*TWEETORIAL ALERT* In light of a recent @washingtonpost story on increasing magnet ingestion in children in the US, a brief tweetorial. This is applicable to all anyone who has, takes care of, or cares about kids. So, why all the fuss?
washingtonpost.com/business/econo…
washingtonpost.com/business/econo…
1)Neodymium-Iron-Boron magnets (or ‘supermagnets’ for short) were created in the late 1970s for cars. They aren’t your average fridge magnets – they have much more ‘attractive’ force, and have many industrial uses
2)Toys were developed in the early 2000s that used them – and predictably, children ingested them. Most of the toys aimed at kids were quickly recalled by manufacturers
3)The management is varied – if one magnet is ingested, it can be treated as most benign foreign bodies and will be expelled naturally. However, it must be assured that there is only one. If multiple are ingested quickly, they often form a ‘ball’ of magnets, and again, they
may be expelled as one unit. Plain film serial imaging can confirm this. The biggest concern is if they are ingested at separate time points (even a few minutes apart), as they can attract one another across loops of bowel, causing pressure necrosis, abdominal sepsis and death 
4)There are numerous fatalities reported in the literature, mostly in young children.
5)Even if they are caught in time, they are a complicated surgical resection and that can have significant morbidity
5)Even if they are caught in time, they are a complicated surgical resection and that can have significant morbidity
6)In the mid-late 2000s, various companies created ‘adult desk toys’, the most popular being ‘buckyballs’. These sets of 64+ tiny supermagnets made cute shapes, and were popular items to be ingested by children. As the toys became popular, the incidence of ingestion increased
7)The consumer product safety commission (CPSC) in the US recognized this danger, and had them banned
8)Most manufacturers either went bankrupt or demand evaporated; however, some companies took the CPSC to court, and (eventually) won the right to continue producing these
8)Most manufacturers either went bankrupt or demand evaporated; however, some companies took the CPSC to court, and (eventually) won the right to continue producing these
9)Other countries (Canada, New Zealand etc) recalled the them, and saw the incidence of ingestion and injury to children decrease substantially, such that today it is rare to see these presentations jpeds.com/article/S0022-…
10)We know that warnings do not work well for these products. The effective way to prevent the injury of children is to remove these products from the market; however, in light of the legal fight that the CPSC lost, this is unlikely in the US despite best advocacy efforts.
11) Thus, parents and healthcare workers who take care of kids need to be aware of the risks and management. @NASPGHAN created a great clinical practice guideline for management in 2012 (naspghan.org/user-assets/Do…) . #FOAMed #FOAMrad #PedsRad @Donteatmagnets @MatttStrickland
Please disseminate widely to clinicians who may encounter this, and primary care clinicians who counsel parents. Ping: @DrJFriedman @First10EM @EMCases @DrCJohns @Kidsdoc1Rick @drdanmagnus @eUSMD @DrJaimeFriedman @DocMaximum @Doctor_Joey
