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Consumer and Competition Policy Directorate
Research into
the mouthing
behaviour of
children up
to 5 years old.
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July 2002
Research commissioned by the Consumer and Competition Policy Directorate, DTI.
Department of Trade and Industry
1 Victoria Street
London
SW1H 0ET
Carried out under contract by:
Dr Beverley Norris
Stuart Smith
Institute for Occupational Ergonomics
School of Mechanical, Materials, Manufacturing Engineering and Management
University of Nottingham
University Park, Nottingham, NG7 2RD
Tel: 0115 9514039 Fax: 0115 9514000
URN 02/748
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Contents
Page No
SUMMARY
1
CHAPTER 1.
1.1
1.2
1.3
Design of the research
Aims of this research
Data Collection
Experimental design
2
2
2
3
CHAPTER 2. Methodology
2.1
Development of materials
2.1.1 Pre-pilot trials
2.1.2 Pilot trials
2.2 Observation protocols
2.2.1 Timing of mouthing behaviours
2.2.2 Classifying what was mouthed
2.2.3 Classifying the type of mouthing behaviour
5
5
5
5
6
6
6
6
CHAPTER 3. Participant Details
3.1
Children's mouthing characteristics and child care details
7
7
CHAPTER 4. Results
4.1
Estimated daily mouthing time by item mouthed
4.2 Estimates of daily mouthing times according to what was mouthed and how
4.2.1 All items
4.2.2 Dummy/soother
4.2.3 Fingers
4.2.4 Toys
4.2.5 Other objects
4.2.6 Items not recorded
4.3 What was mouthed
4.3.1 Categories of toys and other objects mouthed
4.3.2 Mouthed toys and other objects by material
4.3.3 Items intended to be mouthed
4.3.4 Number of items mouthed
10
10
13
14
14
16
18
20
22
23
23
25
26
29
CHAPTER 5.
5.1
5.2
5.3
30
30
31
32
Validation
Analysis of mouthing time
Analysis of what was mouthed
Analysis of how the children mouthed
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CHAPTER 6. Discussion
6.1
Validity and reliability of the study
6.2 Mouthing times
6.2.1 Mean and maximum mouthing times
6.2.2 What is mouthed
6.2.3 How items are mouthed
33
33
33
33
34
34
CHAPTER 7.
7.1
7.2
7.3
7.4
7.5
7.6
7.7
36
36
36
37
38
38
39
43
43
44
44
7.8
Implications
Why children mouth
Overview of legislation and standards
Accident statistics on mechanical hazards
Mouthing times
Items mouthed
Hazards from items mouthed in this study
Reducing accident levels
7.7.1 Toys
7.7.2 Other objects
Using product features to deter mouthing
CHAPTER 8. Conclusions
45
CHAPTER 9. Recommendations
9.1
Toys
9.2 Other objects
47
47
47
CHAPTER 10. References
Appendix A: Observation recording form
Appendix B: Toy and objects details sheet
Appendix C: Child’s daily routine form
Appendix D: Questionnaire
Appendix E: Pictures illustrating mouthing behaviours
Appendix F: Examples of Toy Categories
Appendix G: Examples of "other objects" categories
49
50
51
52
53
56
57
69
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Summary
This report supplements "Report on research into the mouthing behaviour of children up to 5
years old – Executive Summary" (DTI, 2002).
This report presents background information to the study and further data and discussion from
the study, specifically:
i) Information regarding the methodology and protocols of the study
ii) Background data on the sample: Details of children’s mouthing habits, the child’s family, the
observers and their care and work circumstances and child care arrangements
iii) Estimated data on time spent each day mouthing on dummy/soothers, fingers, toys, and other
objects by how the items were mouthed, for each age group
iv) Details of the validation study
v) Discussion of the findings of the work
vi) Details of the items mouthed in the study
vii) Literature review of chemical and mechanical hazards from children’s toys and other plastic items
viii) The forms used in data collection.
Information presented in this report should be used in conjunction with the summary report described above.
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Chapter 1
Design of the Research
1.1 AIMS OF THIS RESEARCH
The research described in this report was designed to expand upon the knowledge of the
mouthing behaviour of children. The ages of children to be observed in this study ranged from
1 month to 5 years, to investigate the extent of exposure to products at this older age (given the
findings of Warren et al. (2000) that over 20% of the children in their study carried a non-nutritive
sucking habit past the age of 36 months). The overall aim of the project was to produce a figure
for the total time that children within this age range are expected to mouth items per day. This
could then be used to assess potential mechanical hazards posed by items on which children
were found to mouth.
1.2 DATA COLLECTION
The behaviour of young children may be greatly affected by all types of stimuli. In studies such
as this where we are attempting to gain information on normal and natural behaviour of children
it is imperative that the environment in which the data are gathered is as unaffected by the
observation as possible. This means that the child should be surrounded by things that they are
used to and know. For this reason, the research by Groot et al (1998) and Juberg et al (2001) both
rely on data being recorded by the parent(s) of each child using a diary format. The child is
obviously used to the presence of their parent and so natural behaviour may be assumed. The
use of a structured formal diary recording system serves to control the type of information that
the parent is recording and therefore provides a level of validity and reliability to the research.
Greater levels of reliability would possibly be obtained through the use of trained researchers
observing the child in their home environment, as the observer is trained to record certain types
of behaviour consistently, and so providing good repeatability of observation. The same is true
for the use of video recording equipment, where very short behaviours can be reliably recorded.
However, it is likely that a child will be very aware of a video camera and being filmed, and this
could lead to a change in behaviour. Likewise, the presence of a stranger in the home is likely to
alter the behaviour of the child being observed to a greater or lesser extent, so while the
reliability of the data may be high, the circumstances are less "realistic" and lower the validity of
the data. Another problem with video recording is that young children are often on the move,
which would make capturing every behaviour extremely difficult. For these reasons this research
used parents/carers as observers, to ensure children’s mouthing behaviour, and behaviour
generally, were as natural as possible to ensure high data validity.
Observations were carried out at home rather than nurseries or childcare establishments as the
home environment has a vast range of items that are accessible to children, not all of which are
intended for use by them. This is a worst case scenario but also realistic compared to more sterile
environments such as playgroups and nurseries where the contents of rooms are very carefully
and rigidly controlled.
Because of the factors mentioned above it was felt that an examination of the reliability of
parents as observers should be carried out. This has not been investigated by prior studies
which have also used parents as observers. A comparison of parent and trained observer data
collection was carried out on a sample of 25 children. Information on this validation part of the
research may be found in Section 5 of this report.
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1.3 EXPERIMENTAL DESIGN
Observation was carried out by parents in the child’s home for a total of five hours, split into 20
fifteen minute observation sessions. A period of two weeks was allowed for the observations to
be completed and the data returned. These observation sessions were to be spread out over
different times of the day and the week as follows:
i) Weekdays:
•
4 fifteen minute sessions between the child waking and 11am
•
4 fifteen minute sessions between 11am and 2 pm
•
4 fifteen minute sessions between 2pm and 6pm
•
4 fifteen minute sessions between 6pm and the child going to bed for the night
ii) Weekend:
•
1 fifteen minute session between the child waking and 11am
•
1 fifteen minute session between 11am and 2 pm
•
1 fifteen minute session between 2pm and 6pm
•
1 fifteen minute session between 6pm and the child going to bed for the night.
This gives in total 5 hours of observation time on each child. Observations could be done at
the discretion of the parent at any time within these zones. However, no more than two
observation sessions were allowed within the same time zone on any one day, and at least 30
minutes was required to be left between observation sessions. These provisions were included
in order to ensure data was gathered spread evenly across the days and week to gather a
representative picture of the child’s behaviour, and also to reduce potential errors from fatigue
caused by observation.
In each 15 minute observation session the following information was recorded:
•
the duration of each mouthing behaviour
•
what types of items were mouthed
•
the type of mouthing behaviour for each item mouthed
•
what was mouthed
•
which room of the house the observation was undertaken in
•
other people present in the room
•
whether the child was feeling unusually ill or tired during the observation
•
how long it had been since the child last ate and slept
•
what the child was doing during the observation.
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Information gathered over the whole study for each participant also included:
•
details of the child’s physical and psychological development
•
details of the child’s family (e.g. size, type of house lived in, social class)
•
details of the time the child spent outside of the family home in a care environment
(e.g. a nursery, playgroup)
•
details of toys mouthed by each child, part of toy mouthed and what each part mouthed
was made of
•
details of what other objects were mouthed and what they were made of
•
details of the child’s daily routine for the first and last days that they were observed i.e. what
time they got up and went to bed, and time spent eating and sleeping during the day.
The questionnaires and forms used to gather these data are presented in Appendices A, B, C and D.
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Chapter 2
Methodology
2.1 DEVELOPMENT OF MATERIALS
2.1.1 Pre-pilot trials
The use of a diary type observation recording system requires that the forms for recording
behaviour are simple and intuitive to complete. For this reason, a pre-pilot stage was undertaken.
Several alternative observation recording forms were produced and trialed in a local day nursery
by members of the Product Safety and Testing Group (PSTG) trained in observation protocols. For
the purposes of this stage, a single child was observed by both members of the PSTG for a
15 minute period, with the type and duration of each mouthing behaviour being recorded. This
process was repeated for each of the sample forms in turn. The results were then analysed for
the similarity of findings between the two members in terms of duration and type of behaviours.
Ease of use of each form was also assessed. One observation recording form was chosen to be
used in the pilot trials.
2.1.2 Pilot trials
The materials developed for use in the pilot trials were as follows:
•
•
•
•
•
•
Consent form
Set of written instructions
Observation recording form (as trialed in the pre-pilot stage)
Questionnaire
Daily routine form
Toy and object details forms.
Also included in the observation pack were a stop-watch, a pen and a freepost labelled
envelope for returning the completed observations.
The pilot trials followed the same format that was proposed for the main part of the study.
Participants were given the folder containing all the required materials (as listed above). They
were given only brief instructions about what they were being asked to do, as it was anticipated
that the only contact with participants taking part in the main study would be on the telephone,
and so the main instructions included in the observation pack would provide all of the necessary
information. Participants were given one week to complete the five hours observation time.
Seven parents were recruited to undertake the observations of their child for the purposes of
pilot testing the protocols and materials developed for the research. Two were unable to
complete the study for personal reasons, and results from one participant did not arrive back at
the PSTG until after the deadline for analysis, providing data from four participants for analysis.
The ages of the children observed were 4 months (female), 10 months (male), 27 months
(female) and 55 months (female). Feedback was obtained from each participant on the ease of
use of the materials contained within the observation pack which resulted in changes being
made to the documents. The final versions that were then used in the main study are presented
in Appendices A to D.
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2.2 OBSERVATION PROTOCOLS
2.2.1 Timing of mouthing behaviours
Participants in the research were each provided with a stopwatch for timing the duration of
mouthing events. They were not required to start, stop and reset the watch each time an event
occurred. Instead, the stopwatch was started at the beginning of the session and not stopped
until the 15 minutes was over. When the behaviour began, i.e. when the item first entered the
mouth, the time on the stopwatch was recorded on the observation form (to the nearest second),
and when that particular behaviour finished the time was again noted. This enabled a quicker
and more accurate time map of the child’s behaviour to be produced than by starting and
stopping the watch for each behaviour, especially for very short time behaviours.
2.2.2 Classifying what was mouthed
Products/items mouthed were classified into four categories: a dummy/soother, fingers,
toys, and other objects. The "fingers" category includes any part of the body of the child or of
another person, and whether an item was classified as a toy or other object was decided upon
by the observer.
2.2.3 Classifying the type of mouthing behaviour
Mouthing behaviour was classified into three categories. The instructions given to observers on
how to classify behaviour were as follows:
•
Licking/lip touching. This is where the item is placed to the front of the mouth, without
actually entering into the mouth. The child may be actually licking an object, or may be
touching the object to their lips. The time recorded should be from when the object first
touches the child’s mouth to when the object is no longer in contact with the mouth. If a
child is licking an object it may be difficult to record because of the short time period
involved. In this case note the time when the object is put close to the mouth to be licked,
and then taken away from the mouth
•
Sucking/trying to bite. The item is put directly into the mouth of the child. The child may
be sucking, holding the object in their mouth or trying to bite (gumming) the object
•
Biting or chewing. The item is directly in the mouth of the child. It is clear that the child is
biting or chewing on it.
It can be difficult to tell exactly what a young child is doing with an item if it is in or near their
mouth. Observers were told that unless they could see that actual biting or chewing was
happening they should tick the sucking/trying to bite category. If the child did more than one
action then they were asked to tick both, e.g. if they lick and then bite an item to put a tick under
both headings. Photographs were included illustrating the licking and sucking behaviours, as
shown in Appendix E, but not biting/chewing; this is difficult to illustrate as the item is shown as
just being at/inside the mouth without the movement which means chewing or biting is occurring.
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Chapter 3
Participant Details
236 children were observed by their parents. The number of children observed in each age
group were as follows:
Age group
1-3 months
3-6 months
6-9 months
9-12 months
12-15 months
15-18 months
18-21 months
21-24 months
2 years
3 years
4 years
5 years
Number of boys
3
7
6
6
5
5
11
6
18
13
17
14
Number of girls
6
7
9
11
11
9
5
6
21
18
12
10
Total
9
14
15
17
16
14
16
12
39
31
29
24
Table 1: Number of children observed in each age group
The upper age limit for each age group was the day before the final month age is reached,
e.g. 1-3 months includes children from one month to two months three weeks and six days.
3.1 CHILDREN'S MOUTHING CHARACTERISTICS AND CHILDCARE DETAILS
Background information was gathered on each child and their families, covering the child’s
physical development, mouthing habits of the child, and information on the child’s family.
The information collected is detailed below.
i) The mouthing habits of the child:
•
29% of children leave bite marks in toys
•
25% of children damage items by biting
•
28% of children use a dummy/soother
•
69% of children were/are breast-fed
ii) Who did the observations, who cares for the child, do they work:
•
99% of the observations were done by the child’s mother
•
97% of the children were (mainly) cared for by their mother
•
47% of main carers did not undertake paid work, 50% worked part-time, 3% worked full-time
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iii) Childcare arrangements:
Childcare arrangements for each child observed ranged from none (i.e. always at home with the
mother or father) to 5 days a week. Details are presented in Figure 1 of the type of childcare that
children taking part in the study attended. For each day of childcare separate values are
presented, for example, day one is not necessarily the same day for all children but instead means
that this represents a single day (or part of a day) where childcare occurs for that child.
Day one
none
creche
playgroup
relative / friend
childminder
nursery
Day two
none
creche
playgroup
relative / friend
childminder
nursery
Day three
none
creche
playgroup
relative / friend
childminder
nursery
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Day four
none
creche
playgroup
relative / friend
childminder
nursery
Day five
none
creche
playgroup
relative / friend
childminder
nursery
Figure 1: Childcare arrangements, by day, for children observed in the study.
