Research into the mouthing behaviour of children up to 5 years old

Research into the mouthingbehaviour ofchildren up to 5 years old.

Consumer and Competition Policy Directorate

22010 DTI Mouthing rep cover 28/8/02 12:00 Page 4


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

July 2002

URN 02/748



SUMMARY 1

CHAPTER 1. Design of the research 2

1.1 Aims of this research 2

1.2 Data Collection 2

1.3 Experimental design 3

CHAPTER 2. Methodology 5

2.1 Development of materials 5

2.1.1 Pre-pilot trials 5

2.1.2 Pilot trials 5

2.2 Observation protocols 6

2.2.1 Timing of mouthing behaviours 6

2.2.2 Classifying what was mouthed 6

2.2.3 Classifying the type of mouthing behaviour 6

CHAPTER 3. Participant Details 7

3.1 Children's mouthing characteristics and child care details 7

CHAPTER 4. Results 10

4.1 Estimated daily mouthing time by item mouthed 10

4.2 Estimates of daily mouthing times according to what was mouthed and how 13

4.2.1 All items 14

4.2.2 Dummy/soother 14

4.2.3 Fingers 16

4.2.4 Toys 18

4.2.5 Other objects 20

4.2.6 Items not recorded 22

4.3 What was mouthed 23

4.3.1 Categories of toys and other objects mouthed 23

4.3.2 Mouthed toys and other objects by material 25

4.3.3 Items intended to be mouthed 26

4.3.4 Number of items mouthed 29

CHAPTER 5. Validation 30

5.1 Analysis of mouthing time 30

5.2 Analysis of what was mouthed 31

5.3 Analysis of how the children mouthed 32

ContentsPage N

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22010 DTI Mouthing Report 28/8/02 11:46 Page 1

CHAPTER 6. Discussion 33

6.1 Validity and reliability of the study 33

6.2 Mouthing times 33

6.2.1 Mean and maximum mouthing times 33

6.2.2 What is mouthed 34

6.2.3 How items are mouthed 34

CHAPTER 7. Implications 36

7.1 Why children mouth 36

7.2 Overview of legislation and standards 36

7.3 Accident statistics on mechanical hazards 37

7.4 Mouthing times 38

7.5 Items mouthed 38

7.6 Hazards from items mouthed in this study 39

7.7 Reducing accident levels 43

7.7.1 Toys 43

7.7.2 Other objects 44

7.8 Using product features to deter mouthing 44

CHAPTER 8. Conclusions 45

CHAPTER 9. Recommendations 47

9.1 Toys 47

9.2 Other objects 47

CHAPTER 10. References 49

Appendix A: Observation recording form 50

Appendix B: Toy and objects details sheet 51

Appendix C: Child’s daily routine form 52

Appendix D: Questionnaire 53

Appendix E: Pictures illustrating mouthing behaviours 56

Appendix F: Examples of Toy Categories 57

Appendix G: Examples of "other objects" categories 69


Page 3

Summary

This report supplements "Report on research into the mouthing behaviour of children up to 5years 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, theobservers 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 otherobjects 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.


1.1 AIMS OF THIS RESEARCH

The research described in this report was designed to expand upon the knowledge of themouthing 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 thefindings of Warren et al. (2000) that over 20% of the children in their study carried a non-nutritivesucking habit past the age of 36 months). The overall aim of the project was to produce a figurefor the total time that children within this age range are expected to mouth items per day. Thiscould then be used to assess potential mechanical hazards posed by items on which childrenwere found to mouth.

1.2 DATA COLLECTION

The behaviour of young children may be greatly affected by all types of stimuli. In studies suchas this where we are attempting to gain information on normal and natural behaviour of childrenit is imperative that the environment in which the data are gathered is as unaffected by theobservation as possible. This means that the child should be surrounded by things that they areused to and know. For this reason, the research by Groot et al (1998) and Juberg et al (2001) bothrely on data being recorded by the parent(s) of each child using a diary format. The child isobviously used to the presence of their parent and so natural behaviour may be assumed. Theuse of a structured formal diary recording system serves to control the type of information thatthe 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 researchersobserving the child in their home environment, as the observer is trained to record certain typesof behaviour consistently, and so providing good repeatability of observation. The same is truefor 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 thiscould lead to a change in behaviour. Likewise, the presence of a stranger in the home is likely toalter the behaviour of the child being observed to a greater or lesser extent, so while thereliability of the data may be high, the circumstances are less "realistic" and lower the validity ofthe 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 researchused parents/carers as observers, to ensure children’s mouthing behaviour, and behaviourgenerally, were as natural as possible to ensure high data validity.

Observations were carried out at home rather than nurseries or childcare establishments as thehome environment has a vast range of items that are accessible to children, not all of which areintended for use by them. This is a worst case scenario but also realistic compared to more sterileenvironments such as playgroups and nurseries where the contents of rooms are very carefullyand rigidly controlled.

Because of the factors mentioned above it was felt that an examination of the reliability ofparents as observers should be carried out. This has not been investigated by prior studieswhich have also used parents as observers. A comparison of parent and trained observer datacollection was carried out on a sample of 25 children. Information on this validation part of theresearch may be found in Section 5 of this report.

Page 4

Chapter 1Design of the Research


Page 5

1.3 EXPERIMENTAL DESIGN

Observation was carried out by parents in the child’s home for a total of five hours, split into 20fifteen minute observation sessions. A period of two weeks was allowed for the observations tobe completed and the data returned. These observation sessions were to be spread out overdifferent 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 twoobservation sessions were allowed within the same time zone on any one day, and at least 30minutes was required to be left between observation sessions. These provisions were includedin order to ensure data was gathered spread evenly across the days and week to gather arepresentative picture of the child’s behaviour, and also to reduce potential errors from fatiguecaused 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.


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.

Page 6


Page 7

Chapter 2Methodology

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 recordingbehaviour 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 nurseryby members of the Product Safety and Testing Group (PSTG) trained in observation protocols. Forthe 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. Thisprocess was repeated for each of the sample forms in turn. The results were then analysed forthe 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 beused 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 labelledenvelope 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). Theywere given only brief instructions about what they were being asked to do, as it was anticipatedthat 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 necessaryinformation. 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 ofpilot testing the protocols and materials developed for the research. Two were unable tocomplete the study for personal reasons, and results from one participant did not arrive back atthe 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 ofuse of the materials contained within the observation pack which resulted in changes beingmade to the documents. The final versions that were then used in the main study are presentedin Appendices A to D.


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 ofmouthing events. They were not required to start, stop and reset the watch each time an eventoccurred. Instead, the stopwatch was started at the beginning of the session and not stoppeduntil the 15 minutes was over. When the behaviour began, i.e. when the item first entered themouth, 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 quickerand more accurate time map of the child’s behaviour to be produced than by starting andstopping 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 ofanother person, and whether an item was classified as a toy or other object was decided uponby the observer.

2.2.3 Classifying the type of mouthing behaviour

Mouthing behaviour was classified into three categories. The instructions given to observers onhow 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 theirmouth. Observers were told that unless they could see that actual biting or chewing washappening they should tick the sucking/trying to bite category. If the child did more than oneaction then they were asked to tick both, e.g. if they lick and then bite an item to put a tick underboth headings. Photographs were included illustrating the licking and sucking behaviours, asshown in Appendix E, but not biting/chewing; this is difficult to illustrate as the item is shown asjust being at/inside the mouth without the movement which means chewing or biting is occurring.

Page 8


Page 9

Chapter 3Participant Details

236 children were observed by their parents. The number of children observed in each agegroup were as follows:

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’sphysical 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

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


Page 10

iii) Childcare arrangements:

Childcare arrangements for each child observed ranged from none (i.e. always at home with themother or father) to 5 days a week. Details are presented in Figure 1 of the type of childcare thatchildren taking part in the study attended. For each day of childcare separate values arepresented, for example, day one is not necessarily the same day for all children but instead meansthat this represents a single day (or part of a day) where childcare occurs for that child.

none

creche

playgroup

relative / friend

childminder

nursery

Day one

none

creche

playgroup

relative / friend

childminder

nursery

Day two

none

creche

playgroup

relative / friend

childminder

nursery

Day three


Page 11

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

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 ofchildcare decreases. Nursery is the most popular form of childcare.

Information was gathered on how much time during a typical normal day the child would haveavailable 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

none

creche

playgroup

relative / friend

childminder

nursery

Day five

none

creche

playgroup

relative / friend

childminder

nursery

Day four


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 bemouthed – 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

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 = the time available over the whole day for the child to mouth per day 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 arelikely 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 thatchildren were observed.

The presented mean values were calculated by dividing the total estimated mouthing time foreach category of item mouthed within each age group by the total number of subjects in that agegroup. For example, for 3-6 months olds, only 4 subjects may have actually mouthed on adummy/soother but the total estimate of daily mouthing on a dummy/soother for that age wasdivided by the total number of subjects in that age group (14) to give the mean value of dailymouthing 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 betaken if using mean estimated daily mouthing values for the purposes of safety. This is becausethe mean value may not reflect the true average or middle value of the sample for each agegroup, 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 foreach item mouthed (in hours:minutes:seconds). Each mean behaviour is the average time that achild in each age group could be expected to mouth a given item over a normal day. Mean totaldaily mouthing time is the time that any child could be expected to mouth, on anything, onaverage over a normal day, and is the sum of mean mouthing time on all items for each age group.

