The Growing Involvement of Pediatric Surgeons in Preventing Toxic Exposures from Consumer Products

In the field of pediatric health care, medical toxicologists and pediatric surgeons are becoming increasingly allied to protect children from risky consumer products. With oversight from the U.S. Consumer Product Safety Commission (CPSC), each year, thousands of children endure injuries or death from exposure to the risks and hazards of consumer products—from button batteries to slime, water beads, and high-powered magnets.

In this 2025 edition of Seminars in Pediatric Surgery, Baerg et al. describe how pediatric surgeons are positioned to take a major role in public health advocacy by translating their clinical observations into action at the policy level. They are in a unique position to convert firsthand experiences of product-related injuries into meaningful advocacy efforts that support toxicologists in reducing exposures and preventing fatalities among children.

Consumer Products as Toxicological Risks

Button Batteries: Caustic Burn Injuries

One of the most urgent topics in toxicology is the ingestion of button batteries, which produce an electrical current that generates hydroxide ions and causes caustic burns. The esophagus is the most susceptible site, and irreversible necrosis can develop within just three hours. From 1990 to 2012, button batteries were responsible for over 66,000 emergency department visits and multiple fatalities. Toxicologists are now working closely with gastroenterologists and surgeons to develop pre-removal mitigation strategies, including the administration of honey or sucralfate, as well as post-removal esophageal irrigation with acetic acid to neutralize pH.

High-Powered Magnets: Implications for Mechanical and Septic Injury

Magnets are not inherently toxic; however, when multiple magnets are ingested, they can migrate across bowel walls, causing pressure necrosis, perforation, fistulas, and even sepsis. Emergency departments across the United States treated over 26,600 cases of pediatric magnet ingestion from 2002 to 2021. Pediatric surgeons, with support from the Consumer Product Safety Commission (CPSC), have called for a ban on these products; however, items previously banned were often replaced with equally hazardous alternatives, leading to more regulatory measures. Toxicologists play a vital role in helping cases through diagnosis, documenting exposures, and advancing public health surveillance and regulation.

Water Beads: Obstructive and Chemical Injuries

Water beads, which consist of absorbent polymer beads, can expand more than 100 times their original size and can cause bowel obstruction, bowel perforation, and sepsis. Water or hydrogel beads may also contain unregulated chemical dyes and are frequently radiolucent, making diagnosis particularly difficult. Also, when used as an ammunition source in toy guns, they can cause inhalation injuries and ocular injuries. Retrospective case reports have indicated that neurotoxicity and intestinal ischemia have been associated with ingestion of water beads. Toxicologists should consider superabsorbent polymers, particularly in low-resource environments, an emergent and underappreciated hazard.

Key Points for Toxicologists: Advocacy and Prevention

The article emphasizes the importance of using clinical expertise for advocacy and encourages pediatric surgeons to:

Partner with toxicologists and professional organizations (AAP, NASPGHAN) to develop safety protocols.

Provide Congressional testimony about patterns in pediatric injury and product risk.

Contribute to developing NEISS (National Electronic Injury Surveillance System) and supported mobile-based global registries to monitor high-risk injuries.

Toxicologists must collaborate with diverse teams to develop upstream strategies that emphasize education and prevention. We, as frontline clinicians, must identify trends in exposures. But as this article underscores, we also need to take initiative—by educating, advocating, and forming interdisciplinary coalitions to drive upstream public health interventions. Only then can we achieve meaningful changes in regulation, recalls, and ultimately, product safety.

Key Points for the Medical Toxicology Community

Toxic exposures often originate from mechanical products. Batteries, magnets, and water beads each cause injury through both physical and chemical mechanisms—but are poorly regulated and underreported.

Public awareness and early intervention save lives. Toxicologists and pediatric surgeons must engage with policymakers, the media, and educational institutions.

Joint advocacy strengthens outcomes. By collaborating with surgeons, toxicologists can expand their influence on training, legislation, and trauma prevention.

Better data equals better action. By utilizing reporting tools such as NEISS, SaferProducts.gov, and mobile applications, we can build awareness around emerging product hazards.

There are continued global inequities. In low-resource contexts, children often have the highest exposure to unsafe products—without regulatory protections or access to care.

FAQ:

1. What consumer products are most dangerous for children?

Answer: The most dangerous products are button batteries, high-powered magnets, and water beads. If children swallow, inhale, or mishandle them, they can cause serious internal injuries or death.

2. How do button batteries injure children?

Answer: When button batteries are swallowed, they produce an electrical current that causes hydroxide ions to form, which can result in caustic burns, especially in the esophagus. Damage can occur in as little as three hours and may cause irreversible necrosis.

3. What are the dangers of high-powered magnets to children?

Answer: When multiple magnets are swallowed, they can attract each other through the bowel walls, leading to perforation, fistulas, sepsis, and other mechanical injuries - all of which are notoriously difficult to treat because they usually require emergency surgery.

4. Why are water beads considered dangerous for kids?

Answer: Water beads can swell up to 100 times their original wet size, which can cause bowel obstruction or intestinal ischemia. Many are radiolucent and extremely difficult to detect on imaging, and they also contain unregulated chemical dyes.

5. How are pediatric surgeons helping with product safety?

Pediatric surgeons are using their clinical observations to inform product safety policies. They testify before Congress, update public databases and registries about safety issues, and collaborate with toxicologists to prevent pediatric injuries caused by products.

6. What role have toxicologists played to help prevent injury from toxic products?

Answer: Medical toxicologists help identify product-related exposures, develop safety protocols, and advocate for regulation using scientific research. They also collaborate with existing systems like NEISS and SaferProducts.gov to enhance surveillance and public awareness. education.

7. What is NEISS, and how does it help ensure children's safety?

Answer: NEISS (National Electronic Injury Surveillance System) is a public health system that collects data on product-related injuries treated in U.S. emergency departments. NEISS helps to identify trends, educate for public health strategies, and motivate product recalls or regulatory action.

8. Are there disparities in pediatric product safety worldwide?

Answer: Yes. In low-resourced environments, children face higher risks due to a lack of regulation, limited access to healthcare, and lower awareness. It is also fair to suggest that children are more exposed to unregulated or counterfeit products in those communities.

9. Is it possible that ingestion of water beads would not lead to chemical toxicity?

Answer: Yes. While case reports exist, some water beads may have caused neurotoxicity and intestinal ischemia. Importantly, many of their chemical components are likely unregulated or untested for safety.

10. What tools exist to track pediatric injuries as a result of toxic products?

Answer: In addition to NEISS, tools such as SaferProducts.gov, and current tools being developed that utilize mobile-based injury registries, help clinicians and policymakers to continue monitoring injuries and taking actions to prevent injuries from future toxicologic risk.