Sept. 17, 2012 -- Little kids have been in the news for swallowing magnetic "Bucky Balls" and detergent pods. And now there's a case report of an 8-month-old baby girl named Aunraya, who was brought to Texas Children's Hospital because she swallowed a new toy: a superabsorbent polymer ball.
Her great grandmother and legal guardian, Freida Deweese, thought Aunraya had swallowed a "piece of candy." But it was actually a Water Balz toy, which starts out the size of a marble and is advertised to grow to 400 times its original size when put in water.
This little girl swallowed it, it absorbed moisture inside her, and it completely blocked her digestive system so that nothing could get through.
She was vomiting bile, had a distended belly, and severe painful constipation by the time she went to the operating room. Her X-ray shows that many loops of her digestive tract are far wider than normal.
Why does this happen? It's similar to plumbing. When there is a complete blockage, things back up behind it and pile up, causing the bowel to get bigger. Because nothing can get through, the areas after the blockage are smaller than usual.
Aunraya was lucky enough to go into surgery to have it removed before it poked a hole in her gut and caused serious complications.
"There is a tendency to wait and wait," said Dr. Oluyinka Olutoye, a pediatric surgeon at Texas Children's Hospital and associate professor of pediatrics at Baylor College of Medicine in Houston. "We were fortunate enough that we did [surgery] early enough. If the treatment is delayed, there could be perforation with peritonitis" -- a life-threatening illness.
When the surgeons operated, they found a 3.5 centimeter intact gel ball that was blocking part of her small intestines. Because they caught it early, she didn't have any complications.
This is the first reported case of a complete blockage caused by one of these polymer balls in humans. The authors of the case report, published today in the journal Pediatrics, wanted to learn more about these polymer balls and conducted an experiment looking at five of the balls. They measured the sizes of the balls at different time intervals up to four days after they were submerged.
Within two hours, the balls had doubled in size, and by 12 hours -- slightly less than the time it took for Aunraya to get to the hospital -- they had doubled in size again to about 4 centimeters. They grew as big as 5.5 centimeters after four days, without any signs of degradation.
A gel toy that "grows" can be very exciting and fun for children to play with, but may pose a potential public health concern, experts say. But the company behind Water Balz says its toys are made for older kids who should know better than to swallow them.
"[These toys are] obviously not for an 8-month-old," said Grant Cleveland, CEO of Dunecraft, Inc., the company that markets Water Balz, adding that the toys' packaging says "For ages 4 and up. Warning: choking hazard." "You wouldn't let your 8-month-old near [loose] change or marbles. Even Legos are dangerous to an 8-month-old."
Cleveland added, "The marked age is 4 and up, so they're not supposed to be around toddlers. We've sold all types of balls, probably for like eight years. We've never had a problem, shipping millions of units."
In fact, 80 to 90 percent of foreign bodies pass through children's digestive systems on their own without problems, 10 to 20 percent require removal with a non-invasive scope, and fewer than 1 percent require surgery.
While most cases of foreign body ingestion in children don't cause a problem, these toys are different.
The unique growth rates of these polymer balls and the fact that they cannot be seen on X-rays present a challenge for doctors.
"We are trying to sound the alarm as the prevalence of the balls is increasing," said Olutoye. "While they are fun and make good science projects, [they] can have disastrous consequence when ingested."
Still, Aunraya was lucky that someone had seen her swallow something. She had prompt surgery. She did well and went home four days after the operation.