — even compared to pre-ban numbers — is alarming," said Leah Middelberg, MD, a pediatric emergency medicine physician, and lead author of the study in a press release. "Parents don't always know if their child swallowed something or what they swallowed — they just know their child is uncomfortable — so when children are brought in, an exam and sometimes x-rays are needed to determine what's happening. Because damage caused by magnets can be serious, it's so important to keep these kinds of magnets out of reach of children, and ideally out of the home."

The researchers calculated a total of 5,738 magnet exposures during the nearly 12-year study period. Male children accounted for the majority of exposures (55%), with the majority of children younger than 6 years (62%), with an unintentional injury (84%). Close to 50% of patients were treated at a hospital or other healthcare facility while nearly 49% received attention in the home, workplace, or school. Older children were more likely than younger children to be admitted to the hospital.

"While many cases occur among young children, parents need to be aware that high-powered magnets are a risk for teenagers as well," said Bryan Rudolph, MD, MPH, co-senior author of this study. "Serious injuries can happen when teens use these products to mimic tongue or lip piercings. If there are children or teens who live in or frequently visit your home, don't buy these products. If you have high-powered magnets in your home, throw them away. The risk of serious injury is too great."

"Significant increases in magnet injuries correspond to time periods in which high-powered magnet sets were sold, including a 444% increase since 2018," said Middelberg, while Rudolf urged that “these data reflect the urgent need to protect children by preventive measures and government action.”

The Magnet Injury Prevention Act, is federal legislation which would limit the strength and size of magnets sold as part of a set, and support reinstatement of a CPSC federal safety standard that would ban the sale of such magnet products in the U.S.

“High-powered magnet sets can cause real harm, and we're seeing more injuries rather than fewer, explained Raja. “We need to enact legislation that limits the sale of these toys, especially since we know that this kind of legislation has worked—temporarily—in the recent past.”

Sacchetti concurred, emphasizing that “the rebound of magnet related calls to poison control centers following the repeal of the earlier ban on their sale demonstrates that the mere presence of these objects in the home is a risk to children of all ages. Parents should recognize that anything bought for an older child is also bought for all the younger children in the household.”  

Sacchetti further explained that “toddlers and young children learn by following the examples of their older siblings; if an adolescent is playing with magnets, then younger brothers or sisters will want to do the same.” 

But his final point should serve as a strong reminder to all parents: “Small magnet balls do not appear dangerous to any parent concerned about their child’s safety. This is why regulations such as the prior ban on the sale of these toys are so important.” 

“Remember, the goal of every toddlers is to place themselves in as much danger as possible, the role of parents and caretakers is to keep them from achieving this goal. Bringing magnet balls into the house just gives them a head start,” Sacchetti concluded.

Peter Antevy, MD, a pediatric emergency physician and EMS medical director for Coral Springs Parkland Fire Department explained that he sees the issue of magnets missed often in both EMS and pediatrician’s offices because these cases are confused with acute gastroenteritis, a condition presenting with nausea, vomiting and diarrhea.

Two magnets connecting between the walls of the bowel

“Once it progresses to perforation and peritonitis [infectious and life threatening condition] develops, it requires operative intervention,” said Antevy. “We had a case like this last year and the child’s bowel required resection.”

“I strongly support the Magnet Injury Prevention Act, and would argue for reinstatement of the CPSC federal safety standard restricting high-powered magnet sales in the U.S,” he added.