1The 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.

2The 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. Page 12

Chapter 4Results

* time available to mouth per day


Page 13

Table 3 presents the mean and maximum estimated daily mouthing data, for males and femalescombined. Data shown for males and females combined as a Mann-Whitney1 test showed nostatistically significant difference in mouthing time between the sexes.

The presented maximum values are the highest estimated daily mouthing times of any child ineach age category, for each item. It does not necessarily follow that the maximum values in eachage 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 onfingers. Also presented is the maximum estimated daily mouthing time for mouthing on all andany items, in each age group, by any single child.

Figure 2: Estimated mean daily mouthing time for each item mouthed and for all items (total

mouthing) (hours:minutes:seconds)

1The 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.

0:00:00

0:15:00

0:30:00

0:45:00

1:00:00

1:15:00

1:30:00

1:45:00

2:00:00

2:15:00

1-3

3-6

6-9

9-12

12-1

5

15-1

8

18-2

1

21-2

4 2 3 4 5

Age category

Mea

n m

outh

ing

tim

e Dummy / Soother

Fingers

Toys

Other objects

Not recorded

Total


Table 3: Estimated mean and maximum daily mouthing time for all items mouthed

(hours:minutes:seconds).

Table 4: Estimated mean and daily mouthing time on all items mouthed (hours:minutes:seconds).

Page 14

Item mouthed

Dummy/Soother

Fingers

Toys

OtherObjects

Not Recorded

Mean

Max

Mean

Max

Mean

Max

Mean

Max

Mean

Max

Age Group

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

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

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

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

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 0:11:37 0:03:11 0:01:53

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

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

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

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

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

1-3months

3-6months

6-9months

9-12months

12-15months

15-18months

18-21months

21-24months

2years

3years

4years

5years

Item mouthed

Totalestimated

mouthing onall items

Mean

Max

Age Group

1-3months

3-6months

6-9months

9-12months

12-15months

15-18months

18-21months

21-24months

2years

3years

4years

5years

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

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


Page 15

No clear age pattern exists for total mouthing time, with the highest estimated daily mean mouthingtime being exhibited by children aged 18-21 months. However, a Kruskal – Wallis test fordifferences in observed mouthing time on all items between the age groups was significant (Chi-square = 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 clearerpattern of change with age emerges. Figure 3 presents the estimated mean daily mouthing times formouthing on toys and other objects only for males and females combined.

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 generallydecreases.

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

0:00:00

0:10:00

0:20:00

0:30:00

0:40:00

0:50:00

1:00:00

1:10:00

1-3

3-6

6-9

9-12

12-1

5

15-1

8

18-2

1

21-2

4 2 3 4 5

Age category

Mea

n m

outh

ing

tim

e

ToysOther objectsTotal


Page 16

4.2.1 All items

Estimated daily mean mouthing time is presented in Figure 4, for mouthing on all items, by howitems were mouthed at each age group.

Figure 4: Estimated mean daily mouthing on all items by how they were mouthed


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.

Figure 5: Estimated mean daily mouthing time for dummy/soothers according to how they

were mouthed (hours:minutes:seconds).

0:00:00

0:15:00

0:30:00

0:45:00

1:00:00

1:15:00

1:30:00

1:45:00

2:00:00

2:15:00

1-3

3-6

6-9

9-12

12-1

5

15-1

8

18-2

1

21-2

4 2 3 4 5

Age category

Mea

n m

outh

ing

tim

e

lick, suck and bite

suck and bite

lick and bite

lick and suck

bite

suck

lick

0:00:00

0:10:00

0:20:00

0:30:00

0:40:00

0:50:00

1:00:00

1:10:00

1:20:00

1-3

3-6

6-9

9-12

12-1

5

15-1

8

18-2

1

21-2

4 2 3 4 5

Age category

Mea

n m

outh

ing

tim

e

Not recordedLick, Suck and BiteSuck and BiteLick and BiteLick and SuckBiteSuckLick


Table 5: Estimated mean and maximum daily mouthing time on dummy/soothers by how they

were mouthed.

Page 17

Lick

Suck

Bite

Lick andSuck

Lick andBite

Mean

Max

Mean

Max

Mean

Max

Mean

Max

Mean

Max

Age Group

1-3months

3-6months

6-9months

9-12months

12-15months

15-18months

18-21months

21-24months

2years

3years

4years

5years

Mean

Max

Suck andBite

Lick, Suck and Bite

Notrecorded

Mean

Max

Mean

Max

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

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

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 -

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 -

- 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 - -

- 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 - -

- - - - 0:01:36 - - - 0:00:23 - - -

- - - - 0:25:40 - - - 0:14:10 - - -

- - - - - 0:01:29 - - - - - -

- - - - - 0:20:44 - - - - - -

- - - - 0:04:55 - 0:01:58 0:03:13 0:00:44 0:01:11 - -

- - - - 1:18:32 - 0:31:23 0:38:36 0:28:49 0:36:43 - -

- - - - - - - - 0:00:37 - - -

- - - - - - - - 0:24:15 - - -

0:01:36 0:00:47 0:02:52 - 0:00:22 0:05:00 0:04:00 - 0:02:01 - - -

0:14:28 0:05:37 0:34:14 - 0:05:22 0:45:26 0:32:25 - 0:32:00 - - -


4.2.3 Fingers

Figure 6 shows how fingers were mouthed at each age group, and Table 6 presents the estimateddaily mouthing data shown in Figure 6.

Figure 6: Estimated mean daily mouthing time for fingers according to how they are mouthed


0:00:00

0:05:00

0:10:00

0:15:00

0:20:00

0:25:00

0:30:00

0:35:00

0:40:00

0:45:00

0:50:00

1-3

3-6

6-9

9-12

12-1

5

15-1

8

18-2

1

21-2

4 2 3 4 5

Age category

Mea

n m

outh

ing

tim

e Not recordedLick, Suck and BiteSuck and BiteLick and BiteLick and SuckBiteSuckLick

Page 18


Page 19

Table 6: Estimated mean and maximum daily mouthing time on fingers by how they were

mouthed (hours:minutes:seconds).

Lick

Suck

Bite

Lick andSuck

Lick andBite

Mean

Max

Mean

Max

Mean

Max

Mean

Max

Mean

Max

Age Group

1-3months

3-6months

6-9months

9-12months

12-15months

15-18months

18-21months

21-24months

2years

3years

4years

5years

Mean

Max

Suck andBite

Lick, Suck and Bite

Notrecorded

Mean

Max

Mean

Max

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

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

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

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

- 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

- 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

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

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

- 0:00:01 0:00:02 - - - - - 0:00:08 0:00:02 0:00:03 0:01:09

- 0:00:19 0:00:23 - - - - - 0:03:55 0:00:46 0:01:24 0:27:29

- 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 -

- 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 -

- 0:00:02 0:00:01 - 0:00:04 - - - 0:00:08 0:00:02 0:00:09 0:02:03

- 0:00:26 0:00:13 - 0:00:31 - - - 0:02:42 0:01:17 0:03:21 0:45:28

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

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


4.2.4 Toys

Figure 7 shows how toys were mouthed at each age group, and Table 7 presents the estimateddaily mouthing data shown in Figure 7.

Figure 7: Estimated mean daily mouthing time for toys according to how they are mouthed


Page 20

0:00:00

0:05:00

0:10:00

0:15:00

0:20:00

0:25:00

0:30:00

0:35:00

0:40:00

0:45:00

1-3

3-6

6-9

9-12

12-1

5

15-1

8

18-2

1

21-2

4 2 3 4 5

Age category

Mea

n m

outh

ing

tim



Table 7: Estimated mean and maximum daily mouthing time on toys by how they were mouthed


Page 21

Lick

Suck

Bite

Lick andSuck

Lick andBite

Mean

Max

Mean

Max

Mean

Max

Mean

Max

Mean

Max

Age Group

1-3months

3-6months

6-9months

9-12months

12-15months

15-18months

18-21months

21-24months

2years

3years

4years

5years

Mean

Max

Suck andBite

Lick, Suck and Bite

Notrecorded

Mean

Max

Mean

Max

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

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

- 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

- 0:18:51 0:45:36 1:01:16 0:23:58 0:23:38 0:14:53 0:08:08 0:26:57 0:18:10 0:06:59 0:05:21

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

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

- 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

- 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

- 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 - -

- 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 - -

- 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

- 0:24:07 0:09:57 0:04:48 0:44:01 0:01:55 0:00:12 0:08:50 0:02:11 0:01:12 0:00:08 0:00:18

- 0:02:54 0:00:07 0:00:01 0:00:30 - 0:00:14 0:00:34 0:00:01 - 0:00:02 -

- 0:34:35 0:01:01 0:00:10 0:04:50 - 0:03:51 0:04:21 0:00:21 - 0:00:53 -

- 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

- 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


Page 22

4.2.5 Other objects

Figure 8 shows how other objects were mouthed at each age group, and Table 8 presents theestimated daily mouthing data shown in Figure 8.

