A ten-year retrospective California Poison Control System experience with water bead exposures: a growing problem

Water beads are superabsorbent children's toys that expand in water. When ingested, they can cause intestinal obstruction. Beyond case reports of ingestion-related morbidity, healthcare utilization and management have not been well-described. This study evaluates the experience of a large poison system with water bead exposures.

A 10-year retrospective review (2014-2023) of the California Poison Control System database was performed. Water bead exposures were identified using product codes and a keyword free-text search for "Orbeez" and "water bead." Demographic and clinical data were abstracted and statistically analyzed for association with a composite endpoint of imaging, endoscopy, surgery and/or need for hospital admission, which was a surrogate measure for clinical acuity.

There were 2,280 water bead exposures. The number increased from 23 patients in 2014 to 1,257 cases in 2023. Thirty-seven (8.1%) patients reached the composite endpoint. Imaging was at the discretion of the treating provider and included radiographs (35 patients), ultrasound examinations (two patients), and computed tomography scan (two patients). One patient underwent endoscopy. No patients required surgery, and no deaths occurred. Patients with symptoms after exposure had 77% increased odds of reaching the composite outcome. Statistically significant symptoms included abdominal pain, nausea/vomiting, constipation, diarrhea, abdominal distention, and fever. Behavioral issues, which included autism and psychiatric diagnoses, were significantly (P = 0.020) associated with reaching the composite outcome.

The number of water bead exposures reported to Californian poison centers has increased over the past 10 years despite regulatory and prevention efforts. Few water bead exposures in our series resulted in procedures, surgeries, or hospitalizations over the study period. More evaluations were performed for children who presented with symptoms.

Even if few cases required procedural intervention, substantial resources were used to address water bead exposures. More stringent regulations, widespread public awareness, and proactive education are needed to curb this potentially dangerous trend.