Recurring concern

Insufficient public awareness of button-battery ingestion risks

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First reported 24 Oct 2014•Latest report 7 Mar 2018

Definition

What this concern includes

Includes only assertions that directly instantiate the manually reviewed condition ‘Insufficient public awareness of button-battery ingestion risks’ and satisfy this evidence boundary: Both distinct reports directly support limited public or caregiver understanding of catastrophic button-battery ingestion risks. Neither establishes child-resistant product design or access-prevention controls, so retain only the public-awareness boundary.

Not included

  • Excludes general battery, lithium-ion battery and e-bike battery risks where button-battery ingestion is not the material hazard.
  • Excludes generic child-safety awareness, supervision or product-safety deficiencies without a specific button-battery risk.
  • Excludes clinical treatment failures after a button battery has been safely identified and the relevant ingestion response has been initiated.
  • Excludes ordinary household-device design or maintenance defects that do not affect access to or warning about button batteries.
  • Excludes manifestations outside the manually reviewed boundary: Both distinct reports directly support limited public or caregiver understanding of catastrophic button-battery ingestion risks. Neither establishes child-resistant product design or access-prevention controls, so retain only the public-awareness boundary.
Reports
2

Distinct published reports

Individual concerns
2

A report can raise multiple concerns

Date range
2014–2018

First to latest report issue date

Stated actions
2

Described in published responses

Reports over time

Reports over time

Reports about this concern issued each year.

* 2026 is projected from reports observed to 7 Sep 2026.

Most frequent recipients

Most frequent recipients

Reports about this concern sent to each recipient.

Department of Health and Social Care2
Department for Business, Energy & Industrial Strategy1
Healthcare Safety Investigation Branch1
Manchester University NHS Foundation Trust1
NHS England1
Oldham Borough Council1
The Royal Society For The Prevention Of Accidents1

Concerns and responses across reports

Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.

  1. Manchester South

    AI-generated summary

    Venkata Naga Lakshyasi KAGGA · Prevention of Future Deaths report

    This summary was generated using AI from the published report. Please read the original report for the complete account.

    Report summary

    Venkata Naga Lakshyasi KAGGA died on 9 July 2017 after a button battery lodged in her oesophagus and caused an oesophageal arterial fistula. Before her death, she was seen by doctors and ambulance staff, but the battery was not identified. Concerns included failures to examine and assess her, non-compliance with ambulance policy for children under five, inadequate information sharing, and limited understanding of the risks posed by button batteries.

    Read the report on judiciary.uk

    Source evidence

    How this individual concern was interpreted

    PFD Monitor created a concise, searchable interpretation from the report wording shown below.

    PFD Monitor interpretation

    Lack of understanding of button-battery risks among people responsible for small children

    Wider context from the report

    “1. The button battery was likely to have come from a remote control. Button batteries once ingested can lead to catastrophic consequences for a child. They are used with increasing frequency in every day household devices which are often easily accessible by children. The remote control had no safety feature to prevent a child having easy access to the battery without the parents knowledge. Risks of button batteries to small children are not widely understood. Whilst there are precautions in place for children’s toys similar precautions are not in place for commonly used household devices, which can easily be accessed by small children. ”

    Source location

    Venkata Naga Lakshyasi KAGGA · Prevention of Future Deaths report
    Page 2 · concerns

    Open source report

  2. Manchester North

    AI-generated summary

    Eliza Bashir · Prevention of Future Deaths report

    This summary was generated using AI from the published report. Please read the original report for the complete account.

    Report summary

    Eliza Bashir swallowed a button battery from a torch on 22 March 2013. Although the battery was removed and she remained well for almost a week, she collapsed on 30 March 2013 and died after resuscitation failed. Concerns included the lack of a lockable battery compartment because the torch was not classified as a toy, uncertainty among clinicians about managing such incidents, and the accessibility and sale of button batteries to young children.

    Read the report on judiciary.uk

    Source evidence

    How this individual concern was interpreted

    PFD Monitor created a concise, searchable interpretation from the report wording shown below.

    PFD Monitor interpretation

    Insufficient national awareness of the risks of ingested button batteries

    Wider context from the report

    “2. Consultant Paediatric Surgeon frankly asserted that both he and his colleagues were still worried as they did not know how best to deal with incidents such as this and whilst awareness of the risks and complications arising from ingested button batteries were being raised locally, there was a need for the profile of those risks to be raised nationally. ”

    Source location

    Eliza Bashir · Prevention of Future Deaths report
    Page 1 · concerns

    Open source report

    Source evidence

    How this respondent action was interpreted

    PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

    PFD Monitor interpretation

    Share button-battery risk information with health visitors, school nurses and regional Public Health England child-health leads.

    Verbatim wording from the response

    “However, I will ensure that the information in your letter and this reply is shared with health visitors, school nurses and the child health leads at Public Health England’s regional centres so that awareness of the risks of button batteries is further raised. My officials will give consideration as to how these professionals can best be supported to use this information to make parents and child carers aware of this issue.”

    Source location

    2014-0461-Response-by-Department-of-Health
    Page 3 · response
    Published 24 October 2014

    Open published response

    Source evidence

    How this respondent action was interpreted

    PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

    PFD Monitor interpretation

    Consider how best to support health professionals in using button-battery information to inform parents and child carers.

    Verbatim wording from the response

    “However, I will ensure that the information in your letter and this reply is shared with health visitors, school nurses and the child health leads at Public Health England’s regional centres so that awareness of the risks of button batteries is further raised. My officials will give consideration as to how these professionals can best be supported to use this information to make parents and child carers aware of this issue.”

    Source location

    2014-0461-Response-by-Department-of-Health
    Page 3 · response
    Published 24 October 2014

    Open published response
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Data last updated 7 September 2026