Thousands of young children worldwide still swallowing magnets despite increased regs

Thousands of young children worldwide are still swallowing magnets despite an increase in regulations, finds a review of the available evidence, published online in the journal Injury Prevention.

With US children among those seemingly most at risk, it’s time to bolster restrictions and use better evidence to inform policy, say the researchers. 

The swallowing of small high powered magnets is a significant issue worldwide, especially among children under the age of 4, note the researchers, because they are commonly found in household items, such as toys, remotes, and small household appliances, they add.

While swallowing one of these magnets isn’t usually problematic, swallowing several or in combination with a metallic object can cause serious harm, often requiring surgery or other invasive procedures, they point out.

In a bid to build the evidence base and better inform policy, the researchers sought to compare global reports of children’s magnet swallowing and current regulatory policies for countries throughout the world.

They trawled through international research databases looking for relevant studies published between 2002 and 2024 on the frequency and medical outcomes of magnet swallowing among children from birth up to the age of 18.

From an initial haul of 2998 articles, 96 eligible studies were included in the review. Information on case volume, demographics of the affected children, and the interventions required was extracted from each study. 

A comprehensive online search was also made of policies related to magnet production, sales, and use in each country, drawing on information from government websites, news articles, or other descriptions of policies that could be translated into English or Spanish.

Most of the published studies originated from Asia and the Middle East (44 studies), North America, including Mexico (28), and Europe (11), plus a handful from Chile, Australia, Egypt and Tunisia, representative of only 23% of the world’s countries.

The number of incidents reported in any one study ranged from 1 to 23,756. Overall, the US reported the highest number of cases (23,756), possibly as a consequence of the breadth of its reporting systems, suggest the researchers. A total of 47 single case reports came from 23 different countries.

Sequential studies in several countries documented an increase in incidence over time, including China and the US. Boys comprised between 20% to 86% of magnet swallowing cases, while the overall average age ranged between 2 and 8. 

There were more cases in towns/cities than in rural communities, and most children found the magnets or objects containing them at home, daycare, and nursery in toys, and in school and office supplies.

A significant proportion of the children required admission to hospital, surgery, and/or other medical interventions. Magnets were found in all parts of the gut, and documented injuries included obstruction,twisted intestine (volvulus), perforation, fistulas, and abscesses.

A rise in the number of cases over time was reported in several countries. This could indicate a true increase, or improvements in reporting accuracy, say the researchers. Magnet marketing, cost, and availability may all explain the increases, as might changes in industry and government regulations, they add. 

But whatever the reason, it’s clear children swallowing magnets remains a problem worldwide, they emphasise.

Only 10 policies were found online: 2 from Canada and the US; 3 from the European Union, UK, and France; 1 each from the UAE, Taiwan, Japan, Australia and New Zealand.

These policies ranged in their intent and wording, with some banning small magnets altogether (UAE, New Zealand, and the UK). Others limited the strength of magnets, required stricter labelling, or some combination of the two. Bans were associated with fewer cases.

The US, for example, introduced regulations in 2014 which were overturned in 2016, after which the number of new cases rose by 444%. New safety standards were adopted in 2022, but these don’t apply to toys marketed for under 14s, the demographic most at risk, say the researchers.

“Many countries still lack national policies aimed at limiting access to small, ingestible magnets, even countries with published incidence of morbidity and mortality from paediatric magnet ingestions,” note the researchers.

They acknowledge that they were often not comparing like with like and that granular data were often not available. Cases that don’t require medical intervention are likely underreported, so potentially underestimating the true number of cases.

But the researchers nevertheless conclude: “These data demonstrate that paediatric magnet ingestion is an international problem that must be addressed. Every geographic area has different availability of products and types of restrictions in place, yet the problem remains the same: If magnets are accessible to children, some children will inevitably ingest them, leading to a wide range of severe consequences. 

“These data also provide some insight about potential solutions. Removal of magnets from the market is linked to a decreased incidence of injuries related to magnet ingestions and thus, such policies should be proposed, promoted, and enforced.”