As the number of observation days increases the number of children going to some form of
childcare decreases. Nursery is the most popular form of childcare.
Information was gathered on how much time during a typical normal day the child would have
available to spend mouthing, that is, time not spent sleeping or eating.
Table 2 presents the mean, minimum and maximum times available to mouth for each age group
Age group
1-3 months
3-6 months
6-9 months
9-12 months
12-15 months
15-18 months
18-21 months
21-24 months
2 years
3 years
4 years
5 years
Mean
8:22
9:09
9:21
9:06
9:15
9:50
10:10
10:12
10:45
11:10
11:31
11:22
Minimum
3:51
6:20
7:10
6:45
7:20
6:57
8:30
6:50
7:35
9:35
9:40
9:30
Maximum
13:30
12:48
11:50
11:23
11:05
12:42
12:15
13:39
13:20
13:50
14:10
14:00
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Chapter 4
Results
The following sections present results for:
4.1 Estimated mouthing time according to what was mouthed
4.2 Estimated mouthing time according to what was mouthed and how it was mouthed
4.3 A breakdown of what was mouthed, including by material (and if it is intended to be
mouthed – as far as can be known).
The estimated daily mouthing time is extrapolated from the mouthing behaviour recorded
over the five hours observation time. This is calculated as follows:
Observed mouthing time
* time available to mouth per day
Total time observed for
Where:
Observed mouthing time
= the amount of mouthing time recorded for each child
Total time observed for
= the total amount of time that they were observed for (5 hours)
Time available to mouth
per day
= the time available over the whole day for the child to mouth
i.e. the time during the day when they were awake but not eating
This calculates the average time spent mouthing per hour, multiplied by the total number
of hours each day that each child has available to mouth i.e. the number of hours they are
awake during the day but not eating. This has been based on the assumption that children are
likely to mouth at the same rate throughout the day. A Kruskal-Wallis1 test showed no
significant differences in observed mouthing between the different times of the day that
children were observed.
The presented mean values were calculated by dividing the total estimated mouthing time for
each category of item mouthed within each age group by the total number of subjects in that age
group. For example, for 3-6 months olds, only 4 subjects may have actually mouthed on a
dummy/soother but the total estimate of daily mouthing on a dummy/soother for that age was
divided by the total number of subjects in that age group (14) to give the mean value of daily
mouthing time that could be expected across that age group generally.
Because of the skewed2 nature of the raw data used to produce these estimates care should be
taken if using mean estimated daily mouthing values for the purposes of safety. This is because
the mean value may not reflect the true average or middle value of the sample for each age
group, depending on the degree to which the data are skewed.
4.1 ESTIMATED DAILY MOUTHING TIME BY ITEM MOUTHED
Figure 2 presents the mean estimated daily mouthing time for males and females combined for
each item mouthed (in hours:minutes:seconds). Each mean behaviour is the average time that a
child in each age group could be expected to mouth a given item over a normal day. Mean total
daily mouthing time is the time that any child could be expected to mouth, on anything, on
average over a normal day, and is the sum of mean mouthing time on all items for each age group.
1
The Kruskal-Wallis test is a non-parametric statistical test used to determine whether values of scores for three or more groups are significantly different, in
this case we have four groups, i.e. those observed between waking and 11am, between 11am and 2pm, between 2pm and 6pm, and 6pm until bedtime.
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2
The observed data have a skewed distribution because in general a high percentage of observed mouthing behaviours for each age group were very short in
nature (i.e. only a few seconds), with only a small percentage being observed with duration of between 1 and 15 minutes.
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Table 3 presents the mean and maximum estimated daily mouthing data, for males and females
combined. Data shown for males and females combined as a Mann-Whitney1 test showed no
statistically significant difference in mouthing time between the sexes.
The presented maximum values are the highest estimated daily mouthing times of any child in
each age category, for each item. It does not necessarily follow that the maximum values in each
age group for each item were exhibited by the same child, that is, one child may have mouthed
a lot on a dummy/soother while another child in the same age group may have mouthed a lot on
fingers. Also presented is the maximum estimated daily mouthing time for mouthing on all and
any items, in each age group, by any single child.
2:15:00
2:00:00
Mean mouthing time
1:45:00
Dummy / Soother
Fingers
Toys
Other objects
Not recorded
Total
1:30:00
1:15:00
1:00:00
0:45:00
0:30:00
0:15:00
5
4
3
2
21-24
18-21
15-18
12-15
9-12
6-9
3-6
1-3
0:00:00
Age category
Figure 2: Estimated mean daily mouthing time for each item mouthed and for all items (total
mouthing) (hours:minutes:seconds)
1
The Mann-Whitney test is a non-parametric statistical test used to determine if there are significant differences between scores or values of two groups
with different subjects in each group, i.e. males and females.
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Item mouthed
Age Group
1-3
3-6
6-9
9-12 12-15 15-18 18-21 21-24
2
months months months months months months months months years
3
years
4
years
5
years
Mean
0:47:13 0:27:45 0:14:36 0:41:39 1:00:15 0:25:22 1:09:02 0:25:12 0:32:55 0:48:42 0:16:40 0:00:20
Max
2:54:50 2:32:48 1:40:02 5:23:45 3:32:15 3:40:21 5:17:35 1:54:37 3:37:00 5:04:03 5:21:39 0:08:08
Mean
0:18:22 0:49:03 0:16:54 0:14:07 0:08:24 0:10:07 0:18:40 0:35:34 0:29:43 0:34:42 0:19:26 0:44:06
Max
0:50:31 1:36:02 1:17:13 1:38:42 0:35:53 0:39:21 1:20:29 1:53:10 2:27:48 3:18:33 2:51:01 9:02:45
Mean
0:00:14 0:28:20 0:39:10 0:23:04 0:15:18 0:16:34 0:11:07 0:15:46 0:12:23
Max
0:00:59 2:34:45 3:46:46 1:04:49 0:44:01 0:58:28 0:32:49 1:42:04 2:05:48 1:34:36 0:20:46 0:11:20
Mean
0:05:14 0:12:29 0:24:30 0:16:25 0:12:02 0:23:01 0:19:49 0:12:53 0:21:46 0:15:16 0:10:44 0:10:00
Max
0:28:11 0:36:39 1:10:23 1:31:00 1:03:03 1:38:02 1:06:21 0:40:20 2:57:58 1:25:29 1:16:40 0:52:47
Dummy/
Soother
Fingers
0:11:37 0:03:11 0:01:53
Toys
Other
Objects
Mean
0:00:45 0:00:24
-
0:00:01 0:00:02 0:00:08 0:00:11 0:14:13 0:02:40 0:00:01 0:00:05 0:02:58
Max
0:06:42 0:03:07
-
0:00:09 0:00:26 0:01:55 0:02:05 2:50:37 1:35:15 0:00:37 0:02:24 1:05:08
Not
Recorded
Table 3: Estimated mean and maximum daily mouthing time for all items mouthed
(hours:minutes:seconds).
Item mouthed
Age Group
1-3
3-6
6-9
9-12 12-15 15-18 18-21 21-24
2
months months months months months months months months years
Total
estimated
mouthing on
all items
3
years
4
years
Mean
1:11:48 1:57:41 1:35:11 1:35:16 1:36:01 1:15:13 1:58:49 1:43:39 1:39:27 1:50:19 0:50:05 0:59:17
Max
3:31:50 3:36:24 5:16:59 6:53:01 4:17:09 5:14:42 6:52:18 6:35:01 7:41:31
8:30:12 5:28:44 10:01:07
Table 4: Estimated mean and daily mouthing time on all items mouthed (hours:minutes:seconds).
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No clear age pattern exists for total mouthing time, with the highest estimated daily mean mouthing
time being exhibited by children aged 18-21 months. However, a Kruskal – Wallis test for
differences in observed mouthing time on all items between the age groups was significant (Chisquare = 30.050, d.f. = 11, p<0.01, 2-tailed).
When estimated daily mean mouthing on just toys and other objects is considered, a much clearer
pattern of change with age emerges. Figure 3 presents the estimated mean daily mouthing times for
mouthing on toys and other objects only for males and females combined.
1:10:00
Mean mouthing time
1:00:00
0:50:00
Toys
Other objects
Total
0:40:00
0:30:00
0:20:00
0:10:00
5
4
3
2
21-24
18-21
15-18
12-15
9-12
6-9
3-6
1-3
0:00:00
Age category
Figure 3: Estimated mean daily mouthing time for mouthing on toys and other objects and
total mouthing on these two items.(hours: minutes: seconds)
It is apparent that after the age of 6-9 months mouthing on toys and other objects generally
decreases.
4.2 ESTIMATES OF DAILY MOUTHING TIMES ACCORDING TO WHAT WAS MOUTHED AND HOW
Mouthing time is presented for mouthing on all items and also separately for each category
of item mouthed (for males and females combined), in the following sections:
4.2.1 All items
4.2.2 Dummy/soother
4.2.3 Fingers (and other parts of the body)
4.2.4 Toys
4.2.5 Other objects
4.2.6 Item not recorded
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4.2.1 All items
Estimated daily mean mouthing time is presented in Figure 4, for mouthing on all items, by how
items were mouthed at each age group.
2:15:00
2:00:00
Mean mouthing time
1:45:00
lick, suck and bite
suck and bite
lick and bite
lick and suck
bite
suck
lick
1:30:00
1:15:00
1:00:00
0:45:00
0:30:00
0:15:00
5
4
3
2
21-24
18-21
15-18
12-15
9-12
6-9
3-6
1-3
0:00:00
Age category
Figure 4: Estimated mean daily mouthing on all items by how they were mouthed
(hours:minutes:seconds).
Sucking is shown to be the most common mouthing behaviour at all ages.
4.2.2 Dummy/Soother
Figure 5 shows how dummies/soothers were mouthed at each age group, and Table 5
presents the estimated daily mouthing data shown in Figure 5.
1:20:00
Mean mouthing time
1:10:00
Not recorded
Lick, Suck and Bite
Suck and Bite
Lick and Bite
Lick and Suck
Bite
Suck
Lick
1:00:00
0:50:00
0:40:00
0:30:00
0:20:00
0:10:00
5
4
3
2
21-24
18-21
15-18
12-15
9-12
6-9
3-6
1-3
0:00:00
Age category
Figure 5: Estimated mean daily mouthing time for dummy/soothers according to how they
were mouthed (hours:minutes:seconds).
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Age Group
1-3
3-6
6-9
9-12 12-15 15-18 18-21 21-24
2
months months months months months months months months years
3
years
4
years
5
years
Mean
0:00:23 0:00:46 0:01:07 0:00:13 0:02:00 0:01:06 0:01:14
-
0:00:52 0:06:37 0:00:01 0:00:20
Max
0:03:23 0:05:58 0:09:45 0:03:29 0:31:56 0:15:30 0:17:59
-
0:21:58 2:05:03 0:00:02 0:08:08
Mean
0:45:14 0:25:43 0:08:27 0:41:00 0:51:12 0:16:56 1:00:24 0:21:56 0:27:58 0:37:58 0:16:39
-
Max
2:54:50 2:27:29 1:30:16 5:23:45 2:54:28 2:06:56 4:13:47 1:41:52 3:06:00 4:02:58 5:21:40
-
Lick
Suck
Mean
-
0:00:09 0:02:10 0:00:26 0:00:11 0:00:50 0:01:26 0:00:04 0:00:20 0:02:56
-
-
Max
-
0:01:20 0:32:25 0:04:10 0:02:38 0:11:46 0:17:59 0:00:46 0:04:23 0:47:05
-
-
Mean
-
-
-
-
0:01:36
-
-
-
0:00:23
-
-
-
Max
-
-
-
-
0:25:40
-
-
-
0:14:10
-
-
-
Mean
-
-
-
-
-
0:01:29
-
-
-
-
-
-
Max
-
-
-
-
-
0:20:44
-
-
-
-
-
-
Mean
-
-
-
-
0:04:55
-
0:01:58 0:03:13 0:00:44 0:01:11
-
-
Max
-
-
-
-
1:18:32
-
0:31:23 0:38:36 0:28:49 0:36:43
-
-
Mean
-
-
-
-
-
-
-
-
0:00:37
-
-
-
Max
-
-
-
-
-
-
-
-
0:24:15
-
-
-
Bite
Lick and
Suck
Lick and
Bite
Suck and
Bite
Lick, Suck
and Bite
Not
recorded
Mean
0:01:36 0:00:47 0:02:52
-
0:00:22 0:05:00 0:04:00
-
0:02:01
-
-
-
Max
0:14:28 0:05:37 0:34:14
-
0:05:22 0:45:26 0:32:25
-
0:32:00
-
-
-
Table 5: Estimated mean and maximum daily mouthing time on dummy/soothers by how they
were mouthed.
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Page 18
4.2.3 Fingers
0:50:00
0:45:00
0:40:00
0:35:00
0:30:00
0:25:00
0:20:00
0:15:00
0:10:00
0:05:00
0:00:00
5
4
3
2
21-24
18-21
15-18
12-15
9-12
6-9
3-6
Not recorded
Lick, Suck and Bite
Suck and Bite
Lick and Bite
Lick and Suck
Bite
Suck
Lick
1-3
Mean mouthing time
Figure 6 shows how fingers were mouthed at each age group, and Table 6 presents the estimated
daily mouthing data shown in Figure 6.
Age category
Figure 6: Estimated mean daily mouthing time for fingers according to how they are mouthed
(hours:minutes:seconds).
