Caroline Helwick

October 25, 2012

NEW ORLEANS, Louisiana — The ingestion of high-powered magnetic balls, which are sold as adult desk toys, has increased 10-fold in the past 2 years, indicating that package warning labels are essentially useless, according to a national survey of pediatric gastroenterologists.

"We are literally sounding an alarm. I don't think people understand the implications of this simple toy and the danger it causes for children," said Mark Gilger, MD, professor of pediatrics at Baylor College of Medicine and a pediatric gastroenterologist at Texas Children's Hospital in Houston.

Dr. Gilger and others spoke at a press briefing here at the American Academy of Pediatrics (AAP) 2012 National Conference and Exhibition.

In 2008, high-powered magnet sets of 2 mm neodymium balls were introduced in the consumer market and generally marketed as adult desk toys. Neodymium magnets are used in hybrid automobiles, computer hard drives, cordless power tools, and for magnetic resonance imaging.

These extremely powerful balls can attract through half an inch of muscle, skin, and bone. The attachment of 2 or more balls can cause perforation of gastrointestinal structures within 12 hours of ingestion.

NASPGHAN Survey

Because bulletin-board postings suggested that these episodes were increasing, the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) surveyed 1747 of its members to document the frequency and severity of cases.

Respondents reported 480 magnet ingestions over the past 10 years, with nearly 204 of these occurring in the past year. In comparison, in the early 2000s, there were fewer than 20 cases annually.

"We have seen a 10-fold increase in magnet ingestions in the past 2 years," said Adam Noel, MD, associate professor of pediatrics at the Louisiana State University Health Sciences Center and a pediatric gastroenterologist at Children's Hospital in New Orleans.

Interestingly, the age of the children with magnet ingestions has shifted as well. Whereas 50% occur in preschoolers, one third occur in children 6 to 12 years of age and 16% occur in teenagers, who primarily use the magnets to mimic piercings. In fact, 24% of the episodes occurred as a result of a person using them for "pretend" body art or piercing of the tongue or lips.

Of those affected, 98% received at least 1 radiograph and 75% received more than 1. More than 83% required endoscopy, surgery, or both; more than 60% required repair of perforations and fistulae; and 16% required bowel resection. Only 14% of cases were managed with observation only, Dr. Noel reported.

The magnet balls were found in the stomach (52%), duodenum (25%), colon (13%), esophagus (6%), terminal ileum (3%) and small intestine (1%).

The outcomes were good for 91% of patients, but 9% needed long-term care because of complications. "When you realize that almost 10% of these children require long-term care because they ingested a toy, that is just not acceptable," Dr. Noel said.

Case in Point

Journalists at the press briefing saw first-hand what some of this long-term care entails. Braylon Jordon, now 2 and a half years old, receives total parenteral nutrition from equipment stored in a small backpack that he must wear all the time. Braylon ingested 8 magnets last April and has since had all but 6 inches of his intestine removed. He will probably be put on an intestinal transplant list at some point in his life, according to Dr. Noel, who is his physician.

Since the accident, his medical costs have approached $2 million, said Jonathan Jordon, his father.

Warnings Not Effective

Interestingly, the increase has occurred since packages of these magnets began carrying warnings of the dangers. The products were initially labeled for use by children 13 years and older; in 2010, this was changed to 14 years and older. Most sets include warnings to keep the product away from children.

"Despite improved warnings, the prevalence of high-powered magnet ingestion is increasing, which tells us that warnings are ineffective," Dr. Noel said. "The most effective way to prevent ingestion is to ban their sale."

The US Consumer Product Safety Commission has proposed a ban on certain high-powered magnet sets, a move strongly supported by NASPGHAN and the AAP. Although 11 manufacturers have complied with this voluntary ban, 2 companies still market the magnets and have taken a proactive stance on their right to do so.

In addition, the ban on products sold in the United States does not apply to the rest of the world, Dr. Gilger noted.

Wendy Sue Swanson, MD, a pediatrician in private practice in Seattle, Washington, and a blogger on health issues for the Seattle Children's Hospital, commented on the problem.

"I think this is a surprise to parents and pediatricians. I am just 6 years out of my training and I was not taught anything about magnet ingestion during that time," Dr. Swanson said.

"I think we will continue to see this happen because so many of these magnets are in people's homes," she noted. "I understand that 2.5 million Buckyball containers have been sold, and there are 216 balls per container, so the numbers are huge, even from just this one company.... It's a big problem," she explained.

Dr. Gilger, Dr. Noel, and Dr. Swanson have disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2012 National Conference and Exhibition. Presented October 23, 2012.

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