Figure 8: Estimated mean daily mouthing time for other objects according to how they are


0:00:00

0:05:00

0:10:00

0:15:00

0:20:00

0:25:00

0:30:00

1-3

3-6

6-9

9-12

12-1

5

15-1

8

18-2

1

21-2

4 2 3 4 5

Age category

Mea

n m

outh

ing

tim



Table 8: Estimated mean and maximum daily mouthing time on other objects by how they were


Page 23

Lick

Suck

Bite

Lick andSuck

Lick andBite

Mean

Max

Mean

Max

Mean

Max

Mean

Max

Mean

Max

Age Group

1-3months

3-6months

6-9months

9-12months

12-15months

15-18months

18-21months

21-24months

2years

3years

4years

5years

Mean

Max

Suck andBite

Lick, Suck and Bite

Notrecorded

Mean

Max

Mean

Max

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

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

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

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

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

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

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

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

- 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

- 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

- 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

- 0:00:45 0:07:28 0:03:05 0:05:28 0:02:08 0:09:12 0:06:03 0:17:11 0:01:27 0:20:29 0:12:05

- - 0:00:24 0:00:04 0:00:27 - 0:00:16 - 0:00:12 - 0:00:09 -

- - 0:03:00 0:01:01 0:05:24 - 0:04:13 - 0:02:46 - 0:02:41 -

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

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


4.2.6 Items not recorded

Table 9 presents the data where what was being mouthed was not recorded by the observer. Thesedata are not presented graphically due to the small quantities.

Page 24

Lick

Suck

Bite

Lick andSuck

Lick andBite

Mean

Max

Mean

Max

Mean

Max

Mean

Max

Mean

Max

Age Group

1-3months

3-6months

6-9months

9-12months

12-15months

15-18months

18-21months

21-24months

2years

3years

4years

5years

Mean

Max

Suck andBite

Lick, Suck and Bite

Notrecorded

Mean

Max

Mean

Max

0:00:01 - - - - - 0:00:08 - - - - 0:00:02

0:00:07 - - - - - 0:01:06 - - - - 0:00:41

- 0:00:06 - 0:00:01 - 0:00:11 0:00:04 - - - 0:00:03 -

- 0:01:26 - 0:00:07 - 0:01:56 0:00:59 - - - 0:02:25 -

- - - - - - - - - - - -

- - - - - - - - - - - -

0:00:41 - - - - - - - - - - -

0:06:12 - - - - - - - - - - -

- - - - - - - - - - - -

- - - - - - - - - - - -

- 0:00:03 - - - - - - - - - -

- 0:00:47 - - - - - - - - - -

- - - - - - - - - - - -

- - - - - - - - - - - -

0:00:03 0:00:16 - - 0:00:02 - - 0:14:13 0:02:40 0:00:01 - 0:02:56

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 itemswere mouthed (hours:minutes:seconds).


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 Tables10 and 11, together with the number of times each of the item categories were mouthed by anychild 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 classifiedas such by the observers and will be the result of their perception, and not the authors’, of whetheror not the items were toys.

Page 25

Rank Toy Category

1 Miscellaneous 1902 Animals 1553 Food/crockery/cutlery 1234 Vehicles - cars/boats/trains/motorbikes/tractors/fire engines 1225 Building bricks/blocks/shapes 1096 Dolls & accessories 1067 Soft/cuddly toys 968 Books 829 Toy figures & accessories 6510 Rattles 5911 Balls 4412 Tools/guns 4213 Drawing/painting including pens/pencils/crayons 4214 Musical instruments including microphones, whistles 3415 Telephones 3316 Stacking cups/rings 2317 Bath toys 2118 Cameras/computers/recording 2019 Jigsaws 2020 Teethers 1421 Household items e.g. vacuum cleaner/iron 1122 Water toys 923 Keys 924 Letters/numbers 825 Modelling clay 826 Walkers 627 Puzzles 628 Bubble blowers 629 Toy/shape sorters 530 Balloons 531 Money 432 Dressing up 433 Bikes 334 Marbles 235 Tools for modelling clay 2

T O T A L 1 4 8 8

Table 10: The categories of toys mouthed across the whole sample

Number of times mouthed


Page 26

Object category

Clothing 241

Miscellaneous 150

Soft furnishings 144

Beakers/cups 94

Paper/card/books/magazines 78

Knives/forks/spoons 62

Brushes (hair/tooth/floor/paint/washing up) 60

Kitchen utensils 33

Bottles and tops (material unknown) 37

Pens 36

Shoes/slippers/shoe laces 35

Remote controls (TV and video) 32

Packaging (material unknown) 29

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 15

Architectural fittings 15

Phones 14

Balloon 14

TV and video 14

Pen tops 13

Baby wipes 12

Wood/cane 12

Chairs 12

Crayons 11

Hair decorations 10

Electrical/phone cables 10

Straps 10

Babies' bottles 10

Number of times mouthed Object category

Money/coins 9

Bath 8

Box 8

Felt tip pen 7

Bowls/dishes/plate/egg cup 7

Clothes fastenings 7

Plastic red noses 7

Tin/metal containers 7

Bubbles (in bath) 7

Peg 7

Fridge magnet 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

Badge 3

Bag 3

Bean bag 3

Coat hangers 3

Folder 3

Glass 3

Spectacles case 3

Packaging (probably soft plastic) 3

Photo 3

Photo frame 3

Eraser 3

Ruler 3

Stones 3

Cotton wool 2

Electrical 2

Flowers 2

Handbag 2

Lipstick/lip salve 2

Pet food 2

Videos 2

T O T A L 1 6 6 5


Table 11: Categories of other objects mouthed across the whole sample


Page 27

A full list of the items that appear in each of the toy and other object categories may be found inAppendices F and G. As these tables show, a huge variety of items were mouthed by the children inthis study. Toy animals, toy vehicles, toy food and building blocks were the most commonlymouthed 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 researchwere 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).

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.

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 than10% of the items mouthed (this excludes dummies/soothers).

05

101520253035404550

Ceram

ics

FabricGla

ss

Meta

l

Miscella

neous

Natura

l

Plastic

Rubber

Wood

Wood-p

ulp

Type of material

Perc

enta

ge o

f ite

ms

mou

thed


The materials of the toys and other objects mouthed were then analysed by age. Figure 10 showsthe percentages by material for each 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 than10% of the time at any age. Also interesting is the cross-over from ages 3-6 to 6-9 months, whereplastic 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 staysreasonably constant at approximately 20% of all items. Plastics account for only 15% of itemsmouthed at age 1-3 months, but by age 6-9 months this has risen to 50%, a level approximatelysustained 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 towhether 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 werenot asked to indicate whether or not the items were intended to be mouthed. Table 12 shows theitems recorded in the study that were considered as intended to be mouthed, by each age group.

Page 28

0

10

20

30

40

50

60

70

80

90

100

1-3

3-6

6-9

9-12

12-1

5

15-1

8

18-2

1

21-2

4 2 3 4 5

Age group

% o

f ite

ms

mou

thed

Ceramic

Fabric

Glass

Metal

Miscellaneous

Natural

Plastic

Rubber

Wood

Wood-pulp


Table 12: Items intended to be mouthed which were mouthed in this study.

Page 29

Mouthed by age group

1-3months

3-6months

6-9months

9-12months

12-15months

15-18months

18-21months

21-24months

2years

3years

4years

5years

✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

✓ ✓ ✓ ✓ ✓

✓ ✓ ✓ ✓ ✓ ✓ ✓

✓ ✓ ✓ ✓ ✓

✓ ✓ ✓

✓ ✓ ✓

✓ ✓ ✓

✓ ✓ ✓

✓ ✓ ✓

✓ ✓

✓

✓

✓

✓

Bottle

Cup

Spoon

Rattle

Balloon

Play food

Beaker

Teether

Toothbrush

Fork

Tin/penny whistle

Doll’s bottle

Straw

Knife

Teaset

Ice lolly stick

Mug

Bubble pipe

Can

Toy spoon


This shows that feeding items such as bottles, cups, beakers and cutlery, and child care itemssuch as teethers and rattles were mouthed by nearly all age groups. Of concern here is thatballoons were mouthed by nearly all ages over 6 months. Table 13 presents those itemsconsidered 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.

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.

Table 14: Items intended to be mouthed as a percentage of all plastic items mouthed.Page 30

Age Group

1-3 months 25

3-6 months 13

6-9 months 11

9-12 months 12

12-15 months 15

15-18 months 15

18-21 months 21

21-24 months 20

2 years 18

3 years 19

4 years 11

5 years 11

Items intended to be mouthed as a % of all items mouthed

Age Group

1-3 months 100

3-6 months 31

6-9 months 18

9-12 months 16

12-15 months 21

15-18 months 22

18-21 months 31

21-24 months 28

2 years 29

3 years 29

4 years 18

5 years 15

Items intended to be mouthed as a % of all plastic items mouthed


For age group 1-3 months all of the plastic items mouthed were intended to be mouthed. After this agea maximum of only 31% of the plastic items mouthed were considered as intended to be mouthed.

4.3.4 Number of items mouthed

Within each age group for each subject the total number of toys and other objects mouthed by eachchild was calculated, as a way of assessing the variety and range of items children will put into theirmouths. A mean value for each age group was then calculated and these data are presented inFigure 11.

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 monthsmouth the fewest number of items on average (3 items).