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Page 19
Age Group
1-3
3-6
6-9
9-12 12-15 15-18 18-21 21-24
2
months months months months months months months months years
3
years
4
years
5
years
Mean
0:05:20 0:07:06 0:00:30 0:03:41 0:00:57 0:01:58 0:01:49 0:07:34 0:09:06 0:07:10 0:05:21 0:07:44
Max
0:15:26 0:36:21 0:03:43 0:51:36 0:03:42 0:12:27 0:05:33 0:45:00 1:03:22 1:08:22 0:22:24 0:29:47
Mean
0:08:57 0:36:03 0:13:59 0:09:26 0:06:10 0:07:08 0:12:49 0:20:01 0:18:59 0:22:28 0:10:40 0:27:54
Max
0:35:37 1:22:08 1:17:13 1:31:44 0:47:16 0:33:38 1:17:47 1:45:22 2:22:06 3:18:06 2:04:34 8:39:09
Lick
Suck
Mean
-
0:01:46 0:00:30 0:00:09 0:00:23 0:00:20 0:02:52 0:01:11 0:00:07 0:03:47 0:00:14 0:00:47
Max
-
0:17:05 0:03:43 0:01:11 0:04:21 0:01:08 0:29:19 0:07:10 0:01:44 1:20:06 0:04:00 0:10:01
Bite
Lick and
Suck
Mean
0:04:02 0:02:28 0:00:59
-
0:00:37 0:00:06 0:00:18 0:06:39 0:00:57 0:01:02 0:02:54 0:03:58
Max
0:20:32 0:15:39 0:07:17
-
0:06:54 0:00:52 0:03:40 0:57:22 0:10:26
0:12:07 0:43:14 1:06:47
Mean
-
0:00:01 0:00:02
-
-
-
-
-
0:00:08 0:00:02 0:00:03 0:01:09
Max
-
0:00:19 0:00:23
-
-
-
-
-
0:03:55 0:00:46 0:01:24 0:27:29
Mean
-
0:01:08 0:00:02 0:00:23 0:00:11 0:00:04 0:00:11 0:00:07 0:00:11
-
0:00:05
-
Max
-
0:10:04 0:00:31 0:05:19 0:05:08 0:00:56 0:02:43 0:01:20 0:02:41
-
0:02:11
-
Mean
-
0:00:02 0:00:01
-
0:00:04
-
-
-
0:00:08 0:00:02 0:00:09 0:02:03
Max
-
0:00:26 0:00:13
-
0:00:31
-
-
-
0:02:42
Lick and
Bite
Suck and
Bite
Lick, Suck
and Bite
Not
recorded
0:01:17 0:03:21 0:45:28
Mean
0:00:03 0:00:28 0:00:18 0:00:27 0:00:01 0:00:30 0:00:40 0:00:02 0:00:06 0:00:11 0:00:01 0:00:31
Max
0:00:22 0:03:07 0:02:40 1:38:42 0:00:09 0:05:14 0:05:23 0:00:18 0:03:19 0:04:20 0:00:07 0:12:27
Table 6: Estimated mean and maximum daily mouthing time on fingers by how they were
mouthed (hours:minutes:seconds).
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Page 20
4.2.4 Toys
Figure 7 shows how toys were mouthed at each age group, and Table 7 presents the estimated
daily mouthing data shown in Figure 7.
0:45:00
Mean mouthing time
0:40:00
Not recorded
Lick, Suck and Bite
Suck and Bite
Lick and Bite
Lick and Suck
Bite
Suck
Lick
0:35:00
0:30:00
0:25:00
0:20:00
0:15:00
0:10:00
5
4
3
2
21-24
18-21
15-18
9-12
6-9
3-6
1-3
0:00:00
12-15
0:05:00
Age category
Figure 7: Estimated mean daily mouthing time for toys according to how they are mouthed
(hours:minutes:seconds).
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Page 21
Age Group
1-3
3-6
6-9
9-12 12-15 15-18 18-21 21-24
2
months months months months months months months months years
3
years
4
years
5
years
Mean
0:00:12 0:03:30 0:07:07 0:04:18 0:01:49 0:02:00 0:01:49 0:03:26 0:04:58 0:03:33 0:01:31 0:00:41
Max
0:00:59 0:18:06 0:30:11 0:37:08 0:06:20 0:12:50 0:12:51 0:18:33 0:49:00 0:24:35 0:13:30 0:09:03
Lick
Mean
-
0:06:51 0:12:05 0:12:37 0:05:36 0:05:09 0:04:04 0:03:43 0:02:54 0:02:33 0:00:59 0:00:40
Max
-
0:18:51 0:45:36 1:01:16 0:23:58 0:23:38 0:14:53 0:08:08 0:26:57
Suck
0:18:10 0:06:59 0:05:21
Mean
0:00:02 0:03:30 0:05:22 0:05:11 0:04:15 0:06:46 0:04:09 0:03:23 0:03:56 0:05:11 0:00:33 0:00:29
Max
0:00:22 0:18:06 0:44:31 0:16:47 0:24:21 0:39:27 0:26:46 0:30:15 0:58:28 1:30:49 0:09:03 0:06:42
Bite
Lick and
Suck
Mean
-
0:01:43 0:11:38 0:00:20 0:01:10 0:01:06 0:00:35 0:00:48 0:00:13 0:00:13 0:00:06 0:00:02
Max
-
0:17:53 2:30:23 0:02:47 0:10:02 0:08:55 0:06:34 0:06:54 0:07:34 0:05:12 0:01:53 0:00:39
Mean
-
0:00:54 0:00:14 0:00:02 0:00:16 0:00:28 0:00:11 0:02:28 0:00:01 0:00:05
-
-
Max
-
0:07:29 0:03:06 0:00:42 0:03:21 0:06:20 0:02:02 0:29:37 0:00:42 0:02:40
-
-
Mean
-
0:02:04 0:01:35 0:00:17 0:01:25 0:00:08 0:00:01 0:01:16 0:00:05 0:00:02 0:00:01 0:00:01
Max
-
0:24:07 0:09:57 0:04:48 0:44:01 0:01:55 0:00:12 0:08:50 0:02:11
Mean
-
0:02:54 0:00:07 0:00:01 0:00:30
-
0:00:14 0:00:34 0:00:01
-
0:00:02
-
Max
-
0:34:35 0:01:01 0:00:10 0:04:50
-
0:03:51 0:04:21 0:00:21
-
0:00:53
-
Mean
-
0:00:14 0:01:20 0:00:18 0:00:17 0:00:56 0:00:04 0:00:09 0:00:15 0:00:01 0:00:01 0:00:01
Max
-
0:01:17 0:07:23 0:01:34 0:03:10 0:10:34 0:00:57 0:01:28 0:07:58 0:00:05 0:00:07 0:00:27
Lick and
Bite
Suck and
Bite
Lick, Suck
and Bite
Not
recorded
0:01:12 0:00:08 0:00:18
Table 7: Estimated mean and maximum daily mouthing time on toys by how they were mouthed
(hours:minutes:seconds).
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4.2.5 Other objects
Figure 8 shows how other objects were mouthed at each age group, and Table 8 presents the
estimated daily mouthing data shown in Figure 8.
0:30:00
Mean mouthing tim e
0:25:00
Not recorded
Lick, Suck and Bite
Suck and Bite
Lick and Bite
Lick and Suck
Bite
Suck
Lick
0:20:00
0:15:00
0:10:00
5
4
3
2
21-24
18-21
15-18
9-12
6-9
3-6
1-3
0:00:00
12-15
0:05:00
Age category
Figure 8: Estimated mean daily mouthing time for other objects according to how they are
mouthed (hours:minutes:seconds).
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Age Group
1-3
3-6
6-9
9-12 12-15 15-18 18-21 21-24
2
months months months months months months months months years
3
years
4
years
5
years
Mean
0:01:23 0:05:03 0:03:27 0:02:17 0:02:13 0:06:21 0:02:46 0:02:28 0:10:13 0:06:14 0:03:28 0:02:16
Max
0:03:10 0:30:01 0:19:35 0:08:45 0:23:21 0:15:52 0:22:58 0:10:32 2:12:57 1:01:36 0:34:17 0:21:21
Mean
0:03:32 0:04:17 0:10:44 0:09:37 0:04:36 0:11:01 0:07:04 0:08:02 0:06:26 0:04:11 0:02:35 0:02:37
Max
0:27:37 0:10:53 0:49:18 1:23:19 0:21:16 0:42:50 0:49:05 0:37:30 0:39:38 0:23:31 0:29:30 0:24:24
Mean
0:00:03 0:00:30 0:05:29 0:03:20 0:03:18 0:04:07 0:07:13 0:01:27 0:03:21 0:03:52 0:01:49 0:03:26
Max
0:00:26 0:05:28 0:42:23 0:11:47 0:13:19 0:15:52 0:42:44 0:05:42 0:42:37 0:18:25 0:19:39 0:46:34
Mean
0:00:13 0:01:08 0:02:13 0:00:39 0:00:04 0:00:05 0:01:27 0:00:17 0:00:24 0:00:13 0:01:43 0:00:28
Max
0:01:58 0:08:56 0:22:29 0:05:43 0:00:51 0:00:44 0:18:06 0:03:24 0:04:12 0:06:33 0:29:59 0:09:01
Lick
Suck
Bite
Lick and
Suck
Mean
-
0:01:04 0:00:43
-
0:00:13 0:00:29 0:00:03 0:00:08 0:00:15 0:00:06
-
0:00:34
Max
-
0:14:57 0:08:53
-
0:02:36 0:06:44 0:00:47 0:01:41 0:07:08 0:02:13
-
0:08:40
Mean
-
0:00:03 0:01:00 0:00:20 0:01:04 0:00:21 0:00:45 0:00:30 0:00:44 0:00:04 0:00:51 0:00:34
Max
-
0:00:45 0:07:28 0:03:05 0:05:28 0:02:08 0:09:12 0:06:03 0:17:11
Mean
-
-
0:00:24 0:00:04 0:00:27
-
0:00:16
-
0:00:12
-
0:00:09
-
Max
-
-
0:03:00 0:01:01 0:05:24
-
0:04:13
-
0:02:46
-
0:02:41
-
Lick and
Bite
Suck and
Bite
Lick, Suck
and Bite
Not
recorded
0:01:27 0:20:29 0:12:05
Mean
0:00:03 0:00:23 0:00:29 0:00:08 0:00:07 0:00:37 0:00:15 0:00:01 0:00:12 0:00:35 0:00:09 0:00:04
Max
0:00:26 0:03:16 0:03:13 0:00:56 0:01:19 0:02:58 0:03:49 0:00:13 0:02:34 1:25:26 0:01:55 0:01:36
Table 8: Estimated mean and maximum daily mouthing time on other objects by how they were
mouthed (hours:minutes:seconds).
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4.2.6 Items not recorded
Table 9 presents the data where what was being mouthed was not recorded by the observer. These
data are not presented graphically due to the small quantities.
Age Group
1-3
3-6
6-9
9-12 12-15 15-18 18-21 21-24
2
months months months months months months months months years
3
years
4
years
5
years
Mean
0:00:01
-
-
-
-
-
0:00:08
-
-
-
-
0:00:02
Max
0:00:07
-
-
-
-
-
0:01:06
-
-
-
-
0:00:41
Mean
-
0:00:06
-
0:00:01
-
0:00:11 0:00:04
-
-
-
0:00:03
-
Max
-
0:01:26
-
0:00:07
-
0:01:56 0:00:59
-
-
-
0:02:25
-
Mean
-
-
-
-
-
-
-
-
-
-
-
-
Max
-
-
-
-
-
-
-
-
-
-
-
-
Mean
0:00:41
-
-
-
-
-
-
-
-
-
-
-
Max
0:06:12
-
-
-
-
-
-
-
-
-
-
-
Mean
-
-
-
-
-
-
-
-
-
-
-
-
Max
-
-
-
-
-
-
-
-
-
-
-
-
Mean
-
0:00:03
-
-
-
-
-
-
-
-
-
-
Max
-
0:00:47
-
-
-
-
-
-
-
-
-
-
Mean
-
-
-
-
-
-
-
-
-
-
-
-
Max
-
-
-
-
-
-
-
-
-
-
-
-
Lick
Suck
Bite
Lick and
Suck
Lick and
Bite
Suck and
Bite
Lick, Suck
and Bite
Not
recorded
Page 24
Mean
0:00:03 0:00:16
-
-
0:00:02
-
-
0:14:13 0:02:40 0:00:01
-
0:02:56
Max
0:00:23 0:03:07
-
-
0:00:26
-
-
2:50:37 1:35:15 0:00:37
-
1:05:08
Table 9: Estimated mean and maximum daily mouthing time on items not recorded by how the items
were mouthed (hours:minutes:seconds).
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Page 25
4.3 WHAT WAS MOUTHED
4.3.1 Categories of toys and other objects mouthed
The toys and other objects most commonly mouthed across the whole sample are shown in Tables
10 and 11, together with the number of times each of the item categories were mouthed by any
child in the study. The miscellaneous categories are made up of items that did not fit into any of
the other categories and which were listed as being mouthed only once across the whole sample.
A few items are listed both as toys and other objects e.g. books, jigsaws. The items were classified
as such by the observers and will be the result of their perception, and not the authors’, of whether
or not the items were toys.
Rank
Toy Category
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
Miscellaneous
Animals
Food/crockery/cutlery
Vehicles - cars/boats/trains/motorbikes/tractors/fire engines
Building bricks/blocks/shapes
Dolls & accessories
Soft/cuddly toys
Books
Toy figures & accessories
Rattles
Balls
Tools/guns
Drawing/painting including pens/pencils/crayons
Musical instruments including microphones, whistles
Telephones
Stacking cups/rings
Bath toys
Cameras/computers/recording
Jigsaws
Teethers
Household items e.g. vacuum cleaner/iron
Water toys
Keys
Letters/numbers
Modelling clay
Walkers
Puzzles
Bubble blowers
Toy/shape sorters
Balloons
Money
Dressing up
Bikes
Marbles
Tools for modelling clay
TOTAL
Table 10: The categories of toys mouthed across the whole sample
Number of
times mouthed
190
155
123
122
109
106
96
82
65
59
44
42
42
34
33
23
21
20
20
14
11
9
9
8
8
6
6
6
5
5
4
4
3
2
2
1488
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Object category
Page 26
Number of
times mouthed
Object category
Clothing
241
Money/coins
9
Miscellaneous
150
Bath
8
Soft furnishings
144
Box
8
Beakers/cups
94
Felt tip pen
7
Paper/card/books/magazines
78
Bowls/dishes/plate/egg cup
7
Knives/forks/spoons
62
Clothes fastenings
7
Brushes (hair/tooth/floor/paint/washing up)
60
Plastic red noses
7
Kitchen utensils
33
Tin/metal containers
7
Bottles and tops (material unknown)
37
Bubbles (in bath)
7
Pens
36
Peg
7
Shoes/slippers/shoe laces
35
Fridge magnet
7
Remote controls (TV and video)
32
Watches
6
Packaging (material unknown)
29
Straw
6
Stop watch inc cord
28
Furniture (solid)
27
Child care articles
26
Pencils
26
Video boxes
25
Sofa/settee
20
Plastic containers (probably hard plastic)
20
Sponge/squeegee
20
Bottles and tops (probably plastic)
19
Tissues/paper towels/toilet paper
17
Cardboard packaging/tubes
16
Keys
16
Food packaging
Carpet
6
Animals/pets
5
Box for cd/cassette/video tapes
5
Necklace
5
Glasses/sunglasses
4
Swimming goggles
4
Badge
3
Bag
3
Bean bag
3
Coat hangers
3
Folder
3
Glass
3
Spectacles case
3
15
Packaging (probably soft plastic)
3
Architectural fittings
15
Photo
3
Phones
14
Photo frame
3
Balloon
14
Eraser
3
TV and video
14
Ruler
3
Pen tops
13
Stones
3
Baby wipes
12
Cotton wool
2
Wood/cane
12
Electrical
2
Chairs
12
Flowers
2
Crayons
11
Handbag
2
Hair decorations
10
Lipstick/lip salve
2
Electrical/phone cables
10
Pet food
2
Straps
10
Videos
2
Babies' bottles
10
TOTAL
1665
Table 11: Categories of other objects mouthed across the whole sample
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Number of
times mouthed
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A full list of the items that appear in each of the toy and other object categories may be found in
Appendices F and G. As these tables show, a huge variety of items were mouthed by the children in
this study. Toy animals, toy vehicles, toy food and building blocks were the most commonly
mouthed types of toy. In the other objects categories, clothing and soft furnishings (such as duvets)
are two of the largest categories.
