It's easy to see why kids like to play with water absorbing beads—they're small, usually multi-colored, and attractive. Kids enjoy the magic of watching these balls grow in size when they absorb water, and the tactile experience of handling the gel-like orbs. In addition, their jelly consistency when they get wet can make them look like candy. Due to their capacity to expand, it's dangerous when they are swallowed or placed in body orifices

The beads are made of non-toxic super-absorbent polymers (SAPs) which when soaked in water can grow up to 200 to 400 times their original size into jelly like orbs. They are sold as children's toys, crafts, and are used in vases and gardens. They are called jelly beads, jelly balls, water jelly balls, fairy eggs, dragon eggs, water orbs, hydro orbs, polymer beads, or gel beads.

In 2011, an 18 month old child from India was reported to have developed intestinal perforation requiring removal of the affected intestine, from swallowing three of these crystal balls used for decoration at home. The following year, an 8 month old baby in the United States developed complete intestinal obstruction about 15 hours after swallowing an older sibling's SAP ball (Water Balz) which had to be removed surgically. This incident led to Water Balz, and other water absorbing balls, beads, and toys, being voluntarily recalled by the US Consumer Product Safety Commission. SAPs are still sold in craft stores and garden centers. They are commonly used to hold flowers in place in vases.

The incidents above are even more concerning because they showed that swallowing non-toxic small objects may no longer be uneventful. Historically, about 40 percent of ingestions of foreign objects by children are unwitnessed. 80 to 90 percent of these objects pass through the gastro-intestinal tract and make its way into poop on their own, with no complications. Ten to 20 percent, usually bigger objects, such as bigger coins, get stuck in the esophagus and require removal by endoscopy. Only objects stuck in the esophagus or stomach can be reached and removed by endoscopy.

Less than 1 percent need to be removed surgically. Smaller objects that pass through the esophagus will also pass through the narrowest portion at the end of the stomach and through the small intestines. Since SAPs can later grow up to 400 times their original size, they may initially pass through the esophagus and stomach but can get stuck in transit in the small intestines, as was the case in the two patients reported above.

The health professionals who reported the case in the US studied how Water Balz behaved when soaked in water. They found that after just two hours, they more than doubled their size, and that the quickest rate at which they grew was during the first 12 hours. These authors therefore recommend prompt removal of these balls when swallowed, by endoscopy, before these leave the stomach. They also recommend having a lower threshold for considering removing these surgically if not found on endoscopy.

Earlier this year, the CPSC received a report of a 5-year-old and a 7-year-old who placed a SAP bead in their ears. Since the beads were clear, the doctor who saw the children when they began to experience ear pain did not see the beads. They were treated for an ear infection. The beads were discovered after they expanded to 3/4 inch causing more pain, and had to be removed surgically. Both children damaged their ear drum and one has permanent hearing loss.

My advice: SAPs should be kept out of sight and out of reach of young children. If parents or other care-givers suspect that a child has swallowed or placed such product in any body orifice, they should immediately seek medical attention.

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