From “Jarts” to “Zen Magnets”: Protecting Our Children from Dangerous Toys

  • Athos Bousvaros
    Correspondence
    Reprint requests: Athos Bousvaros, MD, MPH, 300 Longwood Ave, Hunnewell Building, Ground Floor, Boston, MA 02115.
    Affiliations
    Division of Gastroenterology, Hepatology, and Nutrition Boston Children's Hospital Boston, Massachusetts
    Search for articles by this author

      Keywords

      Abbreviations:

      CPSC (Consumer Product Safety Commission)
      See related article, p 78
      As a baby boomer child, growing up in the 1960s and 70s in the US, I fondly remember a toy called “Jarts.” Jarts were very heavy metal darts, weighing a pound or so, with a sharp tip at the end that children would throw like horseshoes from a distance and try to land in a plastic circle. Children being children, of course, it was also kind of fun to throw Jarts at each other. Although injuries were reported, and the US Consumer Product Safety Commission (CPSC) had tried to ban this product, Jarts remained on the market. The manufacturer of Jarts fought off attempts to remove the toy from the market, in part by putting warning labels on it and stating the Jarts should be used by adults only. Ultimately, a Jart went through a 7-year-old girl's skull, killing her. Her father became a strong advocate for toy safety and facilitated the gathering of more data on this unsafe toy. More than 20 years after injuries started being reported, Jarts were finally banned for good. It was estimated that more than 6000 children had presented to an emergency room for Jart-related injuries in the meantime.
      Demands ban on lawn darts: daughter's death spurs a father's sad crusade.
      History repeats itself. Over the last decade, neodymium magnets have become a popular toy. These extremely powerful small magnets were marketed as a stress reliever and adult desk toy, under several brand names, including “Buckyballs,” “Neocube,” and “Zen Magnets.” After these toys became popular, emergency department evaluations and severe intestinal injuries began to be reported.
      • Waters A.M.
      • Teitelbaum D.H.
      • Thorne V.
      • Bousvaros A.
      • Noel R.A.
      • Beierle E.A.
      Surgical management and morbidity of pediatric magnet ingestions.
      Some of these injuries were quite severe, and in one highly publicized case, an infant who swallowed these magnets developed short-bowel syndrome and became dependent on parenteral nutrition. His physician, Dr Adam Noel, communicated with the pediatric gastroenterology community, and ultimately hundreds of cases of high-powered magnet ingestion, many leading to serious injury and surgery, were documented. At this point, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition initiated a professional education campaign warning physicians about the risk of this product, and providing recommendations for management of magnet ingestions.
      • Hussain S.Z.
      • Bousvaros A.
      • Gilger M.
      • Mamula P.
      • Gupta S.
      • Kramer R.
      • et al.
      Management of ingested magnets in children.
      The American Academy of Pediatrics, North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and various consumer safety advocates communicated their concerns to the CPSC.
      • Bousvaros A.
      • Bonta C.
      • Gilger M.
      • Noel R.A.
      Advocating for child health: how the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition took action against high-powered magnets.
      Ultimately, a recall of these magnets was recommended by the CPSC, as well as by Health Canada. The CPSC also established a safety standard for high-powered magnets. Most retailers and manufacturers ultimately complied, although other manufacturers, such as the makers of “Zen Magnets,” fought the ruling.
      The important report from Rosenfeld et al in this volume of The Journal
      • Rosenfeld D.
      • Strickland M.
      • Moore Hepburn C.
      After the recall: re-examining multiple magnet ingestion at a large pediatric hospital.
      provides additional evidence that the recall has worked. The investigators measured the number of magnet ingestions evaluated in the emergency room of The Hospital for Sick Children in Toronto. They compared the number of visits in the 2 years before the recall and in the 2 years after the recall went into effect. In 2011 and 2012, 29 children underwent medical or surgical procedures to remove magnets, compared with only 10 children in 2014-2015. The number of children requiring abdominal surgery dropped went from 6 cases to 1 case in this same period. Thus, since the period of the mandatory recall in Canada, evaluations, procedures, and surgeries have decreased significantly in Canadian children.
      The study has some limitations, although these do not detract from its overall importance. First, this is a single-center study at a state-of-the-art children's hospital with a large referral area. There is no national tracking system for magnet ingestions in either the US or Canada. Without such a tracking system, it is impossible to ascertain the true incidence or prevalence of such ingestions, which limits the generalizability of this study. Second, outcomes of management may differ by region depending on pediatric expertise. It is possible that in other provinces or states, such children might be evaluated in community hospitals with less awareness of the hazards of these ingestions. In those institutions, the outcomes might not be as good as reported by Rosenfeld et al. Third, there may be additional confounders that can explain the decrease in magnet ingestions in Canada. It is possible that public education independent of the recall may have prompted parents to discard magnetic toys so that their toddlers do not get their hands on them. Finally, the authors did not attempt to characterize any risk factors for magnet ingestions. Physicians suspect that certain groups may be higher risk for magnet ingestion (including toddlers, children with developmental disabilities, and children with behavioral difficulties), but the authors did not examine their patient population for these comorbidities.
      As the authors state, this report provides timely evidence that the magnet recall has contributed to a decline in childhood injuries. Recently, a court overturned the US CPSC recommendations, resulting in a “victory” for Zen Magnets LLC, which plans to resume manufacturing neodymium magnets sets. Whether other companies will follow suit, or if majorretailers will once again start selling these toys, is unclear. Without a national tracking system, epidemiologists will havedifficulty proving that increased sales will result in increased injuries. In the meantime, the best US physicians can do is report all magnet-related injuries to the CPSC using the “report an unsafe product” link on the right side of the front page of CPSC's website.
      According to George Bernard Shaw, “If history repeats itself, and the unexpected always happens, how incapable must man be of learning from experience.” The stories of metal lawn darts and high-powered magnets have similarities, and society indeed seems incapable of learning from experience. As pediatricians, we must educate our patients and parents about the risks of hazardous products, so that tragic injuries such those described above do not occur. In addition, if an unsafe toy with little or no societal benefit continues to hurt children, it is essential that the pediatric community strongly advocate for its removal from the market.