4.3.2 Mouthed toys and other objects by material
Information was gathered on what the toys and other objects that were mouthed in this research
were made from. The materials were classified as follows:
•
•
•
•
•
•
•
•
•
•
Ceramics
Fabrics
Glass
Metals
Miscellaneous
Natural (e.g. soil, animals)
Plastic
Rubber
Wood
Wood pulp products (e.g. paper).
pu
lp
oo
d
W
oo
d-
W
r
bb
e
Ru
tic
Pl
as
al
ur
Na
t
ne
ou
s
l
el
la
et
a
M
isc
M
ss
Gl
a
br
Fa
am
Ce
r
ic
50
45
40
35
30
25
20
15
10
5
0
ics
Percentage of items mouthed
Within many of these categories are sub-categories, e.g. within fabric are cotton and leather.
Figure 9 shows the percentage of the toys and objects mouthed made out of these materials.
Type of material
Figure 9: Percentage composition of toys and other objects mouthed.
Plastics accounted for nearly half of all the toys and other objects mouthed in this research
(49.2%), with the next highest being fabrics (24%). No other material accounted for greater than
10% of the items mouthed (this excludes dummies/soothers).
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The materials of the toys and other objects mouthed were then analysed by age. Figure 10 shows
the percentages by material for each age group.
% of items mouthed
100
90
Ceramic
Fabric
80
70
60
Glass
Metal
Miscellaneous
50
40
30
20
Natural
Plastic
Rubber
Wood
10
0
5
4
3
2
21-24
18-21
15-18
12-15
9-12
6-9
3-6
1-3
Wood-pulp
Age group
Figure 10: Percentage of items of different types of material mouthed in each age group.
This illustrates that for all age groups plastic and fabrics are the only items mouthed more than
10% of the time at any age. Also interesting is the cross-over from ages 3-6 to 6-9 months, where
plastic items become more mouthed than fabric items. At age 1-3 months fabrics account for 80%
of all items mouthed, but at age 6-9 months this has dropped to 29%, after which it stays
reasonably constant at approximately 20% of all items. Plastics account for only 15% of items
mouthed at age 1-3 months, but by age 6-9 months this has risen to 50%, a level approximately
sustained up to 5 years of age.
4.3.3 Items intended to be mouthed
All of the toys and other objects that were mouthed by children in this study were judged as to
whether they were items that are intended to be mouthed, for example teethers, rattles, cups,
bottles and drinking straws. This classification was made on informed opinion only as parents were
not asked to indicate whether or not the items were intended to be mouthed. Table 12 shows the
items recorded in the study that were considered as intended to be mouthed, by each age group.
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Mouthed by age group
1-3
3-6
6-9
9-12 12-15 15-18 18-21 21-24
2
months months months months months months months months years
✓
✓
✓
✓
✓
✓
✓
✓
Bottle
✓
✓
✓
✓
✓
✓
✓
Cup
✓
✓
✓
✓
✓
✓
Spoon
✓
✓
✓
✓
✓
✓
✓
Rattle
✓
✓
✓
✓
✓
✓
Balloon
✓
✓
✓
✓
✓
Play food
✓
✓
✓
✓
✓
Beaker
✓
✓
✓
✓
✓
Teether
✓
✓
✓
Toothbrush
✓
✓
✓
Fork
✓
✓
Tin/penny whistle
✓
Doll’s bottle
✓
Straw
✓
Knife
✓
Teaset
Table 12: Items intended to be mouthed which were mouthed in this study.
Ice lolly stick
Mug
Bubble pipe
Can
✓
Toy spoon
3
years
4
years
5
years
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
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This shows that feeding items such as bottles, cups, beakers and cutlery, and child care items
such as teethers and rattles were mouthed by nearly all age groups. Of concern here is that
balloons were mouthed by nearly all ages over 6 months. Table 13 presents those items
considered as intended to be mouthed (i.e. everything including those items in Table 10) as
a percentage of all items mouthed, according to age group.
Age Group
1-3 months
3-6 months
6-9 months
9-12 months
12-15 months
15-18 months
18-21 months
21-24 months
2 years
3 years
4 years
5 years
Items intended to be mouthed
as a % of all items mouthed
25
13
11
12
15
15
21
20
18
19
11
11
Table 13: Items intended to be mouthed as a percentage of all items mouthed.
These data show that at least an estimated 75% of the items that were mouthed by children
in this study were considered not intended to be mouthed.
An analysis was made of how many of the plastic items were considered as intended to
be mouthed, as shown in Table 14.
Age Group
1-3 months
3-6 months
6-9 months
9-12 months
12-15 months
15-18 months
18-21 months
21-24 months
2 years
3 years
4 years
5 years
Items intended to be mouthed
as a % of all plastic items mouthed
100
31
18
16
21
22
31
28
29
29
18
15
Table 14: Items intended to be mouthed as a percentage of all plastic items mouthed.
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For age group 1-3 months all of the plastic items mouthed were intended to be mouthed. After this age
a maximum of only 31% of the plastic items mouthed were considered as intended to be mouthed.
4.3.4 Number of items mouthed
30
25
20
15
10
5
4
3
2
21-24
18-21
15-18
12-15
9-12
6-9
0
3-6
5
1-3
Mean number of items mouthed
Within each age group for each subject the total number of toys and other objects mouthed by each
child was calculated, as a way of assessing the variety and range of items children will put into their
mouths. A mean value for each age group was then calculated and these data are presented in
Figure 11.
Age category
Figure 11. Mean number of toys and other objects mouthed within each age group.
This shows that the average number of items mouthed each day per child peaks at age 6-9 months
(26 items), and then gradually decreases as the age of the child increases. Children aged 1-3 months
mouth the fewest number of items on average (3 items).
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Chapter 5
Validation
In order to assess the validity and reliability of the observation method used in this study the
observations were repeated with a random selection of 25 of the sample, using parental
observation, plus two alternative methods; trained observers and video recording. For each
person a single 15-minute observation session of their child was undertaken at their home. The
mouthing behaviour of the child in this 15 minute session was recorded simultaneously by the
parent, a trained observer and also captured on video. All protocols were the same as the main
data gathering part of the study. The data gathered from the three different observation methods
were then compared.
5.1 ANALYSIS OF MOUTHING TIME
Table 15 shows the mouthing behaviours recorded by a trained observer, by the parent and by
video for the group of 25 children as a whole.
Trained observer
Parent
Video
110
114
160
Total observed mouthing
time for all children
19:44
19:44
24:15
Mean observed
mouthing time
0:23
0:23
0:21
Standard deviation
mouthing time
1:02
1:00
0:41
Maximum observed
mouthing time
9:43
9:43
6:07
Total number of behaviours
observed in 15 minutes
for all children
Table 15: Comparison of mouthing summary statistics for the three observation methods.
All times are in minutes: seconds format.
The number of behaviours and mouthing times observed by the trained observer and the parent
were very similar, with total mouthing time, mean mouthing time and maximum observed
mouthing time all being exactly the same, and number of behaviours observed and standard
deviation being very similar.
As anticipated, the video analysis captured more incidences of mouthing behaviour and thus
potentially more mouthing time than the direct observation methods. Additionally, mean and
standard deviation mouthing times were lower than those found by direct observation. This
would be expected as video analysis allows for much more accurate observation and time
capture than direct observation, with the lower standard deviation indicating less variance in
the range of mouthing behaviours than observed by trained observer or parent.
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Interestingly, the maximum observed mouthing time was over three minutes lower for
video analysis observation than direct observation. This is because during the video analysis
it was noted that the mouthing behaviour stopped and then started again, but with only a very
short motion away from the mouth which would not have been (and was not) picked up by
direct observation.
A one way analysis of variance (ANOVA)1 was conducted on the mouthing time data to
determine if there were any statistically significant differences between the data gathered by
the three methods. No significant difference was found.
5.2 ANALYSIS OF WHAT WAS MOUTHED
Number of observations
Observations of what was mouthed (i.e. dummy/soother, fingers, toys or other object) were made
and compared across the three groups to determine similarity of observation. Figure 12 illustrates the
numbers of observations recorded for each type of item mouthed as recorded by the three methods.
180
160
140
120
100
80
60
40
20
0
Other object observations
Toy observations
Finger observations
Dummy observations
Trained observer
Parent
Observation typ e
Video
Figure 12. Illustration of what was mouthed by the observed children as recorded by trained
observer, parent and video analysis.
Three of the observations made by parent and video analysis did not record what was mouthed by
the child. It is unknown why the parent did not record what was mouthed, while the video analysis
could not see what was being mouthed due to the child being obscured from view. As the video
analysis observed more behaviours it follows that more behaviours were counted for each type. It is
interesting to note that while the two direct observation methods (i.e. parent and trained observer)
counted the same number of dummy and toy observations, the number of finger and other object
observation differed by five and four counts respectively. This may be because in these cases the
other objects mouthed were small items, which made it difficult to make a distinction between the
child mouthing the small object held in their hand or the hand itself.
1
An analysis of variance (ANOVA) is a parametric test used to determine whether values or scores for three or more groups of subjects are significantly different.
This is the parametric equivalent of the Kruskal-Wallis test.
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5.3 ANALYSIS OF HOW THE CHILDREN MOUTHED
Number of observations
A comparison was also made of how the mouthing behaviour of the children was classified, i.e.
into the categories of licking, sucking or biting. Figure 13 graphically shows this comparison.
180
160
140
120
100
80
60
40
20
0
Lick and suck behaviours
Biting behaviours
Sucking behaviours
Licking behaviours
Trained observer
Parent
Observation type
Video
Figure 13. Illustration of how the observed children mouthed as recorded by trained observer,
parent and video analysis.
Again, video analysis counted more behaviours and so numbers of types of mouthing behaviour
will be higher overall. Three cases of the type of mouthing behaviour were not differentiated by
video analysis (again because of the impaired view of the child) and 24 cases were not
differentiated by parental observations.
This investigation into the validity of the data gathering protocols show that the data gathered in this
study are reliable. As expected video observations captured more behaviours and longer mouthing
times than direct observations, but the presence of the video camera also changes the behaviour of
the child. The similarity of the number of mouthing behaviours and the total mouthing times
observed by the parents and the trained observer mean that the observations of the parents used
to produce the estimates of daily mouthing can be treated with a high degree of confidence.
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Chapter 6
Discussion
This section is split into two parts. First, there is a brief discussion of the methodology and validity
of the study, and then a discussion of the results in terms of the mouthing times recorded, what was
mouthed and how.
6.1 VALIDITY AND RELIABILITY OF THE STUDY
The validation study showed that there was very good agreement between the trained observers
and the parents who were used to observe in this study. Parental observation at home was chosen
as the least intrusive and least disruptive method of recording children’s natural and normal
behaviour. The only limitation to the use of parents (and trained observers for that matter) was
when compared to video observation. Here it was found that through the use of video analysis
software, very short breaks in mouthing behaviours, when a child may have momentarily moved an
item out of, or away from their mouth, could be recorded. These could not be recorded by the normal
eye. However, no significant differences were found between the three methods of observation.
6.2 MOUTHING TIMES
6.2.1 Mean and maximum mouthing times
Overall, mouthing generally shows little relationship with age. The results presented earlier show
that for overall mouthing (i.e. on all items including fingers) the highest estimated mean daily
mouthing time on all items is for the 18-21 month age group (1:58:49), and the lowest at age 4
(0:50:05). This is probably due to the wide variety of items mouthed, including clothes, fingers and
thumbs. Dummy use does not show an obvious relationship with age.
When it comes to toys and other objects around the home, children aged 6-9 months mouth more
than any other age group, and mouthing time generally decreases from this age (estimated mean
daily mouthing time 1:03:40 hours:minutes:seconds). Children aged 1-3 months mouth the least on
these items (0:05:28). This is to be expected as children at this age are reliant on their parents to
provide them with items to play with (and thus to mouth on) as they are not mobile and able to
move about the house to find new items. The majority of "other objects" mouthed by children in this
1-3 months age group were their parents’ clothing.
It is important however to consider the maximum estimated mouthing times which children may mouth
on items over a whole day, as this represents the highest likely exposure to mouthed hazards, and
present a slightly different picture to the mean mouthing times. The highest times are presented below:
•
Highest maximum daily mouthing time on dummy/soother - age group 9-12 months (5:23:45)
•
Highest maximum daily mouthing time on fingers - age group 5 years (9:02:45)
•
Highest maximum daily mouthing time on toys - age group 6-9 months (3:46:46)
•
Highest maximum daily mouthing time on other objects - age group 2 years (2:57:58).
Maximum estimated daily mouthing on a dummy/soother is higher than on fingers for all ages
except 5 year olds, but there is no real pattern of increase or decrease with age. Maximum mouthing
on fingers is approximately the same up to 15-18 months, and then steadily increases to peak at
5 years. Again, this increase is probably attributable to the presence of children in the sample who
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have a thumb sucking habit. Maximum mouthing on toys follows a pattern of increase (to 6-9 months)
- decrease (to 18-21 months) - increase (to age 2) - decrease (to age 5). Finally, maximum mouthing
on other objects stays generally quite level to age 21-24 months, where it then increases to peak at
age 2, and then decreases to approximately the same level as before.
A possible "worst case" of mouthing on toys and other objects for each age could be taken by adding
the two values together. Although the maximum mouthing estimates for mouthing on each item
does not necessarily come from the same child this would give an indicator of a value for daily
mouthing that could possibly be reached. Adding together the estimated maximum mouthing values
for toys and other objects for each age group, we find that the highest daily mouthing time is for
2 year olds (5:03:46) and the 6-9 month olds (4:57:09), with the lowest value for children aged
1-3 months (0:29:10).
6.2.2 What is mouthed
The focus of this research is on children’s mouthing time on toys and other objects as they are
probably the most likely to offer risk, both chemical and mechanical, compared to mouthing on
dummies/soothers or body parts, the two other categories of mouthed items. It has been assumed
for this discussion that dummies are items intended to be mouthed, and as such will be regulated by
appropriate standards.
The highest mean mouthing time on each category occurs in different age categories, but all are
mouthed most by children under 1 year, except dummies/soothers. Toys and other objects are both
mouthed most by age group 6-9 months:
•
Highest mean daily mouthing time on dummy/soother - age group 18-21 months(1:09:92)
•
Highest mean daily mouthing time on fingers - age group 3-6 months (0:49:03)
•
Highest mean daily mouthing time on toys - age group 6-9 months (0:39:10)
•
Highest mean daily mouthing time on other objects - age group 6-9 months (0:24:30).
