J.M. Schuh1, M.N. Perez2, E.L. Abebrese1, A. Morelos1, C. Dounce3, M.V. Raval2, J.H. Salazar1 1Medical College Of Wisconsin, Department Of Surgery, Division Of Pediatric Surgery, Milwaukee, WI, USA 2Northwestern University, Division Of Surgery, Department Of Pediatric Surgery, Chicago, IL, USA 3Tecnologico de Monterrey, Escuela De Medicina Y Ciencias De La Salud, Mexico City, MEXICO CITY, Mexico
Introduction: Water beads, often marketed as colorful children’s toys, are made of superabsorbent polymers designed to rapidly expand in size when mixed with water. Though their popularity is difficult to estimate, one analysis of on-line sales from a single retailer revealed 3.4 million water bead packages were purchased over a two-year period with each package containing thousands of beads. Descriptions of ingestion, aspiration, ear canal damage, and “water bead gun” injury have been reported. The purpose of this study was to evaluate the breadth of injury caused by water beads to inform healthcare providers’ management and advise consumers regarding the safety of these products.
Methods: The United States Consumer Product Safety Commission Reports database was searched for the term “water beads” yielding 5931 results. After initial review, 26 reports were included and reviewed by 2 independent reviewers. Most reports were excluded because they reported a general concern without describing an incident or related to products other than water beads. Entries were examined for state, age, setting of the injury (home, school, etc.), mechanism, anatomic injury location, setting of medical encounters, imaging obtained, interventions, outcomes, and any comments from the manufacturer.
Results: From the 26 reports spanning 2012-2023, 45 individuals were described across 15 states. Mean age for ingestion was 1.3 years old (SD 0.86 years); median was 1 year old (IQR 1-1), range 0-4 years old. Mean age for other non-ingestion injuries was 13.1 years old (SD 9.0 years); median was 11 years old (IQR 7-17), range 1-37 years old. Most incidents (77%) occurred in the home, but an incident at school was also reported. The most common injuries involved ocular trauma from water bead pellets affecting 38% of children; the second most common were ingestions (31%) (Figure 1). There were 3 emergency room visits, 15 hospital admissions, and 6 unspecified medical encounter reports. 31% of reports described diagnostic imaging (x-rays, CT scans, ultrasounds, and an MRI). 62% of reports (16/26) described children requiring surgery, 10 of which were intestinal operations. Outcomes included permanent neurologic consequences, ocular impairment and otologic damage (19% of reports). 6 reports described contact to the manufacturer; no product alterations or recalls were reported.
Conclusion: The use of water beads by children can lead to aspiration, ingestion, and projectile injuries causing an array of long term neurologic, otologic, and ocular damage. Special care is needed for children less than 4 years old for whom there is a risk of obstruction after ingestion. Medical professionals should maintain a high index of suspicion when children report potential water bead injury.