Water Beads – An Expanding Hazard

September 9, 2024

Written by Kimiko Dunbar

Spoon Feed
There are an increasing number of water bead related injuries in children, with the majority occurring in children less than five. While most cases can be treated and released from the ED, water bead injury can be serious and even deadly.

It’s all fun and games until someone gets a water bead stuck in their intestine
Water beads are often sold as a component of toys, floral arrangements, or for agricultural use. These super absorbent polymers are even marked as sensory toys for neuroatypical children. In their dehydrated state they are small, often colorful, candy-like beads with an obvious appeal to children. The danger comes when water beads are rehydrated and can grow to over 100x their original size.

These authors extracted data from the National Electronic Injury Surveillance System, looking at ED visits for patients <20 years old related to water beads from January 1, 2007 through December 31, 2022.  There were 307 reported cases in the study population (which translates to an estimate of 8,159 ED cases nationally), with a 130.9% increase in cases in the last two years of the study. This is likely an underestimate, as it does not include patients managed outside of the hospital. Most injuries occur in children less than 5 years old, with the most common mechanism of injury being ingestion, which may lead to bowel obstruction. All admitted patients had ingestion as the mechanism of injury. Ingestions were most common in children less than 2; however, children ages 3-4 accounted for one fifth of ingestions. Other causes of injury include placement into the ears or nasal cavity and blunt eye trauma. Symptoms of water bead ingestion are non-specific, and water beads are radiolucent, making diagnosis tricky. Alarmingly, rapid increases have occurred despite product recall and implementation of safety standards.

Since the journal’s receipt of this article, “Esther’s Law” was released into the Senate, a law named after Esther, a 10-month-old who died from an obstruction after water bead ingestion. The law would ban the sale of water beads marketed to children as sensory toys, educational materials, or art supplies.

How this will change my practice
This increases my suspicion for a water bead related injury, especially as symptoms are non-specific (i.e. abdominal pain, vomiting) and can mimic the presentation of more common etiologies such as gastroenteritis. It will change my anticipatory guidance for parents of all ages, especially those with young children, and it sparks a sense of urgency regarding preventative measures to remove water beads from access. Personally, after reading this study, you won’t find water beads anywhere around my kids.

Editor’s note: I recently removed a water bead from a child’s nose. It was perfectly clear, very hard to see, and much larger than I expected once I pulled it out! ~Clay Smith

Source
Pediatric water bead-related visits to United States emergency departments. Am J Emerg Med. 2024 Jul 28:84:81-86. doi: 10.1016/j.ajem.2024.07.048. Online ahead of print. PMID: 39096713