Safety of toys - Children´s mouthing behaviour in contact with toys

This Technical report presents the results of a European Study on "Children's mouthing behaviour in contact with toys". It provides statistical data on the duration and frequency that children under 36 months introduce toys into their mouths and estimated data on the time children under 36 months spend mouthing toys each day.
Furthermore, it provides information on
-   the literature focused on children's mouthing behaviour, including commonly used methodologies and significant results;
-   the design and methodology of the study;
-   the data on the children and toy sample;
-   the forms used in data collection.

Sicherheit von Spielzeug - Mundkontaktverhalten von Kindern

Sécurité des jouets - Analyse de la mise à la bouche des jouets par les enfants

Varnost igrač - Obnašanje otroka pri stiku igrače z usti

To tehnično poročilo predstavlja rezultate evropske študije »Obnašanje otroka pri stiku igrače z usti«. Podaja statistične podatke o trajanju in pogostosti, s katero otroci, mlajši od 36 mesecev, v usta vnašajo igrače, ter ocenjene podatke o času, ki ga otroci, mlajši od 36 mesecev, vsak dan namenijo stiku igrač z usti.
Nadalje podaja informacije o
- literaturi, ki se osredotoča na obnašanje otrok, povezano z usti, vključno z najpogosteje uporabljanimi metodologijami in pomembnimi rezultati;
- zasnovi in metodologiji študije;
- podatkih o otrocih in vzorcu igrač;
- obrazcih, uporabljenih za zbiranje podatkov.

General Information

Status
Published
Public Enquiry End Date
01-Dec-2015
Publication Date
03-Feb-2016
Current Stage
6060 - National Implementation/Publication (Adopted Project)
Start Date
08-Jan-2016
Due Date
14-Mar-2016
Completion Date
04-Feb-2016

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SLOVENSKI STANDARD
SIST-TP CEN/TR 16918:2016
01-marec-2016
9DUQRVWLJUDþ2EQDãDQMHRWURNDSULVWLNXLJUDþH]XVWL
Safety of toys - Children´s mouthing behaviour in contact with toys
Sicherheit von Spielzeug - Mundkontaktverhalten von Kindern
Sécurité des jouets - Analyse de la mise à la bouche des jouets par les enfants
Ta slovenski standard je istoveten z: CEN/TR 16918:2015
ICS:
97.200.50 ,JUDþH Toys
SIST-TP CEN/TR 16918:2016 en

2003-01.Slovenski inštitut za standardizacijo. Razmnoževanje celote ali delov tega standarda ni dovoljeno.

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SIST-TP CEN/TR 16918:2016
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SIST-TP CEN/TR 16918:2016
CEN/TR 16918
TECHNICAL REPORT
RAPPORT TECHNIQUE
December 2015
TECHNISCHER BERICHT
ICS 97.200.50
English Version
Safety of toys - Children´s mouthing behaviour in contact
with toys

Sécurité des jouets - Analyse de la mise à la bouche des Sicherheit von Spielzeug - Mundkontaktverhalten von

jouets par les enfants Kindern

This Technical Report was approved by CEN on 7 December 2015. It has been drawn up by the Technical Committee CEN/TC 52.

CEN members are the national standards bodies of Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia,

Finland, Former Yugoslav Republic of Macedonia, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania,

Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey and

United Kingdom.
EUROPEAN COMMITTEE FOR STANDARDIZATION
COMITÉ EUROPÉEN DE NORMALISATION
EUROPÄISCHES KOMITEE FÜR NORMUNG
CEN-CENELEC Management Centre: Avenue Marnix 17, B-1000 Brussels

© 2015 CEN All rights of exploitation in any form and by any means reserved Ref. No. CEN/TR 16918:2015 E

worldwide for CEN national Members.
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Contents Page

European foreword ....................................................................................................................................................... 5

Introduction .................................................................................................................................................................... 6

1 Scope .................................................................................................................................................................... 7

2 Literature review ............................................................................................................................................ 7

2.1 General ................................................................................................................................................................ 7

2.2 Methodological review on children’s mouthing behaviour ............................................................. 8

2.3 Main results on the duration and frequency of children’s mouthing behaviour in

previous literature ...................................................................................................................................... 11

2.3.1 General ............................................................................................................................................................. 11

2.3.2 Daily time available to mouth not spent sleeping or eating ......................................................... 12

2.3.3 Frequency of mouthing objects ............................................................................................................... 13

2.3.4 Amount of the time spent mouthing objects ...................................................................................... 14

3 Design of the research ................................................................................................................................ 16

3.1 General objective.......................................................................................................................................... 16

3.2 Data collection ............................................................................................................................................... 16

3.3 Methodology .................................................................................................................................................. 17