Children aged from 3 to 15 months were found to mouth more on toys than other objects, a pattern
which was reversed from age 15-18 months to 5 years (with the exception of children aged 21-24
months). Such a pattern of mouthing can be explained by the fact that as children learn to walk and thus
become more mobile they become less reliant on their parents to provide them with items intended for
play, and are more able to move around the house exploring and finding new items of interest.
6.2.3 How items are mouthed
Figure 14 shows the percentage contribution to total mouthing for each age group and each type of
mouthing behaviour.
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100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
5
4
3
2
21-24
18-21
15-18
12-15
9-12
6-9
3-6
lick, suck and bite
suck and bite
lick and bite
lick and suck
bite
suck
lick
1-3
% contribution to total mouthing
of type of mouthing
22010 DTI Mouthing Report
Age category
Figure 14. Percentage contribution to total estimated daily mouthing of each recorded type of
mouthing behaviour for all items.
This clearly shows that when considering all types of item mouthed sucking behaviours are exhibited
the most for all age groups, followed by licking and then biting. Licking and sucking behaviours
account for at least 64% of all mouthing for all age groups, with licking, sucking and biting behaviours
accounting for at least 79% for all age groups.
When each category of items mouthed is analysed, mouthing on dummy/soother and fingers had
fewer types of mouthing, mainly sucking, than mouthing on toys and other objects where far greater
types of mouthing behaviour were exhibited by children at all ages. A possible explanation for this is
that dummy/soothers and fingers are familiar items to children that do not require exploration
through mouthing, and are mainly used in their capacity as soothers. However, many toys and other
objects are unfamiliar items, made of materials and of shapes and colours that are new to children,
hence their use of different mouthing behaviours to explore such items.
Estimated maximum daily figures were produced for each type of mouthing behaviour. For biting,
the highest estimated maximum daily mouthing value for toys and for other objects was by 3 year
olds (1:30:49 and 0:46:34). It is of interest that biting behaviours were highest for three year olds
while sucking was highest for younger children. At 9-12 months of age there is a good chance that a
child’s first teeth may not have come through so sucking may be a more natural behaviour, whereas
older children with more established teeth may well find biting to be a more natural behaviour.
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Chapter 7
Implications for product safety
7.1 WHY CHILDREN MOUTH
The urge to suck and mouth by young children is a natural developmental phase. Sucking may be
divided into two distinct behavioural types: nutritive and non-nutritive sucking (Turgeon-O’Brien
et al, 1996). Nutritive sucking is the instinctive need to feed. Non-nutritive sucking (e.g. sucking
on a dummy/soother) is thought to be adopted by infants as a response to frustration, or as a
need for contact, or as a part of the child’s psychological development in exploring the world
around them through touching and tasting objects with the mouth and tongue.
Research on the mouthing behaviour of children has usually concentrated on the psychological
development of the act, being concerned with the cause and motivation behind mouthing. There
is, however, a child safety issue concerned with the safety of items being placed into the mouths
of young children. Some products, such as dummies/soothers, teething rings and bottle teats, are
intended to be placed into the mouth. Unfortunately, products not intended to be mouthed
invariably end up in children’s mouths, as this is how young children explore their world.
Obviously, child safety is of paramount concern, and so products must be as safe as possible,
whether they are being handled or placed in the mouth.
7.2 OVERVIEW OF LEGISLATION AND STANDARDS
All items that are placed into a child’s mouth have the potential to be a mechanical hazard. The most
obvious hazards are choking or suffocation, although there is a risk of any item becoming stuck in
the mouth and the resultant trauma may be serious. There is also the risk of foreign body incidents
where a child swallows an item which may then cause harm to internal systems of the body.
The European Standard on the Safety of Toys (EN 71-1, 1998) details the mechanical and physical
properties to which toys must conform, with toys being "any product or material designed or
clearly intended for use in play by children of less than fourteen years of age" (p4). There are a
large number of requirements to which a toy must conform, with additional requirements for
toys intended for children of less than 36 months. The main requirement for such toys concerns
small parts which could potentially be choking, suffocation or foreign body hazards. The test for
small parts is whether or not the toy or any removable part of the toy fits entirely within a
specified test cylinder. If the toy or any removable part of the toy fits entirely into the truncated
cylinder without compression it does not conform to BS EN 71. The cylinder used for small parts
testing is 31.7 mm (1.25") in diameter, with side lengths of 51.7 and 25.5 mm respectively. The
standard also describes test procedures for the shape and size of certain toys (such as rattles,
teethers and hand-held activity toys) which are intended for use by children who are too young
to sit up unaided.
Certain toys in the EU are required to have a specific safety warning label depending on the type
of toy. For example, latex balloons are required to have a label on the packaging stating
"Warning! Children under eight years can choke or suffocate on uninflated or broken balloons.
Adult supervision required. Keep uninflated balloons from children. Discard broken balloons at
once" (BS EN 71-1, p18). Additional warning labelling is required for toys not intended for
children under the age of 36 months in the form of "Not suitable for children under 36 months"
(BS EN 71-1, p18) together with a description of the hazard, such as "contains small parts".
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The Child Safety Protection Act (CSPA) of 1994 in the US details similar requirements, with the same
size test cylinder defined for small parts testing, but in 1994 a new section was added which puts
labelling requirements on certain balls, balloons, marbles, and certain toys and games intended for
use by children three years of age and older. The amendment also bans certain balls intended for use
by children younger than three years of age. Balls are tested with a cylinder similar to that used for
small parts testing, but with a diameter of 44.5 mm (1.75"). A small parts warning label is also required
in the US: "Warning: CHOKING HAZARD: Small parts. Not for children under 3". The European Standard,
EN71, is being amended to include similar requirements.
According to the guidelines of the Consumer Product Safety Commission (CPSC) and CSPA, toys
pose a choking hazard if they have play value for children under three (e.g. they are easy to
understand and brightly coloured) and would entirely fit into the small parts cylinder or the
small balls cylinder. Toys that may pose a choking risk include those that fit inside the cylinder
only when compressed; fit inside with an area sticking out of the cylinder; play food that fits
through the ball testing cylinder; latex balloons which are deflated or balloon pieces. It is illegal
for a toy manufacturer to make a toy which is obviously intended for children under three and to
label it as intended for children aged over three.
Unfortunately there are many objects in the home environment other than toys which can pose
a choking, suffocation, foreign body or general hazard to young children. Obviously it is
impossible and impractical to attempt to control what people have in their homes, and so the
emphasis is placed on best practice on limiting access to items of potential danger.1
7.3 ACCIDENT STATISTICS ON MECHANICAL HAZARDS
The primary mechanical hazards associated with children placing items into their mouths are
classified as foreign body accidents, which include choking, suffocation or stuck-in-mouth
incidents. A foreign body is basically an object that should not naturally be in the eye, the
stomach or any other orifice of the body. Choking is the main focus of this discussion.
DTI research into choking hazards of children (DTI, 1999) found that over the period 1986/7 to
1995/6 the number of choking cases involving foreign bodies was declining, however there
were still an average of 2600 non-fatal cases a year between 1987 and 1996, and an average of
24 fatalities a year between 1986 and 1995. Most cases (88%) were classified as being ‘trivial’ or
‘minor’2 . Children under three are most vulnerable (82% of non-fatal choking incidents involved
children under 3 years of age), while 56% of choking fatalities involved children under the age
of one year.
Of the choking incidents to children under the age of four over that period, toys were
responsible for 6% and non-food items (or ‘other objects’ as classified in this study) were
responsible for 32%. Of the incidents involving toys, 85% happened to children under three
years of age. Of the fatalities to children under three years, 8% were caused by non-food objects
and 4% by toys or parts of toys. Nearly two thirds of fatalities (60%) at all ages are caused by
items of food.
1
The Department of Trade and Industry’s (DTI) Consumer Affairs Directorate publish safety leaflets aimed at educating the general public about common hazards
and how to avoid them- http://www.dti.gov.uk/cacp/ca/safety/safetyleaflets/safepdf.htm as does the CPSC in the US http://www.cpsc.gov/cpscpub/pubs/pubcat.html
2
trivial – ‘patient did not wait’ or ‘examined but no treatment given’ minor – ‘treated; but no more treatment required’, ‘referred to GP’, ‘referred to any outpatient
(OP) clinic’. ‘referred to OP or GP’, referred to other hospital’ or ‘admitted for less than 1 day’ (DTI, 1999).
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7.4 MOUTHING TIMES
The estimates of daily mouthing times from this study show that the highest estimated mean
time mouthing on toys and other objects is at ages 6-9 months, and that mouthing on these items
drops off at 4 and 5. These data fit the pattern of the accident statistics, as it is logical that the
higher the mouthing time on toys and other objects the higher the risk of an injury occurring due
to greater exposure to the hazard.
7.5 ITEMS MOUTHED
This study has shown that the average number of items mouthed per child peaks at age 6-9 months
and so children at this age are putting the widest variety of items into their mouths. Research by
the DTI (1999) on choking risks to children lists the foreign bodies that caused choking accidents
to young children, by non-food objects (i.e. other objects) and toys or parts of toys. Amongst toys,
the most accidents are caused by small round items, such as marbles, ball bearings, beads and
building bricks. Estimated data on the number of choking accidents caused by toys or parts of
toys between 1986 and 1996 for children under the age of 4 in the UK show there were an
average of 167 incidents a year, with the main hazards coming from:
•
Parts of toys - 26 cases per year
•
Toy (unspecified) - 24 cases per year
•
Toy (specified) - 22 cases per year
•
Toy (unknown) - 19 cases per year
•
Ball bearing - 16 cases per year
•
Plastic beads - 16 cases per year
•
Piece of plastic toy - 12 cases per year
•
Marble - 11 cases per year
•
Plastic brick - 8 cases per year
•
Coin/disk (plastic) - 7 cases per year.
Most accidents that involve toys or parts of toys are of a trivial or minor nature and all accidents
with serious or very serious outcomes involved toys or parts of toys which would fit completely
within the small parts cylinder (DTI, 1999).
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Of the accidents caused by other objects (i.e. neither food, toys or parts of toys), some 30% are
caused by coins, followed by different types of small objects. Most of these accidents are also of
a minor or trivial nature. The main hazards came from the following items (estimated data for
children under 4 from 1986 to 1996 show there were an average of 846 incidents a year involving
other objects):
•
Coin - 255 cases per year
•
Paper/foil - 93 cases per year
•
Piece of plastic/metal - 47 cases per year
•
Top of bottle/tube - 31 cases per year
•
Piece of glass - 30 cases per year
•
Packet/packaging/bag - 24 cases per year.
7.6 HAZARDS FROM ITEMS MOUTHED IN THIS STUDY
The items that children mouthed in this study were assessed for their potential hazards to young
children, for example in terms of choking, suffocation, or foreign body type incidents and for
comparison to the items recorded as causing choking incidents.
Presented in Table 16 are the mouthed items considered to be a potential hazard, what they are
made out of, and what possible hazard they represent. The number of time that each item was
mouthed can be approximated from Appendices F and G.
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Item
Made from
Potential Hazard
Building block
Pen/pencil
Spoon and toy spoon
Toy figures and accessories
Play food
Ball
Remote control (TV, CD player)
Toothbrush
Paper
Baby wipes/tissues
Crayon
Jigsaw piece
Stacking cups/rings
Balloons
Doll accessories
Sponge
Cuddly toy
Key and toy key
Pen top
Coin and toy coin
Straps/cords
Chocolate wrapper/crisp
packet/cake cup/packet
Cables (electrical, telephone,
games controllers)
Bottle lids/tube lids/bottle tops
e.g. shampoo, glue,
toothpaste
Cloth
Ring and toy ring
Bag
Hair band/clip/ scrunchie
Fork and toy fork
Modelling clay
Plastic/rubber/wood
Metal/plastic/wood
Metal/plastic/wood
Plastic/rubber/metal
Plastic
Fabric/foam/plastic/rubber
Plastic
Nylon/metal/plastic
Wood pulp
Fabric/paper
Wax/wood
Wood/cardboard
Plastic
Foil/rubber
Fabrics
Foam
Fur
Metal/plastic
Plastic
Metal/plastic
Canvas / fabric
Foil/plastic
Choking/cut/foreign body
Cut/foreign body/puncture
Cut/foreign body
Choking/foreign body
Choking/foreign body
Choking/foreign body
Choking
Choking/foreign body/puncture
Choking
Choking
Choking/foreign body
Choking
Choking/foreign body
Choking/foreign body/suffocation
Choking/foreign body
Choking
Choking
Choking/cut/foreign body
Choking/foreign body
Choking/foreign body
Strangulation
Choking/cut
Plastic
Strangulation
Plastic
Choking/foreign body
Fabric
Metal/plastic
Plastic / fabric
Fabric/plastic/metal
Metal/plastic
Dough
Choking
Choking/foreign body
Suffocation
Choking/foreign body
Cut/foreign body/puncture
Choking
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Item
Made from
Potential Hazard
Necklace and toy necklace
Straws
Clothes peg
Fridge magnet
Fur
Bamboo cane/stick/
lollipop stick
Cassette tape, reel of tape
Toy screwdriver/ screw
Comb
Dressing gown belt
Emery board/nail
file/sandpaper
Knife and toy knife
Lip salve/lipstick/ make-up
Pebble
Scissors
String
Zip
Ball bearings/marbles
Coat hanger
Eraser
Magnet
Badges
Beads
Cotton thread/wool
Laces
Whistle
Bath toy
Brush/hairbrush
Buttons
Toy car wheel
Dice/domino
Hat bobbles
Pencil sharpener
Toy pliers
Rope
Seashell
Metal/plastic
Plastic
Wood/plastic
Plastic/metal
Natural
Wood/plastic
Choking/strangulation
Choking/foreign body/puncture
Choking
Choking/foreign body
Choking
Cut/foreign body/puncture
Plastic
Plastic
Plastic
Fabric
Wood
Choking/strangulation
Cut/puncture
Choking/puncture
Choking/strangulation
Cut
Metal/plastic
Plastic
Stone
Plastic
Nylon
Metal
Glass/plastic/rubber
Plastic
Rubber
Metal/plastic
Cardboard/metal
Plastic
Cotton
Fabric
Plastic
Foam
Plastic/fibres
Plastic/metal
Rubber
Plastic
Fabric/plastic
Metal
Plastic
Nylon
Natural
Cut/foreign body
Choking/foreign body
Choking/foreign body
Cut/puncture
Choking /strangulation
Cut/choking/pinch
Choking/foreign body
Foreign body
Choking
Choking
Choking/foreignbody/puncture
Choking/foreign body
Choking/strangulation
Choking/strangulation
Choking
Choking/foreign body
Choking
Choking/foreign body
Choking/foreign body
Choking
Choking
Choking/cut
Cut/pinch
Choking/strangulation
Choking/foreign body
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Item
Soap
Soil
Tape measure
Cable tie
Cafetiere plunger
Can
Candle
Chalk
Toy drill bit
Toy fire engine ladder
Toy fishing rod
Gasket
Pastry cutter
Radiator cap
Rubber band
Shredded paper
Syringe
Toy bolt
Toy fire extinguisher
Toy traffic lights
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Made from
Potential Hazard
Natural
Plastic
Plastic
Metal
Metal
Wax
Natural
Plastic
Plastic
Plastic
Rubber
Plastic
Plastic
Rubber
Wood pulp
Plastic
Plastic
Plastic
Plastic
Choking/foreign body
Choking/foreign body
Choking/strangulation
Choking/foreign body
Choking/cut
Cut
Choking/foreign body
Choking/foreign body
Foreign body/puncture
Choking/foreign body
Choking/foreign body
Choking/foreign body
Cut
Choking
Choking/strangulation/foreign body
Choking
Cut/foreign body/puncture
Choking/foreign body
Choking/foreign body
Choking/foreign body
Table 16. Mouthed items that present a mechanical hazard to children.
