Trends in Risk & Management Strategies for Water Bead Injuries, with Patrick Reeves, MD

Credit: Patrick Reeves, MD

New research from the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) 2024 annual meeting paints a concerning picture related to the prevalence and need for escalating care seen with water bead injuries in recent years.

An analysis of data from a nationally representative sample of emergency room data, results point to a consistent increase in these injuries beginning in 2013, but a significant increase in 2020 and beyond, with study investigators highlighting 9% of the more than 6000 cases requiring escalation of care.

“Our study is the first population-based analysis which indicates a significant uptrend of water bead ingestions and insertions in children over the last ten years,” wrote investigators, who were led by Patrick Reeves, MD, an associate professor of pediatrics at University of Texas Health Science Center San Antonio.

In the current study presented at NASPGHAN 2024, Reeves and colleagues examined trends in water bead injuries using the National Electronic Injury Surveillance System database to analyze US hospital emergency department data. Between 2013 and 2023, investigators identified 226 cases among children aged 0 to 17 years, with 66% involving ingestion. These instances generated an estimated 6022 water bead encounters nationally.

The study highlighted that 24% of ingestions occurred in children under age 2, and 48% of ingestions involved children under age 5. Multiple water beads were involved in 56% of cases. A significant rise in injuries was noted after 2020, and 2% of water bead injuries presented with neurologic symptoms—higher than the 0.3% seen with coin ingestion during the same time period.

Most cases (91%) were treated and released, but 9% required care escalation, including 5.7% hospitalization. Among those needing escalation, 75% involved multiple water beads, and 70% occurred in children aged 5 or younger.

For more on this growing issue and how practitioners outlook on management, check out our Q&A with Reeves below!

Q&A with Patrick Reeves, MD: Trends in Risk and Management Strategies for Water Bead Injuries

HCPLive: Can you provide insight into the purpose of these beads and what has contributed to this rising issue?

Reeves: There are 2 primary purposes for water beads. They were originally developed as this sort of polymer solution that you could use to help maintain moisture in things like garden potted plants and stuff, because you expose them to water, they swell up, but through osmosis, that water will leach out eventually. It's a good way I you don't want to have to bring a hose or a watering can to those potted plants every day, you use these water beads, and slowly but surely, the water will escape. So that was one.

But, because they're cool looking, they're squishy and they've got beautiful colors, kids have sort of been infatuated with these for over a decade. We started to see back in the 2010s era, more and more products come out as toys or as sort of sensory therapies for children and, more recently, that's been what has changed—they are marketed as toys and therapy modules for children.

HCPLive: What specific risks do children face when ingesting water beads?

Reeves: There are probably two main risks. While we don't have a perfect model, we know that certain infections and inflammatory disorders can predispose children to gastrointestinal obstructions. We've seen a growing number of cases where children require surgery to remove water beads that have clumped together and caused an obstruction. Similar obstructions can occur with non-cancerous growths, like polyps, or severe inflammation in the small intestine that leads to a telescoping phenomenon. Obstruction in children can occur with objects just two or three centimeters wide, and water beads seem to swell to this size, clumping together and resembling obstructive polyps.

The second big risk isn't related to obstruction but to toxicity. Cases are emerging that show these water beads, made of polymers containing acrylamide, can pose both neurologic and hormonal risks. If the water beads aren't evacuated from the GI tract, they can leach acrylamide to toxic levels, potentially causing chronic neurologic effects in children. So, in addition to the acute risk of obstruction, there is a long-term threat of neurologic harm associated with water bead ingestion.

HCPLive: What factors might have contributed to the observed increase in water bead injuries after 2020?

Reeves: It's hard to say. Since the pandemic, we've seen a more frequent diagnosis of behavioral and chronic issues, including autism spectrum disorder, anxiety, major depression, and conditions like sensory processing disorder. Across the board, water beads have been used as a calming and soothing therapy for children. As a gastroenterologist, I'm concerned about placing these water beads within reach of children, as it increases their risks. Children naturally want to play with them, which I think is unquestionable, but the rise in incidents is likely due to the abundance of these products and their targeted marketing toward children."

HCPLive: What unique challenges do healthcare providers face when managing these cases, particularly in the emergency setting? Does this change when we're talking about the subset of patients with atypical neurological status?

Reeves: The emergency department is absolutely the battleground for this issue, and I commend pediatric emergency physicians for handling what is likely one of the most challenging and frightening acute gastrointestinal problems. Our usual diagnostic tool, X-ray radiography, is ineffective since water beads do not show up on X-rays. Families might bring in a child suspected of swallowing water beads, but without immediate symptoms, the obstruction could develop hours later.

It’s crucial to include questions about water bead ingestion in our review of systems—asking if there’s any chance the child could have swallowed them. If the answer is yes, we should consider advanced imaging, like ultrasound or MRI, to detect and assess any foreign bodies in the GI tract, their quantity, and location. This information can guide us on whether pediatric gastroenterology should be involved for endoscopic management, or if there is a high risk of obstruction, warranting consultation with surgical colleagues.

HCPLive: Can you discuss the impact of product recalls on reducing or mitigating the risk of water bead injuries?

Reeves: That's a hard question, because we've seen similar recalls with high-powered rare earth magnets. Several products were recalled years ago, like Buckyballs, and those recalls were somewhat helpful. Since 2013, the Consumer Product Safety Commission has actively supported both voluntary and involuntary recalls for these products. Unfortunately, water bead ingestion and related injuries continue to rise, and we’re still using the magnet ingestion problem as sort of an archetype for this water breed problem. We didn’t see a significant reduction in ingestion events until the Consumer Product Safety Commission enacted its federal rule on magnets. When this rule took effect, product developers and companies had to change their marketing or the products themselves to meet safety standards. The Consumer Product Safety Commission has now proposed a rule set for water beads, and I believe that once this rule is implemented, we’ll start to see a reduction in water bead ingestion events, although it may take a couple of years to measure the impact.

Editor’s note: This transcript has been edited for clarity using artificial intelligence tools.

Reeves has no relevant disclosures to report.

References:

Pasman E, Khan M, Kolasinksi N, Reeves P. WATER BEAD INJURIES BY CHILDREN PRESENTING TO EMERGENCY DEPARTMENTS 2013-2023: AN EXPANDING ISSUE. Presented at NASPGHAN 2024. Hollywood, Florida. November 7 – November 9, 2024.