3.3.1 General ............................................................................................................................................................. 17

3.3.2 Ethnographic.................................................................................................................................................. 18

3.3.3 Home environment ...................................................................................................................................... 18

3.3.4 Free play environment ............................................................................................................................... 20

3.3.5 Pilot test ........................................................................................................................................................... 21

3.3.6 Observational tool and protocols ........................................................................................................... 22

3.3.7 Training sessions ......................................................................................................................................... 23

3.4 Sample description: Children and toys ................................................................................................ 23

3.4.1 General ............................................................................................................................................................. 23

3.4.2 Children sample ............................................................................................................................................ 24

3.4.3 Sample .............................................................................................................................................................. 31

3.5 Statistical analysis ....................................................................................................................................... 35

4 Results of children’s mouthing behaviour in contact with toys .................................................. 36

4.1 Frequency children mouthed toys ......................................................................................................... 36

4.1.1 General ............................................................................................................................................................. 36

4.1.2 By age ................................................................................................................................................................ 36

4.1.3 By gender ........................................................................................................................................................ 37

4.1.4 By gender and age ........................................................................................................................................ 38

4.1.5 By country ....................................................................................................................................................... 39

4.1.6 By country and age ...................................................................................................................................... 40

4.2 Time children spent mouthing toys ...................................................................................................... 41

4.2.1 General ............................................................................................................................................................. 41

4.2.2 By age ................................................................................................................................................................ 41

4.2.3 By gender ........................................................................................................................................................ 42

4.2.4 By gender and age ........................................................................................................................................ 42

4.2.5 By country ....................................................................................................................................................... 43

4.2.6 By country and age ...................................................................................................................................... 44

4.2.7 Toy-to-mouth contact duration by age ................................................................................................. 45

4.3 Type of mouthing: lip/tongue, suck/engulf, bite/chew ................................................................. 47

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4.3.1 Frequency by type of mouthing ............................................................................................................... 47

4.3.2 Frequency by type of mouthing and age............................................................................................... 48

4.3.3 Time children spent mouthing, by type of mouthing ...................................................................... 49

4.3.4 Time children spent mouthing toys by type of mouthing and age .............................................. 50

4.4 Elastomeric vs. not elastomeric material ............................................................................................ 51

4.4.1 General ............................................................................................................................................................. 51

4.4.2 Frequency by elastomeric and not elastomeric material .............................................................. 51

4.4.3 Frequency by elastomeric and not elastomeric material and age .............................................. 52

4.4.4 Time children spent mouthing by elastomeric and not elastomeric material ....................... 53

4.4.5 Time children spent mouthing, by elastomeric and not elastomeric material and age ..... 53

4.4.6 Toy-to-mouth contact duration by elastomeric and not elastomeric material ..................... 54

4.4.7 Toy-to-mouth duration by elastomeric and not elastomeric material and age ..................... 55

4.4.8 Qualitative approach of the influence of elastomeric material in children’s mouthing

behaviour......................................................................................................................................................... 55

4.5 Toys intended vs not intended to be mouthed ................................................................................... 58

4.5.1 General ............................................................................................................................................................. 58

4.5.2 Frequency children mouthed toys intended vs not intended to be mouthed ......................... 58

4.5.3 Frequency children mouthed toys intended vs not intended to be mouthed by age ........... 59

4.5.4 Time children spent mouthing toys intended vs not intended to be mouthed ...................... 60

4.5.5 Time children spent mouthing toys intended vs not intended to be mouthed by age ........ 60

4.5.6 Toy-to-mouth contact duration for toys intended vs not intended to be mouthed .............. 61

4.5.7 Toy-to-mouth contact for toys intended vs not intended to be mouthed by age ................... 62

4.6 Toy categories ................................................................................................................................................ 63

4.6.1 General ............................................................................................................................................................. 63

4.6.2 Frequency children mouthed toys by toy category .......................................................................... 64

4.6.3 Time children spent mouthing toys by toy category ....................................................................... 65

4.7 Bite marks left on toys ................................................................................................................................ 66

4.8 Degree of salivation ..................................................................................................................................... 67

4.8.1 General ............................................................................................................................................................. 67

4.8.2 Toys that contributed to high degrees of salivation ........................................................................ 68

5 Estimations ..................................................................................................................................................... 69

5.1 General ............................................................................................................................................................. 69

5.2 Results of ethnographic study .................................................................................................................. 69

5.2.1 Time children are awake and not eating.............................................................................................. 69

5.2.2 Time children are in contact with toys ................................................................................................. 71

5.3 Estimation formula ...................................................................................................................................... 72

5.4 Estimation of frequency children mouth toys .................................................................................... 72