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0

5

10

15

20

25

30

1-3

3-6

6-9

9-12

12-1

5

15-1

8

18-2

1

21-2

4 2 3 4 5

Age category

Mea

n nu

mb

er o

f ite

ms

mou

thed


In order to assess the validity and reliability of the observation method used in this study theobservations were repeated with a random selection of 25 of the sample, using parentalobservation, plus two alternative methods; trained observers and video recording. For eachperson a single 15-minute observation session of their child was undertaken at their home. Themouthing behaviour of the child in this 15 minute session was recorded simultaneously by theparent, a trained observer and also captured on video. All protocols were the same as the maindata gathering part of the study. The data gathered from the three different observation methodswere then compared.

5.1 ANALYSIS OF MOUTHING TIME

Table 15 shows the mouthing behaviours recorded by a trained observer, by the parent and byvideo for the group of 25 children as a whole.

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 parentwere very similar, with total mouthing time, mean mouthing time and maximum observedmouthing time all being exactly the same, and number of behaviours observed and standarddeviation being very similar.

As anticipated, the video analysis captured more incidences of mouthing behaviour and thuspotentially more mouthing time than the direct observation methods. Additionally, mean andstandard deviation mouthing times were lower than those found by direct observation. Thiswould be expected as video analysis allows for much more accurate observation and timecapture than direct observation, with the lower standard deviation indicating less variance inthe range of mouthing behaviours than observed by trained observer or parent.

Page 32

Chapter 5Validation

Total number of behaviours observed in 15 minutes for all children

Total observed mouthingtime for all children

Mean observed mouthing time

Standard deviationmouthing time

Maximum observed mouthing time

Trained observer Parent Video

110 114 160

19:44 19:44 24:15

0:23 0:23 0:21

1:02 1:00 0:41

9:43 9:43 6:07


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 veryshort motion away from the mouth which would not have been (and was not) picked up bydirect observation.

A one way analysis of variance (ANOVA)1 was conducted on the mouthing time data todetermine 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

Observations of what was mouthed (i.e. dummy/soother, fingers, toys or other object) were madeand compared across the three groups to determine similarity of observation. Figure 12 illustrates thenumbers of observations recorded for each type of item mouthed as recorded by the three methods.

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 bythe child. It is unknown why the parent did not record what was mouthed, while the video analysiscould not see what was being mouthed due to the child being obscured from view. As the videoanalysis observed more behaviours it follows that more behaviours were counted for each type. It isinteresting 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 objectobservation differed by five and four counts respectively. This may be because in these cases theother objects mouthed were small items, which made it difficult to make a distinction between thechild mouthing the small object held in their hand or the hand itself.

1An 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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0

20

40

60

80

100

120

140

160

180

Trained observer Parent VideoObservation typ

Num

ber

of o

bse

rvat

ions

Other object observationsToy observationsFinger observationsDummy observations

e


5.3 ANALYSIS OF HOW THE CHILDREN MOUTHED

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.

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 behaviourwill be higher overall. Three cases of the type of mouthing behaviour were not differentiated byvideo analysis (again because of the impaired view of the child) and 24 cases were notdifferentiated by parental observations.

This investigation into the validity of the data gathering protocols show that the data gathered in thisstudy are reliable. As expected video observations captured more behaviours and longer mouthingtimes than direct observations, but the presence of the video camera also changes the behaviour ofthe child. The similarity of the number of mouthing behaviours and the total mouthing timesobserved 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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020406080

100120140160180

Trained observer Parent VideoObservation type

Num

ber

of o

bse

rvat

ions

Lick and suck behavioursBiting behavioursSucking behavioursLicking behaviours


Page 35

Chapter 6Discussion

This section is split into two parts. First, there is a brief discussion of the methodology and validityof the study, and then a discussion of the results in terms of the mouthing times recorded, what wasmouthed and how.

6.1 VALIDITY AND RELIABILITY OF THE STUDY

The validation study showed that there was very good agreement between the trained observersand the parents who were used to observe in this study. Parental observation at home was chosenas the least intrusive and least disruptive method of recording children’s natural and normalbehaviour. The only limitation to the use of parents (and trained observers for that matter) waswhen compared to video observation. Here it was found that through the use of video analysissoftware, very short breaks in mouthing behaviours, when a child may have momentarily moved anitem out of, or away from their mouth, could be recorded. These could not be recorded by the normaleye. 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 showthat for overall mouthing (i.e. on all items including fingers) the highest estimated mean dailymouthing 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 andthumbs. 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 morethan any other age group, and mouthing time generally decreases from this age (estimated meandaily mouthing time 1:03:40 hours:minutes:seconds). Children aged 1-3 months mouth the least onthese items (0:05:28). This is to be expected as children at this age are reliant on their parents toprovide them with items to play with (and thus to mouth on) as they are not mobile and able tomove about the house to find new items. The majority of "other objects" mouthed by children in this1-3 months age group were their parents’ clothing.

It is important however to consider the maximum estimated mouthing times which children may mouthon items over a whole day, as this represents the highest likely exposure to mouthed hazards, andpresent 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 agesexcept 5 year olds, but there is no real pattern of increase or decrease with age. Maximum mouthingon 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


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 mouthingon other objects stays generally quite level to age 21-24 months, where it then increases to peak atage 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 addingthe two values together. Although the maximum mouthing estimates for mouthing on each itemdoes not necessarily come from the same child this would give an indicator of a value for dailymouthing that could possibly be reached. Adding together the estimated maximum mouthing valuesfor 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 areprobably the most likely to offer risk, both chemical and mechanical, compared to mouthing ondummies/soothers or body parts, the two other categories of mouthed items. It has been assumedfor this discussion that dummies are items intended to be mouthed, and as such will be regulated byappropriate standards.

The highest mean mouthing time on each category occurs in different age categories, but all aremouthed most by children under 1 year, except dummies/soothers. Toys and other objects are bothmouthed 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 patternwhich was reversed from age 15-18 months to 5 years (with the exception of children aged 21-24months). Such a pattern of mouthing can be explained by the fact that as children learn to walk and thusbecome more mobile they become less reliant on their parents to provide them with items intended forplay, 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 ofmouthing behaviour.

Page 36


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 exhibitedthe most for all age groups, followed by licking and then biting. Licking and sucking behavioursaccount for at least 64% of all mouthing for all age groups, with licking, sucking and biting behavioursaccounting for at least 79% for all age groups.

When each category of items mouthed is analysed, mouthing on dummy/soother and fingers hadfewer types of mouthing, mainly sucking, than mouthing on toys and other objects where far greatertypes of mouthing behaviour were exhibited by children at all ages. A possible explanation for this isthat dummy/soothers and fingers are familiar items to children that do not require explorationthrough mouthing, and are mainly used in their capacity as soothers. However, many toys and otherobjects 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 yearolds (1:30:49 and 0:46:34). It is of interest that biting behaviours were highest for three year oldswhile sucking was highest for younger children. At 9-12 months of age there is a good chance that achild’s first teeth may not have come through so sucking may be a more natural behaviour, whereasolder children with more established teeth may well find biting to be a more natural behaviour.

Page 37

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%1-

3

3-6

6-9

9-12

12-1

5

15-1

8

18-2

1

21-2

4 2 3 4 5

Age category

% c

ontr

ibut

ion

to to

tal m

outh

ing

of ty

pe

of m

outh

ing lick, suck and bite

suck and bite

lick and bite

lick and suck

bite

suck

lick


7.1 WHY CHILDREN MOUTH

The urge to suck and mouth by young children is a natural developmental phase. Sucking may bedivided into two distinct behavioural types: nutritive and non-nutritive sucking (Turgeon-O’Brienet al, 1996). Nutritive sucking is the instinctive need to feed. Non-nutritive sucking (e.g. suckingon a dummy/soother) is thought to be adopted by infants as a response to frustration, or as aneed for contact, or as a part of the child’s psychological development in exploring the worldaround them through touching and tasting objects with the mouth and tongue.

Research on the mouthing behaviour of children has usually concentrated on the psychologicaldevelopment of the act, being concerned with the cause and motivation behind mouthing. Thereis, however, a child safety issue concerned with the safety of items being placed into the mouthsof young children. Some products, such as dummies/soothers, teething rings and bottle teats, areintended to be placed into the mouth. Unfortunately, products not intended to be mouthedinvariably 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 mostobvious hazards are choking or suffocation, although there is a risk of any item becoming stuck inthe mouth and the resultant trauma may be serious. There is also the risk of foreign body incidentswhere 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 physicalproperties to which toys must conform, with toys being "any product or material designed orclearly intended for use in play by children of less than fourteen years of age" (p4). There are alarge number of requirements to which a toy must conform, with additional requirements fortoys intended for children of less than 36 months. The main requirement for such toys concernssmall parts which could potentially be choking, suffocation or foreign body hazards. The test forsmall parts is whether or not the toy or any removable part of the toy fits entirely within aspecified test cylinder. If the toy or any removable part of the toy fits entirely into the truncatedcylinder without compression it does not conform to BS EN 71. The cylinder used for small partstesting is 31.7 mm (1.25") in diameter, with side lengths of 51.7 and 25.5 mm respectively. Thestandard 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 youngto sit up unaided.

Certain toys in the EU are required to have a specific safety warning label depending on the typeof 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 atonce" (BS EN 71-1, p18). Additional warning labelling is required for toys not intended forchildren 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".