Without examining individual items it is difficult to assess potential hazards, but there are
categories of items which could be seen as potentially hazardous. When the list of objects
mouthed in this study is compared to information on choking accidents, of the toys or parts of
toys which were cited as involved in choking accidents by the DTI (1999) report (13 items or
categories), all but 2 were recorded as being mouthed by children in this research. Of the other
objects involved in choking accidents (52 items of categories, not including unknown items) 31
were recorded as mouthed by children in this research. This is evidence that the items causing
choking are commonly mouthed and are not isolated incidents.
The findings of this study reinforce the fact that the high risk age for choking incidents is up to
1 year as having the greatest exposure to choking hazards both in terms of mouthing time and
the number of objects mouthed. The study also shows that children up to 3 years of age are at
risk from the items they mouth.
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7.7 REDUCING ACCIDENT LEVELS
The types of items that are recorded as causing choking incidents were commonly and
frequently mouthed in this study. In fact the toy category ‘building blocks/bricks/shapes’ which
is cited as one of the major toy types involved in choking incidents, was fifth in the list of most
commonly mouthed toys in this study.
Most strikingly, the results of this study illustrate the huge variety of items that are mouthed by
children, and that most items in the home are likely to be mouthed, particularly once the child
becomes mobile. This means that it is not possible to identify specific design features of an item
that makes it more likely to be mouthed. If the complete list of toys and other objects mouthed is
examined in Appendices F and G the vast range of characteristics of each item can be seen.
This study highlights that the majority of items mouthed were made of plastic. However, given
that many items in the home are made of plastic, the exposure level of children to the material is
much higher than (for example) exposure to items made of glass or metal. Also, there are
different types of plastic, such as soft and hard plastic, which were not distinguished between in
this study.
7.7.1 Toys
Accident statistics show that toys which cause serious or very serious choking accidents always
involve toys or parts of toys that fit within the small parts cylinder, such as marbles, ball bearings,
beads and building blocks. Although toys that fail the small parts cylinder test should not be given
to children under the age of three, children who have older siblings may well have access to such
products. Additionally, some toys have small part components, such as pieces of a toy which would
then fit in the small parts cylinder if separated from the main toy body.
This leaves few options with which to try and reduce the number of choking accidents caused by
such items. One route would be to remove all small parts from toys intended for children, although
this would have obvious ramifications for the toy industry. For small items such as marbles and
building blocks, legislation could be introduced to require a new minimum size to ensure that
small children would not be able to swallow them if they had access to them, or to ban all such
items altogether.
However, consideration needs to be given to the effect banning small toys or parts of toys would
have on older children who play with small toys to develop motor and cognitive skills, for example
using building blocks to construct objects. By banning small toys or toys with small parts "the benefit
would be to eliminate a maximum of 100, mostly minor, accidents. The cost would be to deprive
children of an opportunity to learn valuable skills" (p3,DTI, 1999).
Extending or changing the legislation on the small parts cylinder has been assessed for its potential
impact on accident numbers by previous DTI research (DTI, 1999). By extending the current
regulations to cover four year olds it has been estimated that some 19 accidents a year involving
small toys or parts of toys could be prevented (of which one would be classed as serious or very
serious). If children under the age of three could be prevented from coming into contact with small
toys or parts of toys (i.e. if they were banned) then 109 accidents a year could be prevented, with a
further 19 for three to four year olds.
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7.7.2 Other objects
It is logical that by "banning" small toys and small parts of toys we will reduce the potential hazards to
children, but there are many problems with this approach. Also, banning small toys will have no effect
on the hazards posed by the many small objects that children may have access to in their homes.
Obviously it is impossible to use legislation to restrict children’s access to objects other than toys
which may be a hazard, although it may be possible to alter a design to reduce the potential hazard.
Of the six items listed in Section 7.5, which cause most choking accidents, two are not whole items
(i.e. pieces of glass or of plastic/metal), two are packaging (i.e. bags or packets, and paper or foil) and
the others are coins and bottle or tube tops. Of these items, only bottle and tube tops offer any
potential for re-design to reduce the choking hazard they offer, by altering the shape could be
altered in some way. Further design research and evaluation would be required to examine the
feasibility of such a move and its potential in reducing the numbers of choking incidents.
7.8 USING PRODUCT FEATURES TO DETER MOUTHING
An alternative to removing the possibility of children coming into contact with toys and non-toy
items through banning them, is discouraging children from mouthing these items by altering the
product characteristics. Product characteristics have been separated into the following categories,
with potential ways of discouraging mouthing attached to each. These are initial ideas only, and
should be fully researched before being implemented to ensure that natural child development is
not impeded and that the desired effect is produced.
Colour - young children may be attracted to brightly coloured toys. Toys intended for use by older
children, i.e. over three years of age, could be less brightly coloured so as not to catch the eye of
younger children.
Taste and smell - if toys or products taste and/or smell bad then children may be less likely to
mouth them. For instance, bitter tasting agents have been used in some household products to limit
children from swallowing a large amount. A similar taste or an off-putting smell could perhaps be
applied to toys and other objects commonly mouthed (but not intended to be mouthed) to
discourage children from doing so. However, this study shows that children mouth on metal and
other bad tasting items and also on items with an unpleasant smell, which indicates that in younger
children, at least, taste and smell are not strong deterrents to mouthing.
Texture - children do not appear to be put off mouthing by the texture of an item (i.e. whether it is
rough or smooth), but future research could assess if any particular texture would discourage
children from mouthing.
Size and shape - children mouth items of any size, but obviously only the smaller items will fit into
their mouths and become a choking hazard. The shape of an item does not appear to be a factor in
children’s tendency to mouth an item.
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Chapter 8
Conclusions
This study has produced reliable data on the mouthing behaviour of children up to 5 years of age, as
shown by the investigation of the validity of the observation protocol used in the study. It gives
quantitative evidence of mouthing behaviour which can be used to guide the design and regulation
of items intended to be given to children to be mouthed, intended to be given to children but not
mouthed, and those items that are not expected to be given to children but even so are likely to end
up being mouthed. The main findings of the study were:
i) no general trend of increase or decrease over ages 1 month to 5 years was found for mouthing on
all items, although there are differences between age groups within that range
ii) mouthing on toys and other objects (which are most likely to be a hazard) shows a trend with age.
Mean estimated daily mouthing peaks at age 6-9 months (approximately one hour) and decreases
as children grow older. For maximum estimated daily mouthing 2 year olds mouth for as long as
6-9 month olds (approximately five hours a day)
iii) sucking was the most commonly observed mouthing behaviour, accounting for approximately two
thirds of all observed mouthing behaviours
iv) approximately half of all toys and other objects mouthed were made of plastic
v) only around 25% of all toys and other objects mouthed in this study were considered as intended
to be mouthed, and around 30% (after age 3 months) of those made of plastic
vi) children aged 6-9 months not only mouth the longest (on average) on toys and other objects, but
mouth the most number of items (the average number of toys and other objects mouthed per day
peaks at age 6-9 months, at 26 different items per day)
vii) no significant differences were found between the sexes in mouthing times, and no significant
difference was found for mouthing times at different times of the day
viii) a wide array of items were mouthed by the children in this study.
In terms of mechanical hazards, the results of this study support the accident statistics on choking, in
that the highest mean mouthing time is by children under 3 (the high risk age for choking) and
particularly children under 1 year, who mouth the most and put the widest variety and number of
items into their mouth. The high risk age is when children become mobile and can access items
around them rather than being restricted to items that are given to them. The items being mouthed in
this study are similar to those most commonly involved in choking accidents.
Mouthing is a natural, developmental behaviour which is impossible to stop in young children. This
study has shown that a huge variety of items are mouthed, particularly by children under 1 year, due to
teething and using mouthing as a method of exploring their environment. Instruction to children of this
age as to what can and can’t be placed in the mouth is not feasible. It is also not feasible to physically, or
legislatively, restrict the access of young children to their environment. The main route to the prevention
of hazards associated with mouthing, particularly such as choking, is through parental / carer
observation. Continued education of parents and carers is necessary to ensure the awareness of
hazards associated with mouthing, and particularly of those items that accident statistics have shown
can cause choking, e.g. food, balloons, coins and marbles.
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However, this study has shown that nearly all items a child comes into contact with will be mouthed.
This is evidence to suggest that those items which are intended to be used by or with children,
particularly toys and child care items, should be designed with this hazard in mind. This would
include obvious items such as dummies/soothers, feeding equipment and rattles, but also items such
as restraints, nursery furniture, bathing items and stair gates. Standards and guidance for these
products should include requirements to prevent any hazards associated with mouthing.
Anecdotal evidence from many parents taking part in this study indicated surprise at how much their
child actually mouthed (both in terms of the number of times items are mouthed and the number of
items mouthed), and that they would have usually missed the short duration mouthing behaviours
exhibited by their child. This evidence lends support to keeping the most potentially hazardous items
out of the reach of children, as parents cannot always be watching their child and controlling what
they put into their mouths, and as far as possible using design and regulation to ensure those items
which young children are guaranteed to come into contact with and therefore mouth do not present
any mouthing hazards.
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Chapter 9
Recommendations
The results of this study illustrate the huge variety of items that are placed in the mouth by children,
and that most items in the home are likely to be mouthed, particularly once the child becomes mobile.
Unlike controlled environments such as nurseries and crèches, the home environment is virtually
impossible to make entirely free from potentially hazardous items. This leaves the following paths to
reducing choking accidents in children.
9.1 TOYS
If we accept that children under the age of 3 may have access to toys intended for children over three
(i.e. that would fail the small parts test) because they have older siblings, then the only way to reduce
their potential hazard is by the parents taking care about storage and use of such toys or removing
them from the environment altogether (i.e. banning all small parts in toys).
A total ban on small parts is unfeasible. Also, given that choking accidents involving toys only account
for 6% of cases for children under 4 years of age and only 4% of choking fatalities (children under 3
between 1986 – 1995, DTI 1999) were caused by toys or parts of toys the impact of such sweeping
legislation on choking hazards would be small. This leaves the best way to reduce accidents caused
by toys or parts of toys to be through educating parents and carers about the dangers posed by
certain products, and best practice to reduce potential hazards in the home.
9.2 OTHER OBJECTS
Obviously it is not possible to remove all objects which represent a potential hazard from the home,
and so again the best policy is to educate parents and carers about which items are commonly
mouthed and commonly cause choking accidents.
If there are certain objects that children mouth on which are considered to be especially hazardous,
perhaps consideration should be given to design features to discourage mouthing. However, this
would require a degree of initial research followed by trials of re-designed items and then post design
assessment to ensure that there is no unintended impact on child development and safety.
This research has demonstrated that children mouth on such a large range of items, both toys and
other objects, that it is impossible to stop them doing so through legislation. The most productive way
forward is to continue to educate parents and carers, ensuring they understand that:
•
all young children mouth naturally as a way of exploring their environment
•
they will mouth on virtually any item they have access to
•
if they have older siblings then they may have access to toys with small parts
•
marbles, building bricks and beads are the main causes of choking hazards from toys
•
the main choking hazards from other objects mouthed involved coins, pieces of
paper/foil/plastic/metal, bottle and tube tops, pieces of glass and packaging/packets
•
the best way to prevent choking accidents is by restricting access to hazardous items.
For example, putting away toys after use.
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However, it is also important that the risk of children choking on toys and other objects is not
overstated. The accident statistics (DTI, 1999) show that the number of choking cases for children
under four on all items is declining, and that 51% of cases are caused by food, 32% by other objects
and only 6% by toys or parts of toys. The vast majority of cases (88%) are also classed as minor or
trivial. There are still a small number of choking fatalities, but over the period 1986 to 1995 only 4% (or
nine cases) were caused by toys or parts of toys, and 8% by other objects. The vast majority of
fatalities (69%) were food related.
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Chapter 10
References
Department of Trade and Industry (DTI). (1999). Choking risks to children under four from toys and
other objects. DTI, London.
European Committee for Standardisation (1998). Safety of toys - Part 1: Mechanical and Physical
properties, BS EN 71-1.
Groot, M.E.; Lekkerkerk, M.C.; and Steenbekkers, L.P.A. (1998). Mouthing behaviour of young children An observational study. Wageningen: Agricultural University, Household and Consumer Studies,
Wageningen, Netherlands.
Juberg, D.R., Alfano, K., Coughlin, R.J., and Thompson, K.M. (2001). An observational study of object
mouthing behaviour by young children. Pediatrics, 107 (1), 135-142.
Turgeon-O’Brien, H. (1996). Non-nutritive sucking habits: A review. Journal of Dentistry for Children,
63 (5), 321-326.
Warren, J.J., levy, S.M., Nowak, A.J., Shengui Tang, M.A. (2000). Non-nutritive sucking behaviours in
preschool children: A longitudinal study. Pediatric Dentistry, 22 (3), 187-191.
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Appendix A
OBSERVATION RECORDING FORM
Date of observation: ______/______/______ (dd/mm/yy)
Time observation started:
Time observation finished:
Time on
watch
Action
Begin
Page 52
Action
End
What is
being mouthed
Dummy Fingers
Toys
How it is
being mouthed
Other
Sucking/
Licking/
lip touching trying to bite
Biting or
chewing
Type of object
Name or description
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Appendix B
TOY AND OBJECT DETAILS SHEET
Please enter the details of the toys or objects that your child mouths here after each observation
session you complete. You only need to enter the details of each toy or object once, but the name that
you give it here must be the same as on the observation sheet.
Please enter details of the toys that your child mouthed in this table:
Name of toy as written
on observation sheet
What part of the toy was mouthed?
(if more than one part
list them on separate rows)
What is the part that was
mouthed made from?
Please enter details of objects that your child mouthed into this table:
Name of object listed
on observation sheet
What is the part that was
mouthed made from?
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Appendix C
CHILD'S DAILY ROUTINE FORM
We would like to get some idea of your child’s daily patterns of eating and sleeping. On the first and
last day that you observe your child please fill in the time that the child got up (i.e. out of bed not just
awake), ate, slept/napped and went to bed (by eating we mean main meals or feeds, not snacks such
as a biscuit).