5.4.1 General ............................................................................................................................................................. 72

5.4.2 Estimation of frequency children mouth toys by age ...................................................................... 73

5.5 Estimation of time children spend mouthing toys............................................................................ 74

5.5.1 General ............................................................................................................................................................. 74

5.5.2 Estimation of time children spend mouthing toys by age .............................................................. 75

6 Discussion........................................................................................................................................................ 76

6.1 Frequency children mouthed toys .......................................................................................................... 76

6.2 Time children spent mouthing toys ....................................................................................................... 77

6.3 Time available to mouth toys per day ................................................................................................... 78

6.4 Type of mouthing .......................................................................................................................................... 80

6.5 Elastomeric toys ............................................................................................................................................ 80

6.6 Toys intended and not intended to be mouthed ............................................................................... 80

6.7 Mouthing toys by categories ..................................................................................................................... 80

6.8 Bite marks left on toys ................................................................................................................................ 81

6.9 Degree of salivation ..................................................................................................................................... 81

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7 Summary ......................................................................................................................................................... 81

7.1 Introduction ................................................................................................................................................... 81

7.2 Literature review ......................................................................................................................................... 81

7.3 Design of the research ................................................................................................................................ 82

7.4 Results .............................................................................................................................................................. 82

7.4.1 Frequency children mouthed toys ......................................................................................................... 82

7.4.2 Time spent mouthing toys ........................................................................................................................ 82

7.5 Estimations ..................................................................................................................................................... 83

7.5.1 The frequency children mouthed toys ................................................................................................. 83

7.5.2 Time spent mouthing toys ........................................................................................................................ 83

7.6 Childcare articles ......................................................................................................................................... 83

Annex A (informative) Summary of previous quantitative studies on children’s mouthing

behaviour ........................................................................................................................................................ 84

Annex B (informative) Results of children’s mouthing behaviour in contact with childcare

articles .............................................................................................................................................................. 92

B.1 Introduction ................................................................................................................................................... 92

B.2 Design of the research ................................................................................................................................ 92

B.3 Frequency children mouthed childcare articles ............................................................................... 96

B.4 Time children spent mouthing childcare articles ............................................................................ 98

B.5 Type of mouthing lip/tongue, suck/engulf, bite/chew ................................................................ 102

B.6 Childcare article category ....................................................................................................................... 105

B.7 Summary ....................................................................................................................................................... 105

Annex C (informative) Statistical results .......................................................................................................... 107

C.1 Normal distribution test .......................................................................................................................... 107

C.2 Significance test .......................................................................................................................................... 109

C.3 Mean weighted by year ............................................................................................................................ 123

C.4 Observational periods .............................................................................................................................. 128

Annex D (informative) Glossary of terms and definitions .......................................................................... 130

Bibliography ............................................................................................................................................................... 132

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European foreword

This document (CEN/TR 16918:2015) has been prepared by Technical Committee CEN/TC 52 “Safety of

toys”, the secretariat of which is held by DS.

Attention is drawn to the possibility that some of the elements of this document may be the subject of

patent rights. CEN [and/or CENELEC] shall not be held responsible for identifying any or all such patent

rights.
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Introduction

This CEN Technical Report presents the results of a European Study on “Children's mouthing behaviour

in contact with toys”. The objective of the study was the measurement and quantification of the

duration and frequency that children under 36 months introduce toys into their mouths spontaneously.

It presents information about the literature review focused on children's mouthing behaviour, including

commonly used methodologies in addition to a review of significant results from previous research. It

also includes the design of the research; methodology; data on the children and toy sample; complete

results obtained in the frequency and duration that children mouthed toys and estimated data on the

time children under 36 months spend mouthing toys each day.

Up to now, the study was the one with the largest sample (245 children and a total number of 1 680

observations) and the only one to be carried out in three different European countries (Germany,

France and Spain). It was also the study with the highest representation of specific toys (54 different

products) for children up to 36 months.

In addition to the results on the mouthing behaviour with regard to toys, Annex B contains information

concerning children's mouthing behaviour in contact with childcare articles. This informative annex is,

however, just a first approach, and of limited value.