Page 38

Chapter 7Implications for product safety


The Child Safety Protection Act (CSPA) of 1994 in the US details similar requirements, with the samesize test cylinder defined for small parts testing, but in 1994 a new section was added which putslabelling requirements on certain balls, balloons, marbles, and certain toys and games intended foruse by children three years of age and older. The amendment also bans certain balls intended for useby children younger than three years of age. Balls are tested with a cylinder similar to that used forsmall parts testing, but with a diameter of 44.5 mm (1.75"). A small parts warning label is also requiredin 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, toyspose a choking hazard if they have play value for children under three (e.g. they are easy tounderstand and brightly coloured) and would entirely fit into the small parts cylinder or thesmall balls cylinder. Toys that may pose a choking risk include those that fit inside the cylinderonly when compressed; fit inside with an area sticking out of the cylinder; play food that fitsthrough the ball testing cylinder; latex balloons which are deflated or balloon pieces. It is illegalfor a toy manufacturer to make a toy which is obviously intended for children under three and tolabel it as intended for children aged over three.

Unfortunately there are many objects in the home environment other than toys which can posea choking, suffocation, foreign body or general hazard to young children. Obviously it isimpossible and impractical to attempt to control what people have in their homes, and so theemphasis 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 areclassified as foreign body accidents, which include choking, suffocation or stuck-in-mouthincidents. A foreign body is basically an object that should not naturally be in the eye, thestomach 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 to1995/6 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 involvedchildren 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 wereresponsible for 6% and non-food items (or ‘other objects’ as classified in this study) wereresponsible for 32%. Of the incidents involving toys, 85% happened to children under threeyears of age. Of the fatalities to children under three years, 8% were caused by non-food objectsand 4% by toys or parts of toys. Nearly two thirds of fatalities (60%) at all ages are caused byitems 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

2trivial – ‘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).

Page 39


7.4 MOUTHING TIMES

The estimates of daily mouthing times from this study show that the highest estimated meantime mouthing on toys and other objects is at ages 6-9 months, and that mouthing on these itemsdrops off at 4 and 5. These data fit the pattern of the accident statistics, as it is logical that thehigher the mouthing time on toys and other objects the higher the risk of an injury occurring dueto 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 monthsand so children at this age are putting the widest variety of items into their mouths. Research bythe DTI (1999) on choking risks to children lists the foreign bodies that caused choking accidentsto 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 andbuilding bricks. Estimated data on the number of choking accidents caused by toys or parts oftoys between 1986 and 1996 for children under the age of 4 in the UK show there were anaverage 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 accidentswith serious or very serious outcomes involved toys or parts of toys which would fit completelywithin the small parts cylinder (DTI, 1999).

Page 40


Of the accidents caused by other objects (i.e. neither food, toys or parts of toys), some 30% arecaused by coins, followed by different types of small objects. Most of these accidents are also ofa minor or trivial nature. The main hazards came from the following items (estimated data forchildren under 4 from 1986 to 1996 show there were an average of 846 incidents a year involvingother 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 youngchildren, for example in terms of choking, suffocation, or foreign body type incidents and forcomparison to the items recorded as causing choking incidents.

Presented in Table 16 are the mouthed items considered to be a potential hazard, what they aremade out of, and what possible hazard they represent. The number of time that each item wasmouthed can be approximated from Appendices F and G.

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Page 42

Item

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

Made from

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

Plastic

Plastic

Fabric

Metal/plastic

Plastic / fabric

Fabric/plastic/metal

Metal/plastic

Dough

Potential Hazard

Choking/cut/foreign body

Cut/foreign body/puncture

Cut/foreign body

Choking/foreign body



Choking

Choking/foreign body/puncture

Choking

Choking


Choking


Choking/foreign body/suffocation


Choking

Choking

Choking/cut/foreign body



Strangulation

Choking/cut

Strangulation


Choking


Suffocation



Choking


Page 43

Item

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

Made from

Metal/plastic

Plastic

Wood/plastic

Plastic/metal

Natural

Wood/plastic

Plastic

Plastic

Plastic

Fabric

Wood

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

Potential Hazard

Choking/strangulation

Choking/foreign body/puncture

Choking


Choking



Cut/puncture

Choking/puncture


Cut

Cut/foreign body



Cut/puncture

Choking /strangulation

Cut/choking/pinch


Foreign body

Choking

Choking

Choking/foreignbody/puncture




Choking


Choking



Choking

Choking

Choking/cut

Cut/pinch




Table 16. Mouthed items that present a mechanical hazard to children.

Without examining individual items it is difficult to assess potential hazards, but there arecategories of items which could be seen as potentially hazardous. When the list of objectsmouthed in this study is compared to information on choking accidents, of the toys or parts oftoys which were cited as involved in choking accidents by the DTI (1999) report (13 items orcategories), all but 2 were recorded as being mouthed by children in this research. Of the otherobjects involved in choking accidents (52 items of categories, not including unknown items) 31were recorded as mouthed by children in this research. This is evidence that the items causingchoking 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 andthe number of objects mouthed. The study also shows that children up to 3 years of age are atrisk from the items they mouth.

Page 44

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

Made from

Natural

Plastic

Plastic

Metal

Metal

Wax

Natural

Plastic

Plastic

Plastic

Rubber

Plastic

Plastic

Rubber

Wood pulp

Plastic

Plastic

Plastic

Plastic

Potential Hazard





Choking/cut

Cut



Foreign body/puncture




Cut

Choking

Choking/strangulation/foreign body

Choking






7.7 REDUCING ACCIDENT LEVELS

The types of items that are recorded as causing choking incidents were commonly andfrequently mouthed in this study. In fact the toy category ‘building blocks/bricks/shapes’ whichis cited as one of the major toy types involved in choking incidents, was fifth in the list of mostcommonly mouthed toys in this study.

Most strikingly, the results of this study illustrate the huge variety of items that are mouthed bychildren, and that most items in the home are likely to be mouthed, particularly once the childbecomes mobile. This means that it is not possible to identify specific design features of an itemthat makes it more likely to be mouthed. If the complete list of toys and other objects mouthed isexamined 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, giventhat many items in the home are made of plastic, the exposure level of children to the material ismuch higher than (for example) exposure to items made of glass or metal. Also, there aredifferent types of plastic, such as soft and hard plastic, which were not distinguished between inthis study.

7.7.1 Toys

Accident statistics show that toys which cause serious or very serious choking accidents alwaysinvolve 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 givento children under the age of three, children who have older siblings may well have access to suchproducts. Additionally, some toys have small part components, such as pieces of a toy which wouldthen 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 bysuch items. One route would be to remove all small parts from toys intended for children, althoughthis would have obvious ramifications for the toy industry. For small items such as marbles andbuilding 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 wouldhave on older children who play with small toys to develop motor and cognitive skills, for exampleusing building blocks to construct objects. By banning small toys or toys with small parts "the benefitwould be to eliminate a maximum of 100, mostly minor, accidents. The cost would be to deprivechildren 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 potentialimpact on accident numbers by previous DTI research (DTI, 1999). By extending the currentregulations to cover four year olds it has been estimated that some 19 accidents a year involvingsmall toys or parts of toys could be prevented (of which one would be classed as serious or veryserious). If children under the age of three could be prevented from coming into contact with smalltoys or parts of toys (i.e. if they were banned) then 109 accidents a year could be prevented, with afurther 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 tochildren, but there are many problems with this approach. Also, banning small toys will have no effecton 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 toyswhich 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) andthe others are coins and bottle or tube tops. Of these items, only bottle and tube tops offer anypotential for re-design to reduce the choking hazard they offer, by altering the shape could bealtered in some way. Further design research and evaluation would be required to examine thefeasibility 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-toyitems through banning them, is discouraging children from mouthing these items by altering theproduct characteristics. Product characteristics have been separated into the following categories,with potential ways of discouraging mouthing attached to each. These are initial ideas only, andshould be fully researched before being implemented to ensure that natural child development isnot impeded and that the desired effect is produced.

Colour - young children may be attracted to brightly coloured toys. Toys intended for use by olderchildren, i.e. over three years of age, could be less brightly coloured so as not to catch the eye ofyounger children.

Taste and smell - if toys or products taste and/or smell bad then children may be less likely tomouth them. For instance, bitter tasting agents have been used in some household products to limitchildren from swallowing a large amount. A similar taste or an off-putting smell could perhaps beapplied to toys and other objects commonly mouthed (but not intended to be mouthed) todiscourage children from doing so. However, this study shows that children mouth on metal andother bad tasting items and also on items with an unpleasant smell, which indicates that in youngerchildren, 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 isrough or smooth), but future research could assess if any particular texture would discouragechildren from mouthing.

Size and shape - children mouth items of any size, but obviously only the smaller items will fit intotheir mouths and become a choking hazard. The shape of an item does not appear to be a factor inchildren’s tendency to mouth an item.