First observation day:
Last observation day:
Child got up at:
Child went to bed at:
Eating times:
From:
To:
From:
To:
Slept/napped:
From:
To:
From:
To:
First observation day:
29. Was the observation day a normal
day i.e. there were no unusual events?
1 Yes
2No
Last observation day:
1 Yes
2No
30. If no, what made the day unusual?
(for example you may have had a
visitor, or you may have had
building work going on)
First observation day:
31. Was your child behaving normally today ?
Yes
No, the child was teething
No, the child slept longer than usual
No, the child was off his/her food
No, the child was listless
No, the child felt ill
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Last observation day:
1
1
2
2
3
3
4
4
5
5
6
6
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Appendix D
MOUTHING BEHAVIOUR OF CHILDREN QUESTIONNAIRE
Section 1 About the child being observed
1.
The child’s date of birth: ____/____/____ (dd/mm/yy)
2.
The child’s sex:
3.
Which of the following ethnic categories best describes your child:
1 White
2 Indian
3 Pakistani
4 Black- African
5 Black- Caribbean
6 Black - Other (please specify)
7 Bangladeshi
8 Chinese
9 Other (please specify)
4.
Does your child have teeth?
1 No
2 Front teeth through / appearing
3 Front teeth through & back teeth appearing
4 Both front and back teeth
5 Other (please specify)
5.
If they have teeth, how many are partially and/or completely through?
6.
At what age did your child’s first tooth start to come through?
7.
Does you child leave bite marks in toys?
8.
Does your child ever damage things by biting?
9.
Does your child use a dummy ?
1
Male
2
Female
1Yes
1Yes
2No
1Yes
2No
2No
10. If your child uses a dummy do they usually use it when they are: (tick all that apply)
1 Playing
2 Sleeping
3 Unwell
4 Upset
5 Tired
6 Going to bed
11. At what age was your child: (please answer all that apply)
Sitting up
Feeding themselves
Crawling
Talking
Standing
Potty trained
Walking
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Section 2 Feeding habits of your child
12. Is, or was, your child breast-fed?
1Yes
2No
13. For how long has/was your child being breast-fed?
(years)
(months)
14. What type of food does your child eat now? (tick all that apply)
1 Breast fed only
2 Milk (breast or formula) from a bottle
3 Other liquids
4 Solids
5 Same as rest of family
6 Other
Section 3 About your household
15. What type of house do you live in ?
1 Flat
2 Terrace
3 Semi-detached
4 Detached
5 Other (please specify)
16. How many people usually live in the house? (don’t include the child who is being observed)
Adults:
Their ages:
Children:
Their ages:
17. Please indicate what pets you have that live in the house (tick all that apply).
1 None
2 Dog
3 Cat
4 Rabbit
5 Bird
6 Other (please specify)
Section 4 About your family
18. What is the occupation (or most recent occupation) of the head of household ?
19. What is the highest qualification of the head of the household? e.g. GCSE/O level, BTech, Degree, etc.
20. Is the head of the household:
1 Self-employed
2 An employee
21. How many people is the head of household responsible for at work ?
22. Please describe what business sector the head of household works in ? e.g. retail, construction,
manufacturing, financial, etc.
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23. Who will be doing the observations on the child ?
1 Mother/female guardian
2 Father/male guardian
3 Grandmother
4 Grandfather
5 Other
24. Who is the primary carer of the child (i.e. who does most of the child care)?
1 Mother/female guardian
2 Father/male guardian
3 Other
25. How old are the child’s parents or guardians?
Mother/female guardian:
Father/male guardian:
26. Does the primary carer work?
1 No
2 Yes - full-time
3 Yes - part-time
27. If the child attends day-care or is looked after by relatives/friends on a regular basis when does
he/she attend or when is he/she looked after?
Type of day care/looked after by:
Days (eg. Monday
and Thursday)
Time (eg. 9 to 12)
Crèche:
Playgroup:
Nursery:
Child-minder:
Relative/friend:
None (tick here if the child is at home full time)
Please mention any other information that you feel may be relevant to this study.
Thank you.
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Appendix E
Pictures illustrating mouthing behaviours
HOW TO DECIDE WHAT YOUR CHILD IS DOING WITH THEIR MOUTH
Use this page for the first few observations that you do to remind you what each type of mouthing
behaviour involves.
Licking / lip touching - the object is placed to the front of the
mouth, without actually going into the mouth. The child may
be actually licking an object (as in the picture) or may be
touching the object to their lips.
The time that you record should be from when the object first
touched the child’s mouth to when the object is no longer in
contact with the mouth. If a child is licking an object it may be
difficult to record because of the short time period involved. In
this case you should note the time when the object is put close
to the mouth to be licked, and then taken away from the mouth.
Sucking / trying to bite - the object is put directly into the mouth
of the child.
The child may be sucking, holding the object in their mouth or
trying to bite (gumming) the object.
Biting or chewing - the object is directly in the mouth of the child. It is clear that the child is
biting or chewing on it
When watching younger children it may be difficult to tell exactly what the child is doing with the
object if it is in their mouth. Unless you can see that actual biting or chewing is happening you
should tick the sucking / trying to bite category.
If your child does more than one action then tick both, e.g. if they lick and then chew an object in
the same movement put a tick under both the licking / lip touching and biting / chewing columns.
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Appendix F
EXAMPLES OF TOY CATEGORIES
All toys that were mouthed in this study are listed below. Category of toy is arranged in descending
order on times mouthed i.e. the most commonly mouthed category to the least commonly mouthed.
The number after each category heading indicates the number of times that category was mouthed,
with the name and number of times each toy in each category was mouthed also presented. The full
list of miscellaneous toys mouthed is presented at the end of the main list of toy categories.
Toy Category (and number
of times mouthed)
Toy Name
(given by observer)
Miscellaneous: 190
toy
ring
activity centre
activity mat
baby gym
bean toy
action figure
baby nest
bell
bridge
flower
glove puppet
hair brush
missile
paper
play mat
pull-along toy
toy handbag
tree
tunnel
activity gym
activity mat
activity table
baby mirror
ball bearings
bottle
bracelet
card
card game
case
chalkboard
character
child's beaker with lid
clock
cone
connectors
container
cotton comfort rag
cotton reel
cow noise tin
Number of
times mouthed
17
8
3
3
3
3
2
2
2
2
2
2
2
2
2
2
2
2
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
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Toy Category (and number
of times mouthed)
Toy Name
(given by observer)
cube
daisy toy
desk
disc
doctors syringe
dog toy candle
dolphin ring
domino
dominoes
duck on stick and wheels
ducks chain
fabric cube
fence
finger puppet
first words toy
golf club
gym toy
hairbrush
hairdryer
hand puppet
highchair
hoop
inflatable heart
inflatable roll along
knee hammer
lamp-post
licking star
lid of plastic shape sorter
slinky
lipstick
little box
little plastic cup
lotto card
lunch box
marble madness
mat
mirror sun
movie making cube
toy
paper money
plastic
plastic comb
plastic container
plastic craft knife
plastic ring
plastic spinning toy
plastic stick
Page 60
Number of
times mouthed
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
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Toy Category (and number
of times mouthed)
Toy Name
(given by observer)
play rings
push chair
pyjama case
racket
red nose
remote control to car
remote control to toy car
alphabet learning centre
robot
rocket
rocking horse
rocking tail
rocking toy
shaker
shoe
sit&ride
skipping rope
skittle
small box
soft block (tag)
soft mirror
sparkling symphony gym
spinning top
‘squeaker’
squeaky toy
stamp
stethoscope
string of beads
string on ball
electronic pet
tent
tent (pop up)
thermometer
tigger teddy
wacky stick
tooth mirror
toothbrush
toy's bag
toy button
toy cotton reel
toy lipstick
toy magnifying glass
toy pushchair
toy rainmaker
toy stick
toy thermometer
toy watch
triangle
Number of
times mouthed
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
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Toy Category (and number
of times mouthed)
Toy food/crockery/cutlery: 123
Page 62
Toy Name
(given by observer)
Number of
times mouthed
tube
tubes
tumble ball ring
electronic first words
whisk
wooden toy
yo-yo
wobbly toy
zoo
1
1
1
1
1
1
1
1
1
cup
spoon
toy food
toy cup
food
play food
orange
teapot
tea set
pot
fork
fruit
toy fruit
vegetable
apple
banana
beaker
bowl and spoon
bread
cake
chip pan
chips/tomatoes
coffee/tea coaster
crisp
dish
egg
egg shell
frying pan
ice cream cone
knife
plastic bread
plastic cup
plastic fork
plastic tomato
plastic toy ketchup bottle
15
13
11
9
7
5
4
4
4
3
2
2
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
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Toy Category (and number
of times mouthed)
Toy animals: 155
Toy Name
(given by observer)
plate
play banana
play cup
play milk bottle
potato masher
pumpkin
rolling pin
saucer from tea set
sausage
spoon toy
teacup
toy bottle lid
toy chips
toy cooking pot
toy fruit basket
toy pan lid
toy pepper pot
toy pizza
toy vegetable
duck
dog
rabbit
turtle
rubber duck
fish
lion
octopus
animal
elephant
horse
whale
dolphin
frog
hippo
spider
pig
butterfly
cow
crocodile
dinosaur
giraffe
ladybird
monkey
piglet
Number of
times mouthed
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
17
10
10
8
7
6
6
6
5
5
5
5
4
4
4
4
3
2
2
2
2
2
2
2
2
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Toy Category (and number
of times mouthed)
Building bricks/
blocks/shapes: 109
Stacking cups/rings: 23
Page 64
Toy Name
(given by observer)
plastic dinosaur
shark
sheep
tiger
deer
bone of toy dog
butterfly
cat
cat toy
caterpillar
chicken
cow toy
dalmation dog
goat
jelly fish
lobster
mouse
panda
pig toy
plastic rabbit
rubber lion
small dog
toy dog
toy mouse
toy sheep
zebra
building block/bricks
tree/ creeper
plastic shapes
rubber brick
shape
square shape
squashy block
triangle shape
wooden block
stacking cup
stacking ring
rocket stacker
stacker
stacker of stacking rings
stacking beaker
stacking bricks
stacking jack
Number of
times mouthed
2
2
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
101
1
1
1
1
1
1
1
1
8
6
2
1
1
1
1
1
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Toy Category (and number
of times mouthed)
Toy/shape sorters: 5
Toy vehicles: 122
Dolls & accessories: 106
Toy Name
(given by observer)
Number of
times mouthed
stacking toy
stacking tubs
ball with shapes in it
shape ball
shape sorter
toy sorter
shape sorter container
car
train
aeroplane
boat
fire engine
toy car
train track
plane
track
helicopter
lorry
toy train
truck
jeep
car-track
car crusher
car string
car tyre
car wheel
farm truck
fire engine ladder
garage
garage fence
small metal car
spaceship
steering wheel
tractor
traffic lights
truck handle
wheel on car
wooden train track
doll
doll’s bottle
doll’s brush
doll’s shoe
doll's jacket
1
1
1
1
1
1
1
48
12
8
8
5
4
4
3
3
2
2
2
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
65
10
3
3
2
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Toy Category (and number
of times mouthed)
Toy figures & accessories: 65
Toy rattles: 61
Page 66
Toy Name
(given by observer)
Number of
times mouthed
clothes of doll
clown
comb for doll
doll's bag
doll's beaker
doll's hair
doll's hand
doll clothes
doll’s blanket
doll’s dummy
doll’s foot
doll’s hair
doll’s hairbrush
doll’s hand
dolls’ house toy
doll’s milk bottle
doll’s spoon
fabric doll
doll’s milk bottle teat
mermaid
cartoon doll
ribbon on doll
spoon for doll
figure
action figure
man
toy TV figure
action figure axe
skateboard figure
action figure arrow
fashion doll
fashion doll baby
head of toy figure
motorbike figure
motorbike with rider
plastic person
play person
pre-school toy figure
train driver
toy character figure
rattle
bear rattle
cotton rattle
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
28
14
4
4
2
2
1
1
1
1
1
1
1
1
1
1
1
53
2
1
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Toy Category (and number
of times mouthed)
Toy tools/guns: 42
Toy musical instruments: 34
Toy telephones: 33
Drawing/painting including
pens/pencils/crayons: 53
Toy Name
(given by observer)
Number of
times mouthed
big rattle
button rattle
clown rattle
musical rattle
rattle teether
hammer
screwdriver
gun
scissors
pliers
spade
spanner
sword
arrow
axe
bolt
drill bit
fire extinguisher
mower
screw
tool
cement mixer
microphone
drumstick
xylophone beater/stick
trumpet
whistle
maraca
piano
tambourine
musical bee
castanet
clacker
musical ball
musical carousel
musical cow
musical flower
musical toy
penny whistle
xylophone
1
1
1
1
1
12
5
4
3
3
2
2
2
1
1
1
1
1
1
1
1
1
6
4
3
2
2
2
2
2
2
1
1
1
1
1
1
1
1
1
crayon
pencil
19
9
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Toy Category (and number
of times mouthed)
Toy cameras/computers/
recording: 20
Books: 82
Bath toys: 21
Page 68
Toy Name
(given by observer)
paintbrush
felt tip pen
pen
crayon pencil
pen top
wax crayon
coloured pencil
crayons box
mechanical sketch machine
felt pen
stencil
children pencil crayon
camera
recorder
compact disc
cassette player
cassette tape
cd case
cd player
computer
computer steering wheel
mouse from computer
tape recorder
camcorder
camera
book
cloth book
hard book
baby soft plastic book
book-tag
box of books
colouring book
material book
page of book
bath toy
bath book
animal bath toy
baby boat
bath boat
bath book corner of page
bath shape
chain on floating toy
character bath toy
Number of
times mouthed
5
4
3
3
2
2
1
1
1
1
1
1
4
3
2
2
1
1
1
1
1
1
1
1
1
71
3
2
1
1
1
1
1
1
12
2
1
1
1
1
1
1
1
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Toy Category (and number
of times mouthed)
Toy Name
(given by observer)
Water toys: 9
watering can
water pistol
squirty snake
water pump
water scoop
water wheel
vacuum cleaner
shopping basket
iron
kitchen slice
sweeping brush
toy bucket
vacuum cleaner attachment
sweeping brush
keys
key ring
soft toy
teddy
cuddly toy
teddy bear
fluffy rabbit
soft dog
cuddly mouse
granular filled soft dog
bunny
bunny rabbit toys
cloth cow
cloth pig toy
fabric octopus
flashing soft toy
fluffy puppy
fur dog
small soft toy
soft octopus
soft rabbit
soft rocking cow
soft ruffle bear
soft skittle
soft stacking ring
soft triangular toy
soft velour dog
stuffed rabbit
stuffed teddy
Toy household items: 11
Toy keys: 9
Soft/cuddly toys: 96
Number of
times mouthed
3
2
1
1
1
1
3
2
1
1
1
1
1
1
8
1
38
22
6
3
2
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
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Toy Category (and number
of times mouthed)
Teethers: 17
Walkers (classified as
toys by observer): 6
Toy letters/numbers: 8
Toy money: 4
Balls: 44
Bikes: 3
Modelling clay and tools: 10
Jigsaws: 20
Puzzles: 6
Balloons: 5
Bubble blowers: 6
Marbles: 2
Dressing up: 4
Page 70
Toy Name
(given by observer)
Number of
times mouthed
TV character soft toy
teething ring
teether
teething rattle
teething keys
dinosaur teether
teething book
teething toy
walker
push along walker
alphabet letters
magnet lettering
numbers
money
large play coin
plastic money
ball
ball (small)
ball activity toy
bounce ball
football
bike
handle bar of bike
pole handle for bike
modelling clay
plunger
tool
jigsaw
jigsaw piece
1
7
3
2
2
1
1
1
4
2
3
3
2
2
1
1
40
1
1
1
1
1
1
1
8
1
1
17
3
balloon
balloon handle
bubble blower
pipe for bubbles
wand from pot of bubbles
4
1
4
1
1
police helmet
toy dressing up ring
mask
2
1
1
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Appendix G
EXAMPLES OF OTHER OBJECTS CATEGORIES
All other objects that were mouthed in this study are listed below. Category of other object is
arranged in descending order on times mouthed i.e. the most commonly mouthed category to
the least commonly mouthed. The number after each category heading indicates the number of
times that category was mouthed, with the name and number of times each object in each
category was mouthed also presented. The full list of miscellaneous objects mouthed is
presented at the end of the main list of other object categories.
