Superabsorbent polymer (SAP) beads, widely marketed as toys, decorative products, and gardening materials, pose serious risks when ingested or aspirated. These beads expand rapidly upon contact with fluid, causing gastrointestinal obstruction or other complications. Although ingestion is reported across age groups, infants under 18 months are disproportionately vulnerable due to immature intestinal barriers, inability to verbalize ingestion, and delays in diagnosis. Despite increasing reports, comprehensive evidence on clinical features, diagnostic accuracy, management, and outcomes remains limited. This review aimed to systematically synthesize pediatric SAP-related cases, emphasizing age-specific differences in presentation and outcomes to inform clinical management and public health strategies.

Systematic searches of PubMed, Embase, Scopus, Web of Science, and CNKI (January 2005–March 2025) identified pediatric cases of SAP ingestion, aspiration, or insertion. Eligible reports provided demographic data, clinical presentation, imaging findings, interventions, and outcomes. Data were extracted independently by two reviewers, with consensus resolution. Cases were analyzed descriptively and stratified by age (<18 months vs. ≥18 months). Statistical comparisons employed chi-square and t-tests, with p < 0.05 considered significant.

Demographics.
A total of 97 pediatric cases from 53 reports were included. Infants <18 months accounted for 65.98% (n=64), mean age 13.2 ± 2.9 months, compared with 34.02% (n=33) older children, mean 43.8 ± 18.6 months. Infants were significantly overrepresented (p = 0.001). Overall, 53.6% were male (p = 0.02).

Clinical Presentation.
Vomiting was the most common symptom, affecting 95.3% of infants vs. 81.8% of older children (p = 0.001). Constipation (33.8% vs. 6.1%, p = 0.25), dehydration (37.5% vs. 12.1%, p = 0.55), and seizures/neurotoxicity (10.9% vs. 0%, p = 0.12) occurred almost exclusively in infants. Additional infant-specific features included abdominal tenderness (20.3% vs. 0%), abdominal mass (6.3% vs. 0%), and refusal to feed (7.8% vs. 0%). Symptom-to-admission interval was significantly longer in infants (2.9 ± 1.4 vs. 1.4 ± 0.7 days, p < 0.05), reflecting delayed recognition.

Diagnosis.
Ultrasound was the most sensitive modality, identifying beads in 69.7% (46/66) (p = 0.001). In contrast, plain radiography detected only 6.5% (5/77) (p = 0.56), while CT detected 43.8% (7/16) (p = 0.39). MRI was reported in one case, with positive findings (100%). Beads localized most frequently to the small intestine (84.5%), particularly the ileum, followed by jejunum (26.8%), duodenum (11.3%), stomach (4.1%), and colon (3.1%).

Management.
Conservative management was attempted in 21.6%, but 96.9% required surgical intervention. Laparotomy predominated (66.0%), with enterotomy (54.6%, p = 0.001) and crushing (11.3%, p = 0.45). Laparoscopy (19.6%) and endoscopy (5.1%) were less common. Mean admission-to-surgery interval was 4.4 ± 4.9 days, with mean delay from admission to intervention of 1.7 ± 1.1 days.

Complications and Outcomes.
Reoperation occurred in 8.2%, primarily due to forgotten beads or anastomotic leaks. Four forgotten beads were expelled spontaneously. Hospital stay averaged 5.6 ± 2.7 days without complications, extending to 16.7 ± 11.6 days with complications (p < 0.05). Overall, 91.8% were discharged uneventfully; three cases of hearing loss followed ear canal insertion. Mortality occurred in 1 infant (1.03%) due to postoperative sepsis.

SAP ingestion poses a serious and often life-threatening risk in children, particularly infants under 18 months, due to delayed diagnosis and increased severity of complications. Ultrasound proved the most effective non-invasive diagnostic tool, while laparotomy remains the mainstay of treatment. The high rate of surgical intervention and reoperation highlights the need for early detection, prompt management, and stricter regulation of SAP-containing products. Enhanced parental awareness and public health measures are urgently required to reduce preventable morbidity and mortality.