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Chapter 8Conclusions

This study has produced reliable data on the mouthing behaviour of children up to 5 years of age, asshown by the investigation of the validity of the observation protocol used in the study. It givesquantitative evidence of mouthing behaviour which can be used to guide the design and regulationof items intended to be given to children to be mouthed, intended to be given to children but notmouthed, and those items that are not expected to be given to children but even so are likely to endup 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 onall 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 twothirds 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 intendedto 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, butmouth the most number of items (the average number of toys and other objects mouthed per daypeaks 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 significantdifference 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, inthat the highest mean mouthing time is by children under 3 (the high risk age for choking) andparticularly children under 1 year, who mouth the most and put the widest variety and number ofitems into their mouth. The high risk age is when children become mobile and can access itemsaround them rather than being restricted to items that are given to them. The items being mouthed inthis 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. Thisstudy has shown that a huge variety of items are mouthed, particularly by children under 1 year, due toteething and using mouthing as a method of exploring their environment. Instruction to children of thisage as to what can and can’t be placed in the mouth is not feasible. It is also not feasible to physically, orlegislatively, restrict the access of young children to their environment. The main route to the preventionof hazards associated with mouthing, particularly such as choking, is through parental / carerobservation. Continued education of parents and carers is necessary to ensure the awareness ofhazards associated with mouthing, and particularly of those items that accident statistics have showncan cause choking, e.g. food, balloons, coins and marbles.


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 wouldinclude obvious items such as dummies/soothers, feeding equipment and rattles, but also items suchas restraints, nursery furniture, bathing items and stair gates. Standards and guidance for theseproducts 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 theirchild actually mouthed (both in terms of the number of times items are mouthed and the number ofitems mouthed), and that they would have usually missed the short duration mouthing behavioursexhibited by their child. This evidence lends support to keeping the most potentially hazardous itemsout of the reach of children, as parents cannot always be watching their child and controlling whatthey put into their mouths, and as far as possible using design and regulation to ensure those itemswhich young children are guaranteed to come into contact with and therefore mouth do not presentany mouthing hazards.

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Chapter 9Recommendations

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 virtuallyimpossible to make entirely free from potentially hazardous items. This leaves the following paths toreducing 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 reducetheir potential hazard is by the parents taking care about storage and use of such toys or removingthem 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 accountfor 6% of cases for children under 4 years of age and only 4% of choking fatalities (children under 3between 1986 – 1995, DTI 1999) were caused by toys or parts of toys the impact of such sweepinglegislation on choking hazards would be small. This leaves the best way to reduce accidents causedby toys or parts of toys to be through educating parents and carers about the dangers posed bycertain 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 commonlymouthed 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, thiswould require a degree of initial research followed by trials of re-designed items and then post designassessment 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 andother objects, that it is impossible to stop them doing so through legislation. The most productive wayforward 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.


However, it is also important that the risk of children choking on toys and other objects is notoverstated. The accident statistics (DTI, 1999) show that the number of choking cases for childrenunder four on all items is declining, and that 51% of cases are caused by food, 32% by other objectsand only 6% by toys or parts of toys. The vast majority of cases (88%) are also classed as minor ortrivial. There are still a small number of choking fatalities, but over the period 1986 to 1995 only 4% (ornine cases) were caused by toys or parts of toys, and 8% by other objects. The vast majority offatalities (69%) were food related.

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Chapter 10References

Department of Trade and Industry (DTI). (1999). Choking risks to children under four from toys andother objects. DTI, London.

European Committee for Standardisation (1998). Safety of toys - Part 1: Mechanical and Physicalproperties, 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 objectmouthing 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 inpreschool children: A longitudinal study. Pediatric Dentistry, 22 (3), 187-191.


OBSERVATION RECORDING FORM

Date of observation: ______/______/______ (dd/mm/yy)Time observation started: Time observation finished:

Appendix A

Time on watch

What is being mouthed

How it is being mouthed Type of object

Action Begin

Action End

Dummy Fingers Toys Other Licking/lip touching

Sucking/trying to bite

Biting orchewing

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 observationsession you complete. You only need to enter the details of each toy or object once, but the name thatyou 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:

Please enter details of objects that your child mouthed into 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?

What is the part that was mouthed made from?

Name of object listed on observation sheet


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 andlast day that you observe your child please fill in the time that the child got up (i.e. out of bed not justawake), ate, slept/napped and went to bed (by eating we mean main meals or feeds, not snacks suchas a biscuit).

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Appendix C

First observation day: Last observation day:

Child got up at:

Child went to bed at:

Eating times:

Slept/napped:

From: To: From: To:

From: To: From: To:

29. Was the observation day a normal day i.e. there were no unusual events?

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)

31. Was your child behaving normally today ?YesNo, the child was teething No, the child slept longer than usualNo, the child was off his/her foodNo, the child was listlessNo, the child felt ill



1 Yes 2No 1 Yes 2No

1

2

3

4

5

6

1

2

3

4

5

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: 1 Male 2 Female

3. Which of the following ethnic categories best describes your child:1 White2 Indian3 Pakistani4 Black- African5 Black- Caribbean6 Black - Other (please specify)7 Bangladeshi8 Chinese9 Other (please specify)

4. Does your child have teeth? 1 No2 Front teeth through / appearing3 Front teeth through & back teeth appearing4 Both front and back teeth5 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? 1Yes 2No

8. Does your child ever damage things by biting? 1Yes 2No

9. Does your child use a dummy ? 1Yes 2No

10. If your child uses a dummy do they usually use it when they are: (tick all that apply)1 Playing2 Sleeping 3 Unwell4 Upset 5 Tired 6 Going to bed

11. At what age was your child: (please answer all that apply)Sitting upFeeding themselvesCrawlingTalkingStanding Potty trainedWalking


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 only2 Milk (breast or formula) from a bottle 3 Other liquids4 Solids5 Same as rest of family6 Other

Section 3 About your household

15. What type of house do you live in ? 1 Flat2 Terrace3 Semi-detached4 Detached5 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 None2 Dog3 Cat4 Rabbit5 Bird6 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:1Self-employed 2An 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 guardian2 Father/male guardian3 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 guardian2 Father/male guardian3 Other

25. How old are the child’s parents or guardians?Mother/female guardian: Father/male guardian:

26. Does the primary carer work?1 No2 Yes - full-time3 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?

Please mention any other information that you feel may be relevant to this study.

Thank you.

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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)


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 mouthingbehaviour involves.

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 EPictures illustrating mouthing behaviours

Licking / lip touching - the object is placed to the front of themouth, without actually going into the mouth. The child maybe actually licking an object (as in the picture) or may betouching the object to their lips.

The time that you record should be from when the object firsttouched the child’s mouth to when the object is no longer incontact with the mouth. If a child is licking an object it may bedifficult to record because of the short time period involved. Inthis case you should note the time when the object is put closeto the mouth to be licked, and then taken away from the mouth.

Sucking / trying to bite - the object is put directly into the mouthof the child.

The child may be sucking, holding the object in their mouth ortrying to bite (gumming) the object.

Biting or chewing - the object is directly in the mouth of the child. It is clear that the child isbiting or chewing on it

When watching younger children it may be difficult to tell exactly what the child is doing with theobject 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.


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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 descendingorder 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 fulllist of miscellaneous toys mouthed is presented at the end of the main list of toy categories.

Miscellaneous: 190 toy 17ring 8activity centre 3activity mat 3baby gym 3bean toy 3action figure 2baby nest 2bell 2bridge 2flower 2glove puppet 2hair brush 2missile 2paper 2play mat 2pull-along toy 2toy handbag 2tree 2tunnel 2activity gym 1activity mat 1activity table 1baby mirror 1ball bearings 1bottle 1bracelet 1card 1card game 1case 1chalkboard 1character 1child's beaker with lid 1clock 1cone 1connectors 1container 1cotton comfort rag 1cotton reel 1cow noise tin 1

Toy Category (and number of times mouthed)

Toy Name(given by observer)



cube 1daisy toy 1desk 1disc 1doctors syringe 1dog toy candle 1dolphin ring 1domino 1dominoes 1duck on stick and wheels 1ducks chain 1fabric cube 1fence 1finger puppet 1first words toy 1golf club 1gym toy 1hairbrush 1hairdryer 1hand puppet 1highchair 1hoop 1inflatable heart 1inflatable roll along 1knee hammer 1lamp-post 1licking star 1lid of plastic shape sorter 1slinky 1lipstick 1little box 1little plastic cup 1lotto card 1lunch box 1marble madness 1mat 1mirror sun 1movie making cube 1toy 1paper money 1plastic 1plastic comb 1plastic container 1plastic craft knife 1plastic ring 1plastic spinning toy 1plastic stick 1

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play rings 1push chair 1pyjama case 1racket 1red nose 1remote control to car 1remote control to toy car 1alphabet learning centre 1robot 1rocket 1rocking horse 1rocking tail 1rocking toy 1shaker 1shoe 1sit&ride 1skipping rope 1skittle 1small box 1soft block (tag) 1soft mirror 1sparkling symphony gym 1spinning top 1‘squeaker’ 1squeaky toy 1stamp 1stethoscope 2string of beads 1string on ball 1electronic pet 1tent 1tent (pop up) 1thermometer 1tigger teddy 1wacky stick 1tooth mirror 1toothbrush 1toy's bag 1toy button 1toy cotton reel 1toy lipstick 1toy magnifying glass 1toy pushchair 1toy rainmaker 1toy stick 1toy thermometer 1toy watch 1triangle 1

