COMMENTARY

Neodymium Magnets: Too Attractive?

William F. Balistreri, MD

Disclosures

March 12, 2014

In This Article

Advocacy in Action

The magnitude of the problem first came to my attention late last year after a pediatric gastroenterologist, Dr. Adam Noel, described the case of a 2-year-old child who had swallowed several of these high-powered neodymium magnets. They had "pinched" several loops of bowel together, causing ischemia and necrosis, leading to bowel resection and resulting in the development of short-bowel syndrome.

Noel posted this experience on a pediatric gastroenterology online bulletin board, and within days, more than 50 pediatric gastroenterologists reported similar cases from across the country, with many children needing surgery.[12]

Noel and his colleagues next surveyed members of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) to gather information on medical and surgical interventions in patients who ingested magnets. Respondents reported 123 cases occurring between 2008 and 2012 (102 cases in the past 2 years alone).[15] Nearly 80% of patients required endoscopy, surgery, or both; 26% of patients underwent some type of surgery, including laparotomy, laparoscopy, and thoracotomy. Surgery for magnet removal alone occurred in 31%; 43% of patients required an additional surgical procedure, including fistula repair (60%) and bowel resection (15%). Finally, 9% of patients needed long-term care -- such as bowel rehabilitation -- because of complications.

NASPGHAN leadership formulated an aggressive education and advocacy campaign, partnering with other societies, such as the American Academy of Pediatrics and the American Pediatric Surgical Association.[12,16] They developed a comprehensive algorithm for the evaluation and management of ingested rare-earth magnets in children on the basis of the number of magnets ingested, the location of the magnets, and the timing of ingestion before intervention.[17]

They also set out to broadly educate pediatric gastroenterologists and other pediatric clinicians about the management of this new hazard, and the need for urgent intervention if 2 or more magnets have been swallowed.

NASPGHAN sought to educate the public through information on their Website[18] and by working with local and national media. They continue to gather additional primary data on the prevalence and complications of magnet ingestions and to advocate with government leaders for the removal of this hazardous toy from the shelves of retailers.

In a recent journal article, they reported that "one year after our society became aware of the public health implications of high-powered magnets, we have helped reduce sales of these products and inform the public."[12]

Reaction

The US Consumer Product Safety Commission (CPSC) in late 2012 set industry safety standards and sought to remove certain supermagnet desk toys from the market. They issued a restriction on the sale of rare-earth magnets to children younger than 14 years. In 2013, the CPSC announced that several major retailers participated in a recall of rare-earth magnet sets.[19]

Spreading the Word

Neodymium magnet ingestion is a preventable cause of morbidity and costly medical intervention to our children. Clinicians should be aware of the risks and potential morbidity associated with magnet ingestion, as well as with the appropriate management of patients who ingest magnets. The goal of managing cases of suspected magnet ingestion should be to reduce delays between the time of ingestion, diagnosis, and intervention.[2,5,13,14]

Furthermore, given data suggesting that many pediatricians are unaware of the dangers, health organizations should spread the word to providers, parents, teachers, and the general public about the dangers to help ensure that the magnets will be kept away from children.

Prevention of this condition remains a much better option than its cure. Proper education and improved awareness among parents and healthcare professionals will be needed to address this rapidly emerging problem.

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