Object category
(and total number
of times mouthed)
Object
Clothing: 241
jumper
t-shirt
socks
sleeve
bib
trousers
pyjamas
cardigan
sweatshirt
dressing gown
coat
dressing gown belt
hat
jeans
baby grow
shirt
clothing
dress
ribbon
sleep suit
dungarees
fleece top
vest
bobble of hat
clothes
denim jacket
mittens
skirt
toggle
bootee
clothes
baby jacket
collar
top
drawstring
Number of
times mouthed
27
25
24
19
16
14
10
9
7
6
5
5
5
5
5
5
4
4
4
4
3
3
3
2
2
2
2
2
2
1
1
1
1
1
1
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Object category
(and total number
of times mouthed)
Miscellaneous: 150
(see list at end)
Soft furnishings: 144
Page 72
Page 72
Object
Number of
times mouthed
gilet
gloves
jumper tie (on zip)
jumper string
lace toggle
apron
swimsuit
tassel on hat
tie
tights
trouser cord
1
1
1
1
1
1
1
1
1
1
1
flannel
cushion
blanket
towel
pillow
duvet
cloth
curtain
t-towel
sheet
muslin cloth
nappy
quilt
thread/cotton thread
fashion doll cushion
chair cover/throw
cloth napkin
comforter cloth
cover on settee
cushion tassel
duster
hand towel
muslin square
muslin square (comfort blanket)
nappy bag
piece of cotton
piece of fabric
pillowcase
shawl
sheet label
throw
29
22
21
13
10
8
5
4
4
3
2
2
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
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Object category
(and total number
of times mouthed)
Object
Beakers/cups: 94
beaker
cup
drinking cup
beaker lid
feeder cup
mug
drinking bottle
juice cup
plastic beaker
beaker spout
plastic cup
beaker handle
cup lid
drink (cup with lid)
drink of squash
feeding bottle
feeding bottle teat
book
paper
magazine
piece of paper
jigsaw
newspaper
book cover
leaflet
playing card
birthday card
card
cardboard label
edge of card
note pad
paper page
party invite
shredded paper
TV guide
TV instructions
spoon
plastic spoon
fork
knife
hard spoon
metal fork
metal spoon
soft spoon
Paper/card/books/
magazines: 78
Knives/forks/spoons: 62
Number of
times mouthed
31
25
7
4
4
4
3
3
3
2
2
1
1
1
1
1
1
19
18
9
6
4
4
3
3
2
1
1
1
1
1
1
1
1
1
1
45
5
4
3
1
1
1
1
Page 73
22010 DTI Mouthing Report
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11:48
Page 74
Object category
(and total number
of times mouthed)
Brushes (hair/tooth/ floor/
paint/washing up): 60
Kitchen utensils: 40
Bottles and tops
(material unknown): 37
Page 74
Object
teaspoon
toothbrush
hair brush
paint brush
brush
comb
make-up brush
bristles on dustpan brush
broom handle
nailbrush
handle of wash up brush
wooden spoon
coaster
pan lid
jug
measuring jug
spatula
table mat
cafetiere plunger
colander
fish slice
frying pan
jar
kitchen utensil
leaf
pastry cutter
pressure cooker gasket
foam packing
salt grinder
saucepan lid
tray
whisk
bottle
bottle of milk
bottle top
milk bottle
bottle lid
bottle stopper
bottle stopper bung
bottom of bottle
empty bottle
top of small shampoo bottle
sauce bottle
Number of
times mouthed
1
29
13
5
4
3
2
1
1
1
1
7
6
4
3
2
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
21
3
3
3
1
1
1
1
1
1
1
22010 DTI Mouthing Report
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Page 75
Object category
(and total number
of times mouthed)
Object
Pens: 36
pen
ball point pen
inside of a ball point pen
pen end
shoe
slipper
shoelace
baby shoe
jelly shoe
leather moccasin slipper
shoe (child’s)
slipper (sole of)
soft shoe
sole of shoe
hook and loop fastening of shoe
remote control
TV control
video remote control
high chair
stair gate
baby walker
table on highchair
bed guard
cot
dummy cup
dummy holder
feeding spoon
fire guard
handle of pushchair
high chair leg
high chair tray
teething rail
bouncy chair fastener
changing mat
child’s table
childproof cover
stair-gate bars
container
toothpaste tube
toy box
tube of cream
empty mousse carton
empty pencils box
eye shadow case
Shoes/slippers/shoe laces: 35
Remote controls
(TV and video): 32
Child care articles: 21
Packaging
(material unknown:) 29
Number of
times mouthed
33
1
1
12
10
4
2
1
1
1
1
1
1
1
29
2
1
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
4
3
2
2
1
1
1
Page 75
22010 DTI Mouthing Report
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11:48
Object category
(and total number
of times mouthed)
Stop watch inc cord: 28
Furniture (solid): 27
Pencils: 26
Video boxes: 25
Sofa/settee: 20
Page 76
Page 76
Object
Number of
times mouthed
foot scrub tube
glue lid
goggles box
hair gel lid
money box
moisturiser tube
perfume bottle
shoe box
sweet container
toothpaste lid
top of glue stick
toy box edge
tube
tube of chocolate buttons
tube of gel
stopwatch
cord on stop watch
table
side of bath
drawer
stool
bed frame
bed post
chair leg
coffee table corner
dining chair
drawer handle
dresser leg
head board
kitchen door and handle
shelf unit
side board
small wooden drawer
table leg
table top
wall unit
pencil
end of pencil
colouring pencil
lead pencil
pencil (coloured)
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
17
11
5
3
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
21
2
1
1
1
settee
sofa
9
7
22010 DTI Mouthing Report
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Page 77
Object category
(and total number
of times mouthed)
Plastic containers: 20
Sponge: 20
Bottles and tops: 19
Tissues/paper towels/
toilet paper: 17
Cardboard packaging/tubes: 16
Keys: 16
Object
arm of sofa
settee cushion
plastic tub
yoghurt pot
baby wipes plastic tub
plastic container
deodorant lid
lid of butter
lunch box
plastic box
plastic lid
plastic milk container
plastic pipe
plastic toy box
plastic tube
tub lid
sponge
bath sponge
bath ‘squeezie’
shampoo bottle
lid of pop bottle
plastic bottle
conditioner bottle
baby lotion bottle
water bottle
juice bottle
little plastic bottle
tissue
kitchen roll
serviette
toilet roll
cardboard tube
cereal box
stopwatch box
cardboard box
cardboard
jigsaw box
paper plate
crisp tube
chocolate sweet tube
tissue box
toilet roll tube
key ring
key
Number of
times mouthed
2
2
3
3
2
2
1
1
1
1
1
1
1
1
1
1
16
3
1
10
2
2
1
1
1
1
1
10
3
2
2
3
2
2
2
1
1
1
1
1
1
1
7
6
Page 77
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11:48
Object category
(and total number
of times mouthed)
Food packaging: 15
Architectural fittings: 15
Phones: 14
Balloon: 14
TV and video: 14
Pen tops: 13
Baby wipes: 12
Wood/cane: 5
Page 78
Page 78
Object
car keys
key ring and car keys
wardrobe key
crisp packet
chocolate outer wrapper
sweet wrapper
cellophane packet
packet of passata
unopened sweets
window
window ledge
banister
door
door frame
door panel
skirting board
wall
floor
inside of cupboard
mobile phone
phone
aerial of mobile
cordless phone
cordless phone aerial
mobile phone case
telephone receiver
balloon
balloon dog
balloon tip/opening
blown up balloon
TV controls
TV screen
television
video recorder
TV buttons
TV cabinet
pen top
pen lid
crayon top
felt tip top
baby wipe
wet wipe
baby wipes refill
balsa wood
Number of
times mouthed
1
1
1
5
4
3
1
1
1
5
2
1
1
1
1
1
1
1
1
5
3
2
1
1
1
1
11
1
1
1
3
3
2
2
2
2
8
3
1
1
9
2
1
1
22010 DTI Mouthing Report
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11:48
Page 79
Object category
(and total number
of times mouthed)
Chairs: 12
Hair decorations: 10
Electrical/phone cables: 10
Straps: 10
Money/coins: 9
Bath: 8
Box 8
Fridge magnet: 7
Felt tip pen: 7
Bowls/dishes/plate/egg cup: 7
Babies' bottles: 10
Object
Number of
times mouthed
bamboo cane
garden cane
wooden candleholder
stick
chair
chair arm
chair seat
hair clip
hair band
hair scrunchie
hair thing
hair slide
hair tie
telephone cable
vacuum cleaner cable
cable
electric tie cable
video machine wire
wire of hairdryer
string
strap-booster seat
strap from chair
strap of bouncer
strap of rucksack
string end
canvas strap on high chair
cord on bouncer
coin
money
bath
bath handle
bath seat
1
1
1
1
10
1
1
4
2
1
1
1
1
4
2
1
1
1
1
3
1
1
1
1
1
1
1
5
4
4
3
1
felt-tip pen
felt tip
large felt tip pen
pen(marker)
bowl
egg cup
dish
plate
bottle teat
4
1
1
1
3
2
1
1
5
Page 79
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11:48
Page 80
Object category
(and total number
of times mouthed)
Plastic red noses: 7
Tin/metal containers: 7
Clothes fastenings: 7
Bubbles (in bath): 7
Peg: 7
Watches: 6
Straw: 6
Carpet: 6
Animals/pets: 5
Box for cd/cassette/
video tapes: 5
Necklace: 5
Glasses/sunglasses: 4
Swimming goggles: 4
Packaging (prob. soft plastic): 3
Glass: 3
Coat hangers: 3
Photo frame: 3
Photo: 3
Bean bag: 3
Badge: 3
Bag: 3
Spectacles case: 3
Folder: 3
Ruler: 3
Eraser: 3
Stones: 3
Videos: 2
Page 80
Object
Number of
times mouthed
baby bottle
baby bottle lid
baby feeding bottle
3
1
1
chocolates tin
hair mousse container
long metal tube
tin rim
soft drink can
foil dish
zips
buttons
2
1
1
1
1
1
5
2
watch
buckle on watch
face of children’s watch
watchstrap
3
1
1
1
dog
cat
cd case
cassette box
3
2
3
2
handy pack of tissues
tissues (packet)
wipes packet
glass
glass of juice
1
1
1
2
1
22010 DTI Mouthing Report
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Page 81
Number of
times mouthed
Object category
(and total number
of times mouthed)
Object
Pet food: 2
cat food
dog biscuit
light switch
washing machine door
1
1
1
1
artificial flower
nail file
baby nightlight
notepad binder
baby shampoo
ornament
ball
ornamental spoon
bangle
ornament
bath container
paper weight
bath bomb (bath foam cube)
pebble
beads
peg basket
beak
pencil sharpener
bib
photo album
bike
piece of sticky paper
bin bag
piggy bank
binocular case
place mat
bobble
plaster
bookmark
plastic block
bouncy castle
plastic coat hanger
box lid
plastic fishing rod
box model
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
1
1
1
1
1
1
1
1
1
1
1
2
1
1
1
1
Electrical: 2
Cotton wool: 2
Flowers: 2
Handbag: 2
Lipstick/lip salve: 2
Miscellaneous items: (150)
Page 81
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11:48
Object category
(and total number
of times mouthed)
Page 82
Object
plastic lead
bracelet
plastic letter
bucket
plastic scissors
calendar
plastic sponge
calculator
plastic straw
candle
pom pom
car seat buckle
purse
CD
rack on dishwasher
chalk
radiator
child’s apron
radiator button
clothes peg
reading bag
comfort
recorder
computer screen
red vinyl purse
credit card
ring
date block
rolling pin
decorative piece
rope
collectable card
rubber band
disposable nappy
scanner on till
domino bag
seashell
drinking straw
shower gel
duck
small golf club
edge of toy basket
soap
emery board
soap dish
Page 82
Number of
times mouthed
1
1
1
1
1
2
1
1
1
1
1
1
1
1
1
1
2
1
1
1
1
1
1
1
2
1
1
1
1
1
1
1
1
3
1
1
2
1
1
2
2
1
2
1
1
22010 DTI Mouthing Report
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11:48
Object category
(and total number
of times mouthed)
Page 83
Object
envelope window
soap dispenser
eraser
soil
exercise bike
sticker
fastener
sticky name label
fish
supper
funnel
syringe
glasses
tape
gold necklace
tape cassette
green binder
tape measure
green chair
terry bib/bib
handbag
child’s thermometer
handbag strap
tin whistle (pipe)
harmonica
tin whistle (mouthpiece)
hole punch
top
ice lolly stick
torch
jam tart cup
vacuum attachment
label
vase
lace
wash mitt
lid of jar
wash tablet bag
lollypop stick
washing powder ball
magnet
washing scrub
mascara
whale
microphone
whistle
Number of
times mouthed
1
1
1
2
1
2
1
1
2
1
2
1
1
1
1
1
1
2
1
1
1
1
1
1
1
1
1
1
2
1
1
1
2
1
2
1
1
1
1
1
1
1
1
1
2
1
Page 83
22010 DTI Mouthing Report
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11:48
Object category
(and total number
of times mouthed)
Page 84
Object
mirror
wicker basket
motorbike
wind chimes
Page 84
Number of
times mouthed
1
1
1
1