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ORLANDO -- A significant number of kids experienced bowel obstruction after swallowing superabsorbent polymer beads (SAP), commonly referred to as water beads, according to a systematic review.

Water beads are frequently found in children's toys as well as home decorations and gardening products, explained Bryanna Emr, MD, of Penn State Health in Hershey, Pennsylvania. However, the beads can expand to 400 times their original size, creating a serious hazard when ingested, she noted in a presentation at the American Academy of Pediatrics (AAP) annual meeting.

Among 88 individuals in the 46 studies that Emr and colleagues reviewed, along with one additional patient from their own institution, the predominant clinical symptoms of bowel obstruction following water-bead ingestion were emesis (92%) and abdominal distention (48%). The most frequent sites of obstruction were the jejunum (42%) and the ileum (44%).

Ultimately, 84% of the patients required abdominal surgery, mostly enterotomy (70%).

Emr noted that there's been an increase in the number of reported water bead-related cases in the last 10 years as these items have grown in popularity. Water beads are often used in sensory or squishy toys for kids. They are also prevalent in craft stores for use as decorations. Young children may often mistake the colorful beads for candy, warned the .

The beads start out small, but "as they sit in water, they grow to about 400 times their original size," she said, adding that "children -- usually the ones who are toddler age and younger [ages <5 years] -- don't have very big intestines, and so they [SAP] get stuck, and they cause bowel obstructions and require surgery."

Additionally, most toddler patients are unable to communicate that they've swallowed water beads, and the beads can be difficult to see on x-rays, "so, it makes for a very difficult diagnosis [without] a high level of suspicion," Emr said.

In the review, abdominal x-rays were conducted in 74% of the cases, but the foreign body was visualized in only 5.4% of cases. However, sonography proved more useful. Ultrasounds were done in 56% of cases and visualized the foreign body about 85% of the time.

The average age of the kids in the cases reviewed by Emr's group was 14.2 months, and more than half were female. The average water-bead size at retrieval was 33.7 mm.

The researchers found that postoperative complications occurred in 18.4% of cases, and 16% of these were reoperations to remove additional beads not identified in the initial procedure. One death was recorded. In 2023, the AAP reported that the after a child, age 10 months reportedly swallowed one of the water beads and died.

Emr and colleagues also conducted an in vitro experiment in which they cultivated water beads within a simulated intestinal environment (normal saline at 37°C). Beads were grown to an average size of 28.8 mm. The goal of the experiment was to safely shrink ingested waters beads, and "ideally prevent surgery," Emr said.

They reported that a hyperosmolar solution GoLYTELY yielded a 37% reduction in the size of expanded water beads within 12 hours. Other solutions that showed efficacy included Gastrografin, prune juice, and acetylcysteine. ""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," Emr's group stated.

However, they stressed that more data were needed to to develop clear guidelines for treating children who swallow water beads.

Emr emphasized that this type of injury is preventable, and that the current research aims to raise awareness that water beads are "dangerous and need to be supervised very closely with children around."

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