Household Hazards

How everyday products make us sick.

Having a Ball

Hazards of Superabsorbents

The same day this week two different two companies announced recalls for similar toys: Be Amazing!’s Monster Science Growing Spider and Eco-Novelty’s Cosmo Beads (in the jumbo size). One thing they had in common was being made of a superabsorbent synthetic material that swells dramatically when exposed to water. Another was the shared risk that a toddler who ingested the toys might need surgery.

These voluntary recalls might seem, at first blush, like a really victory for consumer protection. After all, it’s hard to foresee all possible mishaps that might occur, just because a product increases in size several hundred-fold in a watery environment. Like in the intestinal tract, for example. Anyway, these products are not intended for children under three years of age.

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“Products” you may wonder – as in other products? More than a month before the Growing Spider was caught in the web of recalls, Be Amazing! saw fit to take Monster Science Colossal Water Balls and Super Star Science Colossal Water Balls off the market. And that was more than half a year after DuneCraft recalled more than 90,000 toys under the names Water Balz, Growing Skulls, H2 Orbs “Despicable Me”, and Fabulous Flowers (http://www.dunecraft.com/safetyrecall.htm).

Granted, these toy brand names are not as darkly humorous as the Pretty Peggy Ear-Piercing Set, Mr. Skin-Grafter, or General Tron's Secret Police Confession Kit, some of Irwin Mainway’s inventory in the classic Dan Akroyd-Candice Bergen consumer protection skit (http://snltranscripts.jt.org/76/76jconsumerprobe.phtml). But the reality of the hazard, ultimately, is more overtly troubling.

DuneCraft was responding to a scientific article published in the October 2012 issue of the medical journal Pediatrics documenting a 6 month-old child in Texas who had to have emergency surgery to correct a blockage in the small bowel from a “3.5-cm spherical gel ball.” It had been part of a toy belonging to her elder sister. Two things are notable about this case report. One is that although small children often ingest various objects not intended for consumption (the medical term is “foreign body”), if such an object gets stuck, it is usually in the throat or at the exit of the stomach, not located potentially more dangerously farther down in the intestinal tract.  The second thing is that the authors of the Pediatrics publication named names.  Not only did they identify the DuneCraft product, they even carried out an experiment timing how fast and how much the ball was prone to expand in water over how many hours (4 times the original diameter in about 12 hours).

This was not the first U.S. report of this problem. The month before, surgeons from California had described an 18-month old with a similar story who also required surgery. Unfortunately, the product brand in that case was not revealed. The authors also erred in another way, confidently stating, “This is the first case of gel bead ingestion leading to a serious complication such as small bowel obstruction.” Actually, more than a year before, in July 2011, a case of bowel perforation following a superabsorbent object ingestion in an 18 month-old, with peritonitis (very much as if from a burst appendix) was reported by surgeons working in Lahore, Pakistan. Although that case recovered, by January 2012 the same team  experienced a case fatality: this time from obstructing sludge in the intestine of a 6-month old from a single swallowed “crystal jelly ball” of superabsorbent given by a neighbor to play with (http://www.ncbi.nlm.nih.gov/pubmed/22953300).

Although these two cases might be seen as canaries in a coal mine, the real canaries aren’t really canaries at all but rather a blue-tailed targon and red-billed malkoha. These two birds at the Miami Metrozoo both succumbed in 2009 to a mysterious form of intestinal obstruction.  It took sophisticated forensic analysis to determine that they had ingested superabsorbent polymer particles. Most likely the foreign bodies came into the aviary through potting soil in which the material had been added to retain water for later plant nourishment. That is but one common application for these synthetic superabsorbents.

Diapers are another big use for superabsorbent polymers, not surprisingly.  My colleague in Sweden, Kjell Torén, has investigated a factory manufacturing such diapers. Reassuringly, inhalation of the dust in adults and in small quantities does not seem to pose a risk http://www.ncbi.nlm.nih.gov/pubmed/21752269). One report out of Teheran in 2010, however, found a three-fold risk of urinary tract infection in infants and children using absorbent diapers compared to other products (http://www.ncbi.nlm.nih.gov/pubmed/23056689). It is a study that has yet to be replicated, unless such an investigation is banned as a weapon of mass destruction insofar as the superabsorbent diaper industry is concerned.

 

Paul D. Blanc, M.D., M.S.P.H., is Professor of Medicine and Endowed Chair in Occupational and Environmental Medicine at the University of California San Francisco.

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