COMMENTARY

Unhealthy Attraction: Revisiting the Risks of Magnet Ingestion in Kids, as Product Recall Fails

William F. Balistreri, MD

Disclosures

May 12, 2017

Popular Toys With Overlooked Risks

In a previous Medscape article, we related our concern that popular adult novelty items containing neodymium magnets (so-called "supermagnets") present an underappreciated danger to children. At that time, several brands of extremely powerful small magnetic balls (eg, Buckyballs, Neocube, and Zen Magnets) were aggressively marketed as stress relievers and adult desk toys in the form of sculptures and puzzles, in the process becoming highly popular. Many of these innocent-looking items contained 100-200 high-powered magnetic spheres, which were difficult to account for once the set was removed from its original packaging.

A recurring story was heard by emergency medicine physicians, pediatricians, and gastroenterologists, as the ingestion of these magnets, especially by young children, led to increasing cases of injury to the gastrointestinal tract.

It was clear that parents were not aware of the danger presented. The incidence of visits to the emergency department for children with possible magnet ingestion progressively increased in direct relationship to their popularity, with a documented 75% average annual increase over a 10-year period.[1,2,3,4,5,6,7,8,9,10,11,12,13]

The Scope of the Problem

Even though these novelty items were labeled as being "not for use by children," they exerted a strong attraction upon this group. The neodymium/iron/boron magnets in these products are small (2-5 mm), smooth, and spherical—characteristics of an object that should easily complete the route from ingestion to excretion.[14]

However, if ingested, the magnets are capable of attracting each other with formidable forces in the vicinal loops of the bowel. This powerful binding causes pressure necrosis of the bowel wall, leading to ulceration and intestinal perforation.

Over time, pediatric gastroenterologists began to describe cases of children who had swallowed several high-powered neodymium magnets, which then "pinched" loops of the bowel, leading to bowel resection and the resulting development of short-bowel syndrome.[14]

A survey of members of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) reported 123 cases of magnet ingestion between 2008 and 2012.[15] A further sequence of events is shown in the Table.

Table. Timeline of Events

Year Event
2008 Magnet toys (5-mm spheres) enter the market in the form of the Neocube; Buckyballs are released the following year
2009 The USCPSC documents more than 200 reports of injury related to ingestions, many of which require emergency surgery to remove the magnets and repair intestinal injuries[16,17]
2009-2011 The USCPSC estimates that 1700 ED-treated magnet ingestion cases occur; the majority of injuries (70%) happen in children aged 4-12 years
2009 The USCPSC issued a restriction on the sale of rare-earth magnets to children under age 14 years; after manufacturers failed to comply with proper labeling, the USCPSC orders a recall on 175,000 packages
2009-2012 One company's sales increase from $0 to $25 million per year[14]
2012 USCPSC develops federal standard for hazardous, high-powered magnet sets
2012 Between February and October, Children's Hospital in New Orleans reports six cases of magnetic ball ingestions[15]
2012 In spring, an informal pediatric gastrointestinal bulletin board survey reported 123 ingestion cases.[15] It finds that:
  • Nearly 80% of patients required endoscopy or surgery, or both

  • 26% of patients underwent some type of surgery, including laparotomy, laparoscopy, and thoracotomy

    • 31% had surgery for magnet removal alone

    • 43% required an additional surgical procedure, including fistula repair (60%) and bowel resection (15%)

  • 9% of patients required long-term care (eg, bowel rehabilitation) owing to complications. Gastrointestinal endoscopy was performed for magnet removal in 10%-12% of these children, and 4%-5% required surgical intervention

2012 At the end of this year, the USCPSC set industry safety standards and sought to remove certain supermagnet desk toys from the market
2013 The USCPSC announced that several major retailers participated in a recall of rare-earth magnet sets
2014 In September, the USCPSC approved strong federal safety standard for high-powered magnet sets to protect children and teenagers[18]

ED = emergency department; USCPSC = US Consumer Product Safety Commission

On the basis of these alarming data, NASPGHAN leadership launched an aggressive education and advocacy campaign in partnership with other societies, such as the American Academy of Pediatrics and the American Pediatric Surgical Association.[14,15,18,19,20,21,22] They collectively joined other concerned consumer safety advocates to communicate the public health implications of high-powered magnets to the US Consumer Product Safety Commission (USCPSC), which is charged with protecting the public from unreasonable risks for injury or death associated with the use of consumer products. A recall was recommended by the USCPSC, as well as Health Canada. The USCPSC also established a safety standard for high-powered magnets. These collective efforts helped to inform the public.[14,16,22,23,24]

Public education independent of the recall prompted parents to discard magnetic toys, removing the temptation for toddlers. Many manufacturers withdrew their products from the market—some voluntarily, some after retail sales dropped. Most retailers and manufacturers ultimately complied with the USCPSC recall; however, other manufacturers, such as the makers of Zen Magnets, fought the appeal.

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