Water Bead Injuries, Need for Escalating Care Becoming More Common in United States

Patrick Reeves, MD
Credit: Uniformed Services University

Water bead injuries, including ingestion, among children has become a growing crisis for emergency rooms and gastroenterologists, according to new research.

An analysis examining the number of National Electronic Injury Surveillance System (NEISS) from 2013 to 2023, results demonstrate a significant uptrend of water bead ingestions and insertions in children over the last ten years, with children less than 5 years of age most likely to be admitted for water bead-related injuries. While results indicate more than 90% of encounters were able to be treated and released back home, investigators note the number of cases requiring intervention has also increased.¹

“We've seen a growing number of cases for children requiring surgery where their bellies are cut open to expose the bowel and remove the materials of water beads that have clumped together and caused an obstruction,” explained Patrick Reeves, MD, a pediatric gastroenterologist and obesity medicine specialist at Uniformed Services University, in an interview with HCPLive.

Water bead injuries have garnered a considerable level of mainstream media attention recently but have been a concern for emergency medicine specialists, pediatric gastroenterologists, and caregivers alike for more than a decade now. Although the US Consumer Product Safety Commission issued its first warning related to blockages caused by accidental ingestion of water beads, in March 2024 they released their first warning related to chemical poisoning hazards posed by these products.²

“Since 2013. the Consumer Products Safety Commission has been very active in supporting both voluntary and involuntary recalls for some of these products,” Reeves noted. “Unfortunately, we've seen that for about a decade, but the water bead ingestion and other injuries, continues to go up and up.”

In the current study, which was presented at the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) 2024, Reeves and a team of colleagues representing other military medical centers and Nationwide Children’s Hospital sought to describe the trends in exposure and management of water bead injuries in the US. A nationally representative sample of US hospital emergency departments, the NEISS database supplied weights and variance variables to generate national estimates. The database also uses disposition codes to help identify management courses for recorded encounters.¹

From the database, investigators identified 226 water bead injuries occurring between 2013 and 2023 among children aged 0 to 17 years of age, with 66% being ingestion. According to investigators, the 226 unweighted instances of water bead injuries generated an estimated 6022 water bead encounters during the study period.¹

Investigators pointed out the 24% of ingestions occurred among children under 2 years of age and children under 5 years of age accounted for 48% of all ingestions. Additionally, 56% of cases involved multiple waterbeds. Investigators also called attention to a significant uptrend in injuries beginning after 2020 and data suggesting typical neurologic status was observed in 2% of water bead injuries relative to 0.3% of cases of coin ingestion cases during the time period.¹

Investigators found 91% of encounters were treated and released, but 9% required escalation of care, with 5.7% requiring hospitalization, 0.9% being transferred to other facilities or departments, and 0.4% being held for observation. Of the 9% requiring escalation, all but 1 (94%) case in the unweighted sample was related to ingestion. Investigators pointed out 75% of encounters requiring escalation involved multiple waterbeds and 70% occurred in patients aged 5 years or less.¹

“Our study is the first population-based analysis which indicates a significant uptrend of water bead ingestions and insertions in children over the last 10 years,” investigators wrote.¹

References:

1. 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.
2. U.S. Consumer Product Safety Commission. CPSC announces new hazard posed by deadly water beads, warning consumers about products containing toxic acrylamide. U.S. Consumer Product Safety Commission. March 19, 2024. Accessed November 10, 2024. https://www.cpsc.gov/About-CPSC/Commissioner/Richard-Trumka/Statement/CPSC-Announces-New-Hazard-Posed-by-Deadly-Water-Beads-Warning-Consumers-About-Products-Containing-Toxic-Acrylamide.