Clause 7 of this CEN Technical Report contains a more detailed summary of the results of the European

Study on “Children's mouthing behaviour in contact with toys”.
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1 Scope

This Technical Report presents the results of a European Study on “Children's mouthing behaviour in

contact with toys”. It provides statistical data on the duration and frequency that children under

36 months introduce toys into their mouths and estimated data on the time children under 36 months

spend mouthing toys each day.
Furthermore, it provides information on:

— the literature focused on children's mouthing behaviour, including commonly used methodologies

and significant results;
— the design and methodology of the study;
— the data on the children and toy sample;
— the forms used in data collection.
2 Literature review
2.1 General

Mouthing is an important component in childhood development. In early development, sucking

provides essential nutrients in the form of breast or bottle-feeding, as well as a feeling of well-being and

a sense of security (Juberg et al., 2001 [1]). If infants are not allowed unrestricted breast-feeding, they

will suck on a dummy, thumb (or other fingers), blanket, or toy (Groot et al., 1998 [2]). As children

develop, mouthing behaviour, in combination with looking and touching, allows children to explore and

investigate their environment. Mouthing behaviour develops into an exploratory behaviour in which

objects are placed into the mouth for a few seconds for purposes of discovery. During this stage of

development, children will put their hands, and any object that they come in contact with, into their

mouths (Ruff, 1984 [3]; Ruff and Dubiner, 1987 [4]; Davis et al., 1995 [5]; Groot et al., 1998 [2]: Tulve et

al., 2002 [6]).

In the field of psychology, Freud named the stage between birth and 2 years of age the 'oral stage'. This

first stage of development is characterized by the physical aspects of sucking, encompassed by the

mouth, tongue and lips. During the oral stage, it is common for children to have a persistent tendency to

put whatever falls into their hands into their mouths. It is the means by which they express their need

to experience the world through their mouths. The pleasurable activity of sucking, biting and chewing,

means the child starts to recognize objects and distinguish them as separate from himself. When a baby

puts something in his mouth, he bites it with his gums, sucks it and moves it with his tongue. It is the

first form of learning that children experience, as they begin to recognize textures, temperatures and

forms through mouthing. Furthermore, it benefits verbalization processes, chewing and teething.

Teething is another reason that children will mouth fingers and objects. At this stage of development,

mouthing alleviates the pain and discomfort associated with teething (Groot et al., 1998 [2]). Teething

usually begins at 6 months to 8 months, but may start several months earlier or later. Teething

continues in babies until approximately the age of 3.

The first teeth to appear are usually the two bottom front teeth, also known as the lower front incisors.

Between 4 weeks to 8 weeks later, they are followed by the four upper front teeth. About a month later,

the lower lateral incisors appear. Next come the first molars, and then finally the canines. Most children

have their 20 milk teeth (which are the first teeth to appear) when they reach three years of age. The

commencement of teething is the most important stage in babies' mouthing.

Young children's urge to suck and mouth is a natural developmental phase. Sucking may be divided into

two distinct behavioural types: nutritive and non-nutritive sucking (Turgeon-O'Brien et al., 1995 [7]).

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Nutritive sucking is the instinctive need to feed. Non-nutritive sucking (e.g. sucking on a

dummy/soother) is thought to be adopted by infants as a response to frustration, or as a need for

contact, or as a part of the child's psychological development in exploring the world around them

through touching and tasting objects with the mouth and tongue (Norris and Smith, 2002 [8]).

Research on the mouthing behaviour of children has usually concentrated on the psychological

development of the act, being concerned with the cause and motivation behind mouthing. There is,

however, a child safety issue concerned with the safety of the items being placed into the mouths of

young children. Some products, such as dummies, teething rings and bottle teats, are intended to be

placed into the mouth. Unfortunately, products not intended for mouthing invariably end up in

children's mouths, as this is how young children explore their world. Obviously, child safety is of

paramount concern, and so products shall be as safe as possible, whether they are handled or placed

into the mouth (Smith and Norris, 2003 [9]).

This is the reason why there is an increasing focus on children in exposure and risk assessments, as

they are more sensitive to environmental contaminants than adults (Silvers et al., 1994 [10]). All items

that are placed into a child's mouth have the potential to be a mechanical hazard. The most obvious

hazards are choking or suffocation, although there is a risk of any item becoming stuck in the mouth and

the resultant trauma may be serious. There is also the risk of foreign body incidents where a child

swallows an item, which may then cause harm to internal systems of the body (Norris and Smith, 2002

[8]).

Because of their mouthing behaviour, children have a higher potential for exposure to available

chemicals through the non-dietary ingestion route; thus, frequency of hand-to-mouth activity is an

important variable for exposure assessments. Such data are limited and difficult to collect. Few

published studies report such information, and the studies that have been conducted used different

data collection approaches: e.g. videography vs. real-time observation, data analysis and reporting

methods, ages of children, locations (indoor vs. outdoor), and even definitions of “mouthing” (Xue et al.

2007 [11]).

As children in all geographic regions spend most of their time indoors, at home, Silvers et al. (1994) [10]

indicated that risk assessments should focus on indoor, on-site hazards. The same conclusion was made

by Xue et al. (2007) [11], as was seen in the review of previous research. The present study is consistent

with these conclusions: observing in
...

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