      References

      1. How one dad got lawn darts banned.
        (Available at:) (Accessed February 15, 2017)
      2. Demands ban on lawn darts: daughter's death spurs a father's sad crusade.
        (Available at:) (Accessed February 15, 2017)
        • Waters A.M.
        • Teitelbaum D.H.
        • Thorne V.
        • Bousvaros A.
        • Noel R.A.
        • Beierle E.A.
        Surgical management and morbidity of pediatric magnet ingestions.
        J Surg Res. 2015; 199: 137-140
      3. Two-year-old boy critical after 8 pea-sized magnets he swallowed “destroyed his insides.”.
        (Available at:) (Accessed February 15, 2017)
        • Hussain S.Z.
        • Bousvaros A.
        • Gilger M.
        • Mamula P.
        • Gupta S.
        • Kramer R.
        • et al.
        Management of ingested magnets in children.
        J Pediatr Gastroenterol Nutr. 2012; 55: 239-242
        • Bousvaros A.
        • Bonta C.
        • Gilger M.
        • Noel R.A.
        Advocating for child health: how the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition took action against high-powered magnets.
        J Pediatr. 2014; 164 (e1): 4-5
      4. CPSC approves strong federal safety standard for high-powered magnet sets to protect children and teenagers.
        (Available at:) (Accessed February 15, 2017)
        • Rosenfeld D.
        • Strickland M.
        • Moore Hepburn C.
        After the recall: re-examining multiple magnet ingestion at a large pediatric hospital.
        J Pediatr. 2017; 186: 78-81
      5. Report an unsafe product.
        (Accessed February 15, 2017)

      Linked Article