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tube 1tubes 1tumble ball ring 1electronic first words 1whisk 1wooden toy 1yo-yo 1wobbly toy 1zoo 1

Toy food/crockery/cutlery: 123 cup 15spoon 13toy food 11toy cup 9food 7play food 5orange 4teapot 4tea set 4pot 3fork 2fruit 2toy fruit 2vegetable 2apple 1banana 1beaker 1bowl and spoon 1bread 1cake 1chip pan 1chips/tomatoes 1coffee/tea coaster 1crisp 1dish 1egg 1egg shell 1frying pan 1ice cream cone 1knife 1plastic bread 1plastic cup 1plastic fork 1plastic tomato 1plastic toy ketchup bottle 1

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plate 1play banana 1play cup 1play milk bottle 1potato masher 1pumpkin 1rolling pin 1saucer from tea set 1sausage 1spoon toy 1teacup 1toy bottle lid 1toy chips 1toy cooking pot 1toy fruit basket 1toy pan lid 1toy pepper pot 1toy pizza 1toy vegetable 1

Toy animals: 155 duck 17dog 10rabbit 10turtle 8rubber duck 7fish 6lion 6octopus 6animal 5elephant 5horse 5whale 5dolphin 4frog 4hippo 4spider 4pig 3butterfly 2cow 2crocodile 2dinosaur 2giraffe 2ladybird 2monkey 2piglet 2





plastic dinosaur 2shark 2sheep 2tiger 2deer 1bone of toy dog 1butterfly 1cat 1cat toy 1caterpillar 1chicken 1cow toy 1dalmation dog 1goat 1jelly fish 1lobster 1mouse 1panda 1pig toy 1plastic rabbit 1rubber lion 1small dog 1toy dog 1toy mouse 1toy sheep 1zebra 1

Building bricks/ building block/bricks 101blocks/shapes: 109 tree/ creeper 1

plastic shapes 1rubber brick 1shape 1square shape 1squashy block 1triangle shape 1wooden block 1

Stacking cups/rings: 23 stacking cup 8stacking ring 6rocket stacker 2stacker 1stacker of stacking rings 1stacking beaker 1stacking bricks 1stacking jack 1

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stacking toy 1stacking tubs 1

Toy/shape sorters: 5 ball with shapes in it 1shape ball 1shape sorter 1toy sorter 1shape sorter container 1

Toy vehicles: 122 car 48train 12aeroplane 8boat 8fire engine 5toy car 4train track 4plane 3track 3helicopter 2lorry 2toy train 2truck 2jeep 2car-track 1car crusher 1car string 1car tyre 1car wheel 1farm truck 1fire engine ladder 1garage 1garage fence 1small metal car 1spaceship 1steering wheel 1tractor 1traffic lights 1truck handle 1wheel on car 1wooden train track 1

Dolls & accessories: 106 doll 65doll’s bottle 10doll’s brush 3doll’s shoe 3doll's jacket 2


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clothes of doll 1clown 1comb for doll 1doll's bag 1doll's beaker 1doll's hair 1doll's hand 1doll clothes 1doll’s blanket 1doll’s dummy 1doll’s foot 1doll’s hair 1doll’s hairbrush 1doll’s hand 1dolls’ house toy 1doll’s milk bottle 1doll’s spoon 1fabric doll 1doll’s milk bottle teat 1mermaid 1cartoon doll 1ribbon on doll 1spoon for doll 1

Toy figures & accessories: 65 figure 28action figure 14man 4toy TV figure 4action figure axe 2skateboard figure 2action figure arrow 1fashion doll 1fashion doll baby 1head of toy figure 1motorbike figure 1motorbike with rider 1plastic person 1play person 1pre-school toy figure 1train driver 1toy character figure 1

Toy rattles: 61 rattle 53bear rattle 2cotton rattle 1





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big rattle 1button rattle 1clown rattle 1musical rattle 1rattle teether 1

Toy tools/guns: 42 hammer 12screwdriver 5gun 4scissors 3pliers 3spade 2spanner 2sword 2arrow 1axe 1bolt 1drill bit 1fire extinguisher 1mower 1screw 1tool 1cement mixer 1

Toy musical instruments: 34 microphone 6drumstick 4xylophone beater/stick 3trumpet 2whistle 2maraca 2piano 2tambourine 2musical bee 2castanet 1clacker 1musical ball 1musical carousel 1musical cow 1musical flower 1musical toy 1penny whistle 1xylophone 1

Toy telephones: 33Drawing/painting including crayon 19pens/pencils/crayons: 53 pencil 9





paintbrush 5felt tip pen 4pen 3crayon pencil 3pen top 2wax crayon 2coloured pencil 1crayons box 1mechanical sketch machine 1felt pen 1stencil 1children pencil crayon 1

Toy cameras/computers/ camera 4recording: 20 recorder 3

compact disc 2cassette player 2cassette tape 1cd case 1cd player 1computer 1computer steering wheel 1mouse from computer 1tape recorder 1camcorder 1camera 1

Books: 82 book 71cloth book 3hard book 2baby soft plastic book 1book-tag 1box of books 1colouring book 1material book 1page of book 1

Bath toys: 21 bath toy 12bath book 2animal bath toy 1baby boat 1bath boat 1bath book corner of page 1bath shape 1chain on floating toy 1character bath toy 1

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Water toys: 9 watering can 3water pistol 2squirty snake 1water pump 1water scoop 1water wheel 1

Toy household items: 11 vacuum cleaner 3shopping basket 2iron 1kitchen slice 1sweeping brush 1toy bucket 1vacuum cleaner attachment 1sweeping brush 1

Toy keys: 9 keys 8key ring 1

Soft/cuddly toys: 96 soft toy 38teddy 22cuddly toy 6teddy bear 3fluffy rabbit 2soft dog 2cuddly mouse 2granular filled soft dog 1bunny 1bunny rabbit toys 1cloth cow 1cloth pig toy 1fabric octopus 1flashing soft toy 1fluffy puppy 1fur dog 1small soft toy 1soft octopus 1soft rabbit 1soft rocking cow 1soft ruffle bear 1soft skittle 1soft stacking ring 1soft triangular toy 1soft velour dog 1stuffed rabbit 1stuffed teddy 1

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TV character soft toy 1Teethers: 17 teething ring 7

teether 3teething rattle 2teething keys 2dinosaur teether 1teething book 1teething toy 1

Walkers (classified as walker 4toys by observer): 6 push along walker 2Toy letters/numbers: 8 alphabet letters 3

magnet lettering 3numbers 2

Toy money: 4 money 2large play coin 1plastic money 1

Balls: 44 ball 40ball (small) 1ball activity toy 1bounce ball 1football 1

Bikes: 3 bike 1handle bar of bike 1pole handle for bike 1

Modelling clay and tools: 10 modelling clay 8plunger 1tool 1

Jigsaws: 20 jigsaw 17jigsaw piece 3

Puzzles: 6Balloons: 5 balloon 4

balloon handle 1Bubble blowers: 6 bubble blower 4

pipe for bubbles 1wand from pot of bubbles 1

Marbles: 2Dressing up: 4 police helmet 2

toy dressing up ring 1mask 1

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Object category(and total number of times mouthed)

Object Number of times mouthed

EXAMPLES OF OTHER OBJECTS CATEGORIES

All other objects that were mouthed in this study are listed below. Category of other object isarranged in descending order on times mouthed i.e. the most commonly mouthed category tothe least commonly mouthed. The number after each category heading indicates the number oftimes that category was mouthed, with the name and number of times each object in eachcategory was mouthed also presented. The full list of miscellaneous objects mouthed ispresented at the end of the main list of other object categories.

Clothing: 241 jumper 27t-shirt 25socks 24sleeve 19bib 16trousers 14pyjamas 10cardigan 9sweatshirt 7dressing gown 6coat 5dressing gown belt 5hat 5jeans 5baby grow 5shirt 5clothing 4dress 4ribbon 4sleep suit 4dungarees 3fleece top 3vest 3bobble of hat 2clothes 2denim jacket 2mittens 2skirt 2toggle 2bootee 1clothes 1baby jacket 1collar 1top 1drawstring 1

Appendix G


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gilet 1gloves 1jumper tie (on zip) 1jumper string 1lace toggle 1apron 1swimsuit 1tassel on hat 1tie 1tights 1trouser cord 1

Miscellaneous: 150(see list at end)Soft furnishings: 144 flannel 29

cushion 22blanket 21towel 13pillow 10duvet 8cloth 5curtain 4t-towel 4sheet 3muslin cloth 2nappy 2quilt 2thread/cotton thread 2fashion doll cushion 1chair cover/throw 1cloth napkin 1comforter cloth 1cover on settee 1cushion tassel 1duster 1hand towel 1muslin square 1muslin square (comfort blanket) 1nappy bag 1piece of cotton 1piece of fabric 1pillowcase 1shawl 1sheet label 1throw 1


Beakers/cups: 94 beaker 31cup 25drinking cup 7beaker lid 4feeder cup 4mug 4drinking bottle 3juice cup 3plastic beaker 3beaker spout 2plastic cup 2beaker handle 1cup lid 1drink (cup with lid) 1drink of squash 1feeding bottle 1feeding bottle teat 1

