Water-absorbing Beads Pose Increasing Hazard for Young Children; Researchers Test Methods on How to Shrink Them

Results of experiment to avoid surgery in cases of swallowed beads presented during American Academy of Pediatrics 2024 National Conference & Exhibition

ORLANDO, Fla.—Water-absorbing beads have become increasingly hazardous to children over the past 10 years, as children who swallow the beads can experience life-threatening problems such as bowel obstruction.

In new research presented during the American Academy of Pediatrics 2024 National Conference & Exhibition, researchers reveal the results of an experiment in which they grew the beads to different sizes and tested different child-safe liquids to see which ones could shrink the beads after they had expanded.

The abstract, “The Hidden Dangers: Superabsorbent Polymer (SAP) Beads as an Increasing Cause of Bowel Obstruction in Children,” will be presented during the conference at the Orange County Convention Center Sept. 27-Oct. 1.

“Water beads can pose serious risks if ingested, including choking and bowel obstructions needing surgery,” said senior author Bryanna Emr, MD, FACS, a pediatric surgeon. “If you have young children, it’s best not to have these beads in the home.”  
In a literature review, researchers found that children under the age of 5 years are more likely to swallow the beads and have a resulting intestinal blockage. Ultrasounds can be performed to identify the bead inside the intestine. Most of the time, doctors need to perform surgery to remove one or more beads.

Over the past decade, the number of cases of children swallowing water beads and experiencing intestinal blockage has increased, the authors note. They conducted an experiment in which they found that certain liquids such as GoLYTELY, a type of bowel prep, worked best to shrink the beads and was able to shrink the beads by more than 38%.

“Water beads are a growing problem for young children and there needs to be more awareness about the risks if swallowed,” Dr. Emr said. “Despite the recall of some children’s toys containing water beads, they remain widely available in home decorations, gardening supplies, and craft materials. They are soft textured and often in bright colors, making them easy to swallow and attractive to young children.”

The beads can expand up to 400 times their original size upon contact with liquids, putting children at risk for intestinal blockage and other complications.

More research should be completed to develop clear guidelines for treating kids who swallow these beads, the authors conclude. 

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Media Relations Contact: Barb Snesavage, bsnesavage@pennstatehealth.psu.edu or 717-531-8342

Study author Alicia Greene, DO, a general surgery resident at Penn State Health, is scheduled to present her research, which is below, from 10:12-10:20 AM Saturday, Sept. 28 in H2015.

In addition, Dr. Greene, Dr. Afif Kulaylat and Dr. Bryanna Emr will be among highlighted abstract authors who will give brief presentations and be available for interviews during a press conference from noon – 1:30 pm ET in the  National Conference Press Room, W208 AB. During the meeting, you may reach AAP media relations staff at 407-685-5401.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.  

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/

Abstract

Program Name: 2024 AAP National Conference-Abstracts

Submission Type: Section on Surgery

Abstract Title: The Hidden Dangers: Superabsorbent Polymer Beads as an Increasing Cause of Bowel Obstruction in Children

Alicia Greene
Harrisburg, PA, United States

Superabsorbent polymer (SAP) beads, commonly found in children’s toys, home decorations, and gardening products, have the ability to expand up to 400 times their original size, presenting a distinctive challenge when ingested by children. While many pass through the gastrointestinal tract without incident, some instances lead to urgent surgical intervention due to bowel obstruction. Our study aims to present an updated systematic review of existing literature, summarize our institution’s experience, and introduce an innovative in vitro experiment aimed at mitigating the need for future surgical interventions by exploring methods to reduce the size of enlarged SAP beads.

A systematic review was conducted utilizing PudMed and Google Scholar databases to identify cases of SAP bead ingestion in children associated with bowel obstruction. Patient demographics, clinical manifestations, diagnostic approaches, treatment strategies, and outcomes were extracted for descriptive analysis. Additionally, we add an unpublished case encountered within our institution. Furthermore, an in vitro experiment was devised wherein SAP beads were cultivated within a simulated intestinal environment (normal saline at 37°C) and subsequently subjected to agents with varying osmolarities to investigate potential size reduction mechanisms.

We identified 88 patients from 46 studies who experienced bowel obstruction following SAP bead ingestion, alongside an additional patient from our institution. Forty-two studies (n=50) provided individualized information and were included in the descriptive analysis. The average age was 14.2 (±4.6) months, with females comprising the majority (64%) of patients. Predominant clinical symptoms included emesis (92%) and abdominal distention (48%). While abdominal X-rays were conducted in 74% of cases, only 5.4% visualized the foreign body. Conversely, ultrasound, performed in 56% of cases, successfully visualized the foreign body in 85.7% of instances. The most frequent sites of obstruction were the jejunum (42%) and the ileum (44%). 84% of patients required abdominal surgery, predominantly undergoing enterotomy for SAP bead removal (70%). The average bead size at retrieval was 33.7 (±8.3) mm. Postoperative complications occurred in 18.4% of cases, the majority of which were reoperations (16%) to remove additional beads not identified in the initial procedure. One mortality was recorded. In the in vitro experiment, the beads were grown to an average size of 28.8 mm. The hyperosmolar solution GoLYTELY contributed to a 37% reduction in the size of expanded SAP beads within 12 hours, demonstrating its efficacy alongside other solutions such as Gastrografin, prune juice, and acetylcysteine.

Due to the increased frequency in the number of cases published each year describing bowel obstruction after SAP bead ingestion, increased education efforts are required for prompt diagnosis and removal. Encouragingly, the use of hyperosmolar agents holds promise in effectively reducing SAP bead size and thus may offer a future proactive strategy to diminish the necessity for surgical interventions in affected children.

In Vitro Experiment: Effect of Osmolarities on SAP Bead Size

The average size of SAP beads over time in different solutions.