Caveat Emptor: Characterizing Water Bead Consumer and Safety Reporting.

Introduction: Water beads, often marketed as toys, rapidly expand in water and have caused injuries from ingestion, aspiration, and as projectiles. This study analyzed consumer reports to assess the scope and severity of such reported injuries compared to the published literature.

Methods: The United States Consumer Product Safety Commission Reports database was searched for "water beads" yielding 5931 entries spanning 2012-2023. Twenty-six relevant reports were analyzed for state, age, mechanism, anatomic injury location, setting of medical encounters, imaging obtained, interventions, and outcomes.

Results: The 26 consumer reports described 45 individuals across 15 states. Ingestion cases (mean age 1.3 y; range 0-4) and noningestion injuries (mean age 13.1 y; range 1-37) were reported. The most common injuries were projectile ocular trauma (38%) and ingestions (31%). Medical encounters included three emergency room visits, 15 hospital admissions, and six unspecified visits. Diagnostic imaging was reported in 31% of cases. Surgery was reported in 62% of reports (16/26), including 10 intestinal operations. Outcomes included permanent neurologic injury, ocular impairment, and otologic damage.

Conclusions: Water beads have been found to cause aspiration, ingestion, and projectile injuries resulting in long-term neurologic, otologic, and ocular damage. Special care is needed for children of ≤4 y old for whom there is a risk of obstruction after ingestion. Medical professionals should maintain a high index of suspicion when children report water bead exposure. The consumer reports underrepresent the true scope and degree of injury; increased consumer reporting is important for regulatory agencies, the public, and provider awareness.