Paper/card/books/ book 19magazines: 78 paper 18

magazine 9piece of paper 6jigsaw 4newspaper 4book cover 3leaflet 3playing card 2birthday card 1card 1cardboard label 1edge of card 1note pad 1paper page 1party invite 1shredded paper 1TV guide 1TV instructions 1

Knives/forks/spoons: 62 spoon 45plastic spoon 5fork 4knife 3hard spoon 1metal fork 1metal spoon 1soft spoon 1



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teaspoon 1Brushes (hair/tooth/ floor/ toothbrush 29paint/washing up): 60 hair brush 13

paint brush 5brush 4comb 3make-up brush 2bristles on dustpan brush 1broom handle 1nailbrush 1handle of wash up brush 1

Kitchen utensils: 40 wooden spoon 7coaster 6pan lid 4jug 3measuring jug 2spatula 2table mat 2cafetiere plunger 1colander 1fish slice 1frying pan 1jar 1kitchen utensil 1leaf 1pastry cutter 1pressure cooker gasket 1foam packing 1salt grinder 1saucepan lid 1tray 1whisk 1

Bottles and tops bottle 21(material unknown): 37 bottle of milk 3

bottle top 3milk bottle 3bottle lid 1bottle stopper 1bottle stopper bung 1bottom of bottle 1empty bottle 1top of small shampoo bottle 1sauce bottle 1


Pens: 36 pen 33ball point pen 1inside of a ball point penpen end 1

Shoes/slippers/shoe laces: 35 shoe 12slipper 10shoelace 4baby shoe 2jelly shoe 1leather moccasin slipper 1shoe (child’s) 1slipper (sole of) 1soft shoe 1sole of shoe 1hook and loop fastening of shoe 1

Remote controls remote control 29(TV and video): 32 TV control 2

video remote control 1Child care articles: 21 high chair 2

stair gate 2baby walker 1table on highchair 1bed guard 1cot 1dummy cup 1dummy holder 1feeding spoon 1fire guard 1handle of pushchair 1high chair leg 1high chair tray 1teething rail 1bouncy chair fastener 1changing mat 1child’s table 1childproof cover 1stair-gate bars 1

Packaging container 4(material unknown:) 29 toothpaste tube 3

toy box 2tube of cream 2empty mousse carton 1empty pencils box 1eye shadow case 1

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foot scrub tube 1glue lid 1goggles box 1hair gel lid 1money box 1moisturiser tube 1perfume bottle 1shoe box 1sweet container 1toothpaste lid 1top of glue stick 1toy box edge 1tube 1tube of chocolate buttons 1tube of gel 1

Stop watch inc cord: 28 stopwatch 17cord on stop watch 11

Furniture (solid): 27 table 5side of bath 3drawer 2stool 2bed frame 1bed post 1chair leg 1coffee table corner 1dining chair 1drawer handle 1dresser leg 1head board 1kitchen door and handle 1shelf unit 1side board 1small wooden drawer 1table leg 1table top 1wall unit 1

Pencils: 26 pencil 21end of pencil 2colouring pencil 1lead pencil 1pencil (coloured) 1

Video boxes: 25Sofa/settee: 20 settee 9

sofa 7

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arm of sofa 2settee cushion 2

Plastic containers: 20 plastic tub 3yoghurt pot 3baby wipes plastic tub 2plastic container 2deodorant lid 1lid of butter 1lunch box 1plastic box 1plastic lid 1plastic milk container 1plastic pipe 1plastic toy box 1plastic tube 1tub lid 1

Sponge: 20 sponge 16bath sponge 3bath ‘squeezie’ 1

Bottles and tops: 19 shampoo bottle 10lid of pop bottle 2plastic bottle 2conditioner bottle 1baby lotion bottle 1water bottle 1juice bottle 1little plastic bottle 1

Tissues/paper towels/ tissue 10toilet paper: 17 kitchen roll 3

serviette 2toilet roll 2

Cardboard packaging/tubes: 16 cardboard tube 3cereal box 2stopwatch box 2cardboard box 2cardboard 1jigsaw box 1paper plate 1crisp tube 1chocolate sweet tube 1tissue box 1toilet roll tube 1

Keys: 16 key ring 7key 6

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car keys 1key ring and car keys 1wardrobe key 1

Food packaging: 15 crisp packet 5chocolate outer wrapper 4sweet wrapper 3cellophane packet 1packet of passata 1unopened sweets 1

Architectural fittings: 15 window 5window ledge 2banister 1door 1door frame 1door panel 1skirting board 1wall 1floor 1inside of cupboard 1

Phones: 14 mobile phone 5phone 3aerial of mobile 2cordless phone 1cordless phone aerial 1mobile phone case 1telephone receiver 1

Balloon: 14 balloon 11balloon dog 1balloon tip/opening 1blown up balloon 1

TV and video: 14 TV controls 3TV screen 3television 2video recorder 2TV buttons 2TV cabinet 2

Pen tops: 13 pen top 8pen lid 3crayon top 1felt tip top 1

Baby wipes: 12 baby wipe 9wet wipe 2baby wipes refill 1

Wood/cane: 5 balsa wood 1


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bamboo cane 1garden cane 1wooden candleholder 1stick 1

Chairs: 12 chair 10chair arm 1chair seat 1

Hair decorations: 10 hair clip 4hair band 2hair scrunchie 1hair thing 1hair slide 1hair tie 1

Electrical/phone cables: 10 telephone cable 4vacuum cleaner cable 2cable 1electric tie cable 1video machine wire 1wire of hairdryer 1

Straps: 10 string 3strap-booster seat 1strap from chair 1strap of bouncer 1strap of rucksack 1string end 1canvas strap on high chair 1cord on bouncer 1

Money/coins: 9 coin 5money 4

Bath: 8 bath 4bath handle 3bath seat 1

Box 8Fridge magnet: 7Felt tip pen: 7 felt-tip pen 4

felt tip 1large felt tip pen 1pen(marker) 1

Bowls/dishes/plate/egg cup: 7 bowl 3egg cup 2dish 1plate 1

Babies' bottles: 10 bottle teat 5


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baby bottle 3baby bottle lid 1baby feeding bottle 1

Plastic red noses: 7Tin/metal containers: 7 chocolates tin 2

hair mousse container 1long metal tube 1tin rim 1soft drink can 1foil dish 1

Clothes fastenings: 7 zips 5buttons 2

Bubbles (in bath): 7Peg: 7Watches: 6 watch 3

buckle on watch 1face of children’s watch 1watchstrap 1

Straw: 6Carpet: 6Animals/pets: 5 dog 3

cat 2Box for cd/cassette/ cd case 3video tapes: 5 cassette box 2Necklace: 5Glasses/sunglasses: 4Swimming goggles: 4Packaging (prob. soft plastic): 3 handy pack of tissues 1

tissues (packet) 1wipes packet 1

Glass: 3 glass 2glass of juice 1

Coat hangers: 3Photo frame: 3Photo: 3Bean bag: 3Badge: 3Bag: 3Spectacles case: 3Folder: 3Ruler: 3Eraser: 3Stones: 3Videos: 2


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Pet food: 2 cat food 1dog biscuit 1

Electrical: 2 light switch 1washing machine door 1

Cotton wool: 2Flowers: 2Handbag: 2Lipstick/lip salve: 2

Miscellaneous items: (150)artificial flower 1nail file 1baby nightlight 1notepad binder 1baby shampoo 1ornament 1ball 1ornamental spoon 1bangle 1ornament 1bath container 1paper weight 1bath bomb (bath foam cube) 1pebble 1beads 1peg basket 1beak 1pencil sharpener 2bib 1photo album 1bike 1piece of sticky paper 1bin bag 1piggy bank 1binocular case 1place mat 1bobble 1plaster 1bookmark 1plastic block 1bouncy castle 2plastic coat hanger 1box lid 1plastic fishing rod 1box model 1


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plastic lead 1bracelet 1plastic letter 1bucket 1plastic scissors 1calendar 2plastic sponge 1calculator 1plastic straw 1candle 1pom pom 1car seat buckle 1purse 1CD 1rack on dishwasher 1chalk 1radiator 2child’s apron 1radiator button 1clothes peg 1reading bag 1comfort 1recorder 1computer screen 1red vinyl purse 2credit card 1ring 1date block 1rolling pin 1decorative piece 1rope 1collectable card 1rubber band 1disposable nappy 3scanner on till 1domino bag 1seashell 2drinking straw 1shower gel 1duck 2small golf club 2edge of toy basket 1soap 2emery board 1soap dish 1




envelope window 1soap dispenser 1eraser 1soil 2exercise bike 1sticker 2fastener 1sticky name label 1fish 2supper 1funnel 2syringe 1glasses 1tape 1gold necklace 1tape cassette 1green binder 1tape measure 2green chair 1terry bib/bib 1handbag 1child’s thermometer 1handbag strap 1tin whistle (pipe) 1harmonica 1tin whistle (mouthpiece) 1hole punch 1top 1ice lolly stick 2torch 1jam tart cup 1vacuum attachment 1label 2vase 1lace 2wash mitt 1lid of jar 1wash tablet bag 1lollypop stick 1washing powder ball 1magnet 1washing scrub 1mascara 1whale 1microphone 2whistle 1

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mirror 1wicker basket 1motorbike 1wind chimes 1

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Documents

Research into the mouthing behaviour of children up to 5 years old