Monday, August 20, 2012

The Stick of the Issue (Marin IJ)

A Kiwi grade-schooler amazed his classmates with a remarkable feat of attraction. He suspended a spoon from his navel, held, as if floating, by an invisible attachment. An American preteen was the envy of her BFFs because she had a tongue bolt – achieved without the pain of piercing. How did they do it? Gorilla strength glue? Superhuman powers? Neither, actually, but rather a stalwart force present all around us but not usually within us. Fans of AMC’s Breaking Bad will recognize this force as the same one that Walter White used to destroy the evidence police had linking him to methamphetamine production. More mundanely, most of us will recognize it as the molecular reaction that secures photos and to-do lists to our refrigerators. Magnetism. And although magnets are part of our daily lives, they are not always harmless – in fact can exert very powerful and destructive forces on the human body. You may not have heard about it yet, but around the globe there’s a mini magnet problem. Here in the U.S., you might even call it an epidemic, with reports of magnet ingestions in children ages 0 to 17 having increased by approximately tenfold over the last ten years and resulted in hundreds of injuries and at least one known death.  
How can swallowing a magnet be worse than swallowing a marble or a bead? The stick of the issue has to do the remarkable force with which some magnets are attracted to one another – a force that can cause a lot of damage to gastrointestinal tissue when magnets travel through the gut to reunite with one another. Recently, a clinical report in the Lancet described two children (one aged 18 months and the other 8 years) with toy magnet ingestions. Both kids required surgeries  - one for significant intestinal injuries caused by the magnets’ compressive “pull” forces  – which can be up to 1300 Gauss (by comparison, a typical refrigerator magnet exerts only 50 Gauss) – against the bowel wall.
A few months ago, the case of a ten-year old girl who ingested two toy magnets she had used to make her own “tongue piercing” received national news attention. While she avoided the pain of a real tongue piercing, she ended up short her appendix in the process. In Portland this past March, a three-year-old nearly died after swallowing 37 magnets. Inside her abdomen, the balls snapped together to form a ring – and tore at least four holes in her gastrointestinal tract.  
In these instances, the common and concerning characteristic was the ingestion of multiple neodymium (“rare earth”) magnets. These neodymium magnets are a relatively new product – they were invented by General Motors in 1982 – and are five to ten times more powerful than traditional magnets. Still, solitary magnets, even of the neodymium variety, tend to pass through the gut without major incident. But multiple magnets, or magnets paired with other metal objects in the gut, pose a unique problem as, like young lovers, they have an insatiable desire to find and press up against each other. Some describe such magnets as “kissing magnets.” And, like love-struck fools, kissing magnets will do anything to stay together, even, for example, pushing right through the linings of internal organs. If you can picture your anatomy; imagine two different loops of bowel with a magnet in each – straining to reach each other. As the magnets are drawn together they bring the loops of bowel tightly together and create connections or holes between them (known as fistulas or perforations). So, if you have kids, magnets are no toy.
For some time, pediatricians and consumer product safety groups have been warning about the dangers of kissing magnets. In fact, in 2008 the Consumer Product Safety Commission (CPSC) issued new standards for children’s products and toys containing magnets. The standards require that the magnets be secured so that they will not fall out of the toy or become unattached.
Despite this, we’re hearing about more and more kids swallowing magnets – especially neodymium magnets used as “stress relief” desk toys for adults. You may have seen these “Buckyballs” at your local Brookstone or thought of getting a set for your spouse. The magnets are generally sold in groups of 100 to 1000 and are replete with enticing shapes and colors. Although the products are labeled and designed for adults and contain prominent safety warnings, they can easily find their way into the hands and mouths of children. And while youngsters with developmental delay are known to be at higher risk for ingesting objects, many kissing magnet reports – such as a couple of those mentioned above – have occurred in developmentally normal children. As such, the CPSC has just recently filed suit to prevent the sale of Buckyball magnets by retailers.
But, whether such products stay on the market in the long-term or not, parents, caregivers and teachers should be aware of the risks. Thus, here are some helpful tips. First, be aware of the potential complications of magnets – just because they are small doesn’t mean they aren’t capable of exerting a lot of Gauss. Second, for those who might enjoy Buckyballs or related products – keep them at work rather than at home. Third, if you suspect that a child has ingested magnets, get him or her evaluated early – magnets show up quite clearly on x-ray but a child’s symptoms won’t show up until later – when the damage is already done. Medical providers and parents should be sure to report all cases of magnet ingestion. You can visit to report (anonymously if you prefer) injuries related to magnets or other products. Accurate accounting of cases can help with efforts to educate the public and maintain safety in consumer products.

If you still feel a strong need to impress and amaze your friends… forget the spoons, tongue bolts, and Buckyball shapes. I suggest a different type of magnetism – one of personality – not potential perforation.