It all started with something no bigger than a grain of sand.
Around 3 a.m. on March 28, 2022, Haley Nickols awoke to her infant son, Deacon, throwing up. Haley cleaned him up, calmed him down and comforted him as he continued to throw up until morning.
The next day, Deacon’s demeanor was no better. He was still throwing up and refusing to eat.
With four other children, Haley has just about seen it all. But, still, she was concerned and called Deacon’s pediatrician. The nurse said she could either bring him to the office for evaluation, go to an urgent care, or bring him to a local emergency department (ED). Thinking he likely had a virus and was concerned about him becoming dehydrated, Haley decided to take Deacon to an ED near their home in Appleton.
A couple weeks earlier, Deacon’s four older siblings had been playing with water beads — small, brightly colored polymer balls that expand in water. They are a popular kid’s toy and Haley had purchased some for home-schooling activities with her kids.
“With five kids, including Deacon who was only 9 months old at the time, I did a lot of research on the beads before I bought them to make sure they were safe,” said Haley. “From what I read, everyone said they were nontoxic and very popular for sensory play. There were a lot of hands-on activities kids can use them for, scooping, pouring and measuring, so I bought some.”
The container was normally kept high up on a shelf, but one day the beads spilled all over the floor.
With Deacon crawling around the floor, the family worked quickly to pick them all up. And they carefully checked Deacon’s mouth to make sure he wasn’t chewing on any.
But on the way to the emergency department, Haley’s husband, Willie, called and told her he had found Deacon by another pack of open water beads on the floor and had swiped two of them out of his mouth the day after the spill.
“I understood what my husband said, but I honestly thought that probably wasn’t what was making him sick. In my mind, the beads were just so tiny and nontoxic. I thought even if he did swallow one they are so squishy and slippery he’d probably just poop it out. It wasn’t really on our radar as anything that dangerous,” said Haley. “But I did mention it to the physicians in the emergency department, just in case.”
At the ED, staff did an X-ray, and, sure enough, they found two round balls. One was in Deacon’s stomach and the other was in his intestine. But they were no longer the size of a grain of sand — they had expanded as they are designed to do. Doctors called the Children’s Wisconsin Transport Team and an ambulance soon arrived to take Deacon to Children’s Wisconsin in Milwaukee.
Adrian Miranda, MD, with the Children’s Wisconsin Gastroenterology, Liver, and Nutrition Program, did the initial assessment of Deacon when he arrived. After some additional tests, Dr. Miranda paged the pediatric surgeon on call, Thomas Sato, MD.
Together, Dr. Miranda and Dr. Sato decided Deacon needed to be admitted, but opted to not immediately perform surgery. They wanted to observe him to see if the beads would either dissolve or pass on their own. While they waited, they also researched the best course of action. Unfortunately, there was not a lot of published information on how water beads react in the body and how to treat them if ingested.
“We felt really comfortable at Children’s Wisconsin. We were reassured that we were in the best, most competent hands,” said Haley. “I really appreciated that they took a measured approach and didn’t rush to surgery that first night.”
The next day, Deacon was still throwing up and refusing to eat. Jose Salazar, MD, PhD, a pediatric surgeon at Children’s Wisconsin, was now the surgeon on call and took over Deacon’s case. After an X-ray showed the slippery, squishy balls continued to travel around Deacon’s GI tract, and showed no signs of passing or dissolving on their own, Dr. Salazar decided it was time for surgery.
Before going to the operating room, Dr. Salazar consulted with two of his Children’s Wisconsin surgical colleagues — Kyle Van Arendonk, MD, and Casey Calkins, MD. A few weeks earlier, those two doctors had treated another boy at the Marshfield Clinic who had ingested water beads.
“They had to do two surgeries because not all water beads were discovered on the first surgery,” said Dr. Salazar. “Dr. Van Arendonk and Dr. Calkins said the beads expanded at different rates, which could have been why they were not detected on the first try. From them, I knew it was really important to be thorough as to not miss any beads during the surgery.”
On March 29, Dr. Salazar took Deacon in for surgery. Initially, he performed a laparoscopic procedure — he made several small incisions in Deacon’s abdomen and inserted a small metal tube with a camera on the end. Unfortunately, due to obstruction, the intestines were dilated and visibility was very low. Not wanting to risk missing any of the beads, Dr. Salazar and his team opted to move to an open surgery. He extended one of the incisions near Deacon’s belly button and examined the intestines to locate the beads. Once the beads were found, he made a small incision in the intestine and removed it.
In a three-hour surgery, Dr. Salazar removed four water beads from his bowels, which were now the size of large grapes.
While recovering in the hospital, Deacon was doing well, hitting all the milestones and even nursing.
But the next day, Deacon began throwing up again. More imaging — this time an ultrasound — showed what Dr. Salazar had worked so hard to prevent. Another bead was in Deacon’s intestine.
“I actually suggested using the ultrasound,” said Haley. “As a mom of five, I had seen lots of cool, detailed things on ultrasounds. I really appreciated how the team listened to me. It made me feel like we were on this journey together.”
Yet again, Deacon was taken back for surgery. This time, while another surgeon, Dr. David Lal, went in through the same incision as before, the gastroenterology team performed an endoscopic procedure that accessed Deacon’s intestines by inserting a thin, flexible camera down his throat. Not only were two more beads found, but one of them had ripped open the stitches from the first surgery and created a blockage in his intestines, which had caused an infection and tissue damage. In addition to the two beads, Dr. Lal ultimately had to remove 15 centimeters of his intestine.
After one final procedure a couple days later to close the incision, Deacon was well enough to go home. While Deacon only needed four days of rest and recovery, the situation was very serious. Most of the time he was in the hospital, Deacon was not able to eat. By the time he went home, he had lost nearly 10 percent of his total body weight.
“Any ingestion that leads to an operation is a major thing,” said Dr. Salazar, who is also an assistant professor of pediatric surgery at the Medical College of Wisconsin. “If the obstruction remained, he would eventually get severely dehydrated, his electrolytes would have been unbalanced, and it very easily could be a life-threatening situation.”
Today, Deacon is doing great — he just turned 1 and he’s back to his normal, happy self. Haley has thrown out all the water beads in the house and is working to raise awareness of their dangers so no other family has to go through what they did.
“There is not a lot of information out there about the dangers of these water beads and how they behave in the body,” said Haley. “I really appreciate how Children’s Wisconsin has worked to share what they learned with others — both in the medical community and in the general community.”
Dr. Salazar and his team — including Kathy Leack, MS, RN, clinical nurse specialist — shared Deacon’s story with SaferProducts.gov, the U.S Consumer Product Safety Commission, and the Children’s Wisconsin Injury Prevention team. They have also worked closely with the Wisconsin Poison Center — (800) 222-1222 — which is a resource for parents if they suspect their child has ingested any foreign substances. The Poison Center also tracks the data and shares it with the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration, as well as manufacturers when there are requests or trends to promote product safety.
“I’ve been a clinical nurse specialist with pediatric general surgery for many years and have seen many cases of injury or ingestion. This scenario was a new one for me,” said Kathy. “That prompted me to reach out. I think it is important that we always keep all kids in mind when we encounter new or infrequent events. I am pleased that the organization responded promptly to this concern.”
As for Dr. Salazar’s advice for parents and water beads, it’s simple. “I would recommend parents not buy water beads, especially if they have younger children,” he said. “If a parent witnesses an ingestion or is concerned about one, seek out medical care right away. Don't wait for your child to develop symptoms.”