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LEIPZIG, GERMANY — Children frequently ingest small magnets from magnetic construction kits, board games, 3D puzzles, figurines, or doll clothing. The consequences can be fatal, warned Felicitas Eckoldt, MD, director of the pediatric surgery clinic at the University Hospital Jena in Jena, Germany. "Swallowing multiple magnets or swallowing a magnet and a metal part is extremely dangerous," Eckoldt said at a press conference during the 141st Congress of the German Society of Surgery.

"Toys for adults and children with strong magnets have been in circulation since the early 2000s. These are usually small beads, and one can construct interesting things with them," said Eckoldt. Warnings about swallowable magnets in toys were issued as early as 2007. Severe incidents resulting in fatalities due to the ingestion of multiple small magnet pieces continue to occur, however.

In 2018, in response to the death of a 4-year-old child, the Bavarian State Association of Child Protection and the Bavarian State Ministry for the Environment and Consumer Protection provided information to parents, childcare facilities, schools, associations, and medical practices.

Intestinal Risks

During the first few years of life, children and babies explore their environment. This includes putting all objects within their reach into their hands and mouths. The risk of swallowing an object exists during the first 4 years of life. Swallowing several magnets simultaneously or at intervals is particularly problematic, explained Eckoldt.

The magnetic attraction creates high pressure. The intestinal walls can thus be pressed so tightly together that it leads not only to intestinal obstruction but also to the death of the intestinal wall. Holes and fistulas can form, resulting in peritonitis, sepsis, and even death of a child despite emergency surgery.

"A child's intestine is much thinner and more delicate and requires good blood circulation. If the intestine is trapped between the magnets, this part cannot be adequately supplied with blood," emphasized Till Dresbach, MD, senior consultant of neonatology and pediatric intensive care medicine at the University Hospital Bonn in Bonn, Germany.

There are no figures on the frequency of swallowed magnets in Germany, said Eckoldt. "However, we know that children very frequently swallow objects: The smaller and more interesting, the more likely. Most often, it's children under 5 years old. Usually, the pediatric surgeon would say, 'What leaves the esophagus will come out by the end of the day.' But swallowed magnets can cause devastating effects." Eckoldt recalled that earlier in the year, a 20-month-old toddler died as a result of swallowing multiple magnets.

An Increasing Problem

In 2021, doctors in the United Kingdom raised alarms about swallowed toy magnets. Hemanshoo Thakkar, MBBS, pediatric surgeon at Evelina London Children's Hospital in London, England, and colleagues stated that the number of children requiring medical intervention due to swallowed magnets had quintupled within a few years. More than 40% of the affected children had to undergo surgery, and half of the procedures resulted in complications.

Between 2016 and 2020, 251 children were admitted to four of the largest hospitals in the southeast of England because of swallowed foreign bodies. Besides magnets, coins and mini batteries were also swallowed frequently. Overall, the number of swallowed objects increased by more than half between 2016 and 2020; for magnets, it increased fivefold.

Doctors stated that warning labels on toys are often not clearly visible and demand an awareness campaign about the special dangers of toys with small magnets.

A recent study in Nature also suggests that the number of cases has increased. Amani N. Alansari, MD, a pediatric surgeon at Hamad General Hospital in Doha, Qatar, and colleagues conducted a retrospective, multicenter cross-sectional study to determine the prevalence, clinical presentation, and treatment of ingestion of single or multiple magnets.

All pediatric patients younger than 18 years who were admitted to hospital emergency departments in Qatar, the United Arab Emirates, Saudi Arabia, Tunisia, and Turkey with one or more magnets between January 2011 and December 2021 were included in the study.

The researchers found 189 magnet ingestions, of which 88 (46.6%) were multiple magnet ingestions. Most patients (55.6%) were boys, with a mean age of 3.9 years. An abdominal x-ray was obtained in all cases.

Overall, 119 (62%) patients were treated conservatively, 53 (28%) required surgical intervention, and 17 (8.9%) underwent endoscopy. None of the patients who had ingested only one magnet experienced morbidity or serious consequences.

Swallowing multiple magnets, however, led to more hospitalizations, perforations (44.3%), severe intestinal necrosis (19.3%), peritonitis (13.6%), severe abdominal infections (10.2%), and septic shock (4%). The rate of surgical interventions (59.1% vs 1%) and endoscopies (15.9% vs 3%) was significantly higher in the multiple ingestion group than in the single magnet ingestion group. No deaths were reported.

"A high risk of serious complications, including the need for surgery to remove the magnets and substantial morbidity, may result from swallowing more than one magnet," the study authors wrote. "Magnet safety requirements, public education, and improved legislation are urgently required."

EU Labels

In 2022 and 2023, the EU Commission conducted a detailed examination of toys with magnets and established standards. CE marking indicates that manufacturers have tested their own products. However, according to Eckoldt, GS marks, which are awarded by an independent testing body, are better for the following reasons:

• The CE mark indicates that the applicable safety standards have been met and that magnets must not be too strong or must be at least large enough not to be considered swallowable small parts.
• The GS mark additionally indicates that these standards have been verified by a recognized testing body.
• When purchasing toys online, one must remember that just because products are offered in the EU does not necessarily mean they meet the applicable safety standards.

Small, strong magnets should not be accessible to children, said Eckoldt. She advocated for completely banning such toys from households with young children, even if they belong to older siblings.

This story was translated from the Medscape German edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.