Button-type batteries present safety hazards. A 6.7-fold increase in the percentage of severe injuries and deaths from swallowing batteries occurred between 1985 and 2009, according to two reports in the June issue of Pediatrics. About 60% of cases occur in young children who swallow "button" lithium batteries used in toys, games, and hearing aids. Batteries, especially those with a 20-millimeter diameter, can stick in the esophagus and cause severe tissue damage within two hours of ingestion. Further damage can include vocal cord paralysis, narrowing of the esophagus, and internal bleeding. Health care providers often misdiagnose the problem because of nonspecific symptoms like vomiting, cough, and wheezing. Even after batteries are removed, injuries can worsen. The researchers recommend X-rays to see whether the battery has moved to the stomach where it will pass in stool; immediate endoscopic removal of batteries lodged in the esophagus; monitoring for signs of fever, vomiting, abdominal pain, or bloody stools; and calling the 24-hour National Battery Ingestion Hotline at (202) 625-3333 to talk with an expert.