Pediatric Water Bead Ingestion: Experience from a Quaternary Care Children's Hospital and a Proposed Management Algorithm.

Objective: Water bead ingestion has become increasingly common, with variation in management strategies. This study examines the presentation, management, and complications associated with water bead ingestion at a quaternary care children's hospital, situating it within the broader context of the medical literature and proposing a management algorithm. Study design: This is a case series of pediatric patients who presented to a quaternary care children's emergency department for water bead ingestion from 2015 to 2024. Results: There were 36 pediatric encounters involving water bead ingestion from 2015 to 2024, with a median age of 2 years (IQR, 1-6), and the majority (n = 28, 78%) were asymptomatic. A total of 52 imaging studies were performed, of which 4 (8%) were abnormal. Endoscopy was performed in 6 (17%) patient encounters, none of which successfully retrieved water beads. In our case series, there were no patients with bowel obstructions or complications. Conclusions: Best practices for managing children with water bead ingestion remain unclear. Although there were no complications noted in this study, complications due to water bead ingestion do occur, and we support continued efforts to decrease the risk of injury and death associated with water bead ingestions. Upon reviewing our findings and comparing them with current literature, we propose a new algorithm for managing water bead ingestion. This algorithm is intended as a provisional, experience-informed framework to guide management, reduce unnecessary interventions, and standardize care but will require further validation.