Written By: Dr Anitha Anchan | Updated : February 18, 2016 2:41 PM IST
Each day there is a new development in babies growth. Each day they learn a new skill. By three to four months of age, babies try to explore everything with their mouth - from their own fingers to almost anything that they can lay their hands on like hair, clay, crayon, toys, etc. This habit of mouthing will most often continue till they are two, and in some cases even beyond two and is often a part of the natural developmental milestones. Most often the habit resolves on its own. However, some kids continue the practice beyond their developmental stage.
Mouthing involves no ingestion of the article. Some children develop the habit of eating non-nutritive substances like soil, clay, chalk, charcoal, paint, paper, soap, glass, hair, ice, etc. This eating disorder is called pica. But how safe is the mouthing habit? Mouthing carries mechanical and chemical hazard potential for injury to the children[1]. Children are at risk of choking on objects. The choking can cause wheezing, coughing, breathing troubles, and even unconsciousness. Kids may swallow things like small parts of toys, buttons, beads, marbles, coins, etc. Tiny objects may harmlessly pass through children s body, especially once the objects reach stomach or intestine. Some ingested items may get stuck while others may be poisonous. The upper third of the esophagus (food pipe) is the common site of obstruction. There is also a risk of stomach perforation, infection, and death from swallowing batteries or sharp items like safety pins, broken pieces of glass, etc[2]. Do you know what to do if your kid swallows fruit seeds?
With all the harmful microorganisms lurking around and the risk of choking and injury, the tasting spree in children is a cause for concern to the parents. It's good to know what are the 12 things you should never keep around your children to avoid fatal accidents. Here is a list of some of the common things that kids put in their mouth that signal danger:
Clay/Soil: The usual soil and dust ingestion is normal in children. It helps train their immune system and help develop good immunity. But there are risks involved too. The bugs and parasites in soil or clay can cause infections and infestations. Soil contaminated with worms or their eggs enter the children s body and grow inside their stomach. Contamination with insecticides, pesticides, lead, feces, etc. is another concern. Various infections and food poisoning may cause diarrhea or constipation, loss of appetite, vomiting, abdominal pain, etc. Consumption of soil is associated with chronic inflammatory disease of the small intestine (environmental enteropathy) and stunting in children[3].
Coins: Coins are the most commonly ingested object. Swallowing coin may cause symptoms such vomiting, coughing, noisy breathing, etc.
Fallen food: Most people believe the 5-second rule when it comes to eating food fallen on the ground. There is a general consensus that it s ok to eat the dropped food that has been picked up within 5 seconds. A study demonstrated that over 99% of bacteria were transferred from the floor surface to the dropped food after 5 seconds. Also, the food being contaminated with bacteria depended more on how much dirty the surface was, and the kind of surface the food was dropped on. Bacteria were least likely to transfer from carpeted surfaces than from wood or tiled surfaces to moist foods [4]. So, is it ok for kids to eat that chocolate picked up from the floor? The odds are that they may not get sick. But remember that only a small amount of extremely infectious bacteria is enough to make children sick. Though, there are very fewer chances of these bacteria being on most surfaces. There are 10 things we touch every day that are dirtier than a toilet seat! Children are also at risk of parasitic worm infection when they eat food fallen on the soil.
Toys and metal jewelry: There is a reason why it's advisable to buy age appropriate toys. Small parts of toys that come off pose a choking and injury hazard in young kids. Stuffed toys can harbor bacteria. Chewing on plastic toys exposes kids to toxic chemicals that potentially affect hormones and interfere with growth and brain development. Metallic toys and low-cost jewelry are often highly contaminated with toxic substances such as lead and cadmium. These metals find their way into the body through mouthing and pica. Exposure to non-essential metals, especially lead, is a great concern due to the widespread presence of this metal in various products we use. Chronic mouthing of metallic objects by children can increase their blood lead concentration[5]. The rates of metal release vary depending on how aggressive the behavior is. Lead is toxic. It has adverse effects on our nerve, blood, gut, heart and kidneys. Children are particularly sensitive to lead because their stomach easily absorbs the metal, and also their nervous systems are not fully developed. Low-level lead exposure in children has been associated with decreased IQ[6]. And the habit of ingesting lead metal objects can result in acute lead intoxication. It can be even lethal if the object does not successfully transit the gut.
Pencil, chalk, crayon and other art supplies: Most kids nibble on their pencils. As believed by a majority of people, there is no lead in the so-called 'lead' pencils. Most pencils are made of graphite (a form of carbon) and clay. Earlier, the lead present in the paint used for the outer coating was a concern, though. But with the elimination of lead from paints, the worry is no more. A single instance of putting a piece of chalk or crayon into the mouth won t harm your child from the chemicals present in it. But choking on the piece is a concern. When eating chalk becomes a practice, it can catch up and takes a toll on their body. It can cause gut problems and nutritional deficiencies. Chalks and crayons may contain toxic dyes. Beware of the artificially scented and flavored art items. They can contain various chemicals that could be fatal if ingested. Aerosol and powdered paints may contain lead, asbestos, etc. that are disastrous to the body.
Balloons: Balloons are placed in the mouths of children during play activities. Some kids have the habit of chewing on them. This practice can pose a risk of choking from ingestion. Constant mouthing of balloons brings young children into repeated and frequent contact with the hazardous compounds like benzene, xylene and phthalates present in the materials[7]. Benzene has been linked to cancer producing tendency. Xylene has adverse effects on the functioning of the brain nerves and hormones. It also causes reproductive health disorders and DNA damage. Phthalates are also known to be detrimental to the reproductive systems. They interfere with hormone system too[8].
Medicines: The warning on medicines is clear Keep out of children s reach. Paracetamol, cough syrups and antibiotics are some of the most common medicines that are inadvertently ingested by young children. Children may also lay their hands on any medicine within their reach. Swallowing medicines could have disastrous consequences. They affect the liver and the kidneys. Ibuprofen can cause breathing difficulties.
Chemical products: Ingestion of small amounts of mouthwashes may cause nausea and an upset stomach. Mouthwashes containing fluoride and alcohol are poisonous when ingested in large quantities. Swallowing of cleaning agents like dishwashers, detergents, cleaners, etc. can cause burn injuries on the lips, mouth, and the throat. Camphor present in insect repellents, chest rub, etc. can be harmful even in small amounts. It can cause seizures.
Batteries and magnets: Small batteries used in some toys, etc. can be easily swallowed. Leaking out of its contents can cause serious harm to the food pipe such as severe burns and holes in the food pipe, communication between the windpipe and food pipe (tracheoesophageal fistula), blood vessel damage, excessive bleeding, etc.[9] Ingestion of several and distinct magnetic objects can cause serious risks of gut complications like ulceration and perforation of the intestine. There may be a painful obstruction due to an abnormal twisting of the intestine (volvulus), or a portion of the intestine may collapse into another portion (intussusception). Swallowing magnets can cause inflammation of stomach lining, life-threatening complication of an infection (sepsis) and even death [10].
Glow-in-the-dark products: Glow-in-the-dark products are available as sticks, bracelets, wands, etc. Children may tend to bite into them. The liquid present in these products are considered minimally toxic but may cause irritation and burning sensation in the mouth, and nausea [11].
References
1. Smith SA, Norris B. Reducing the risk of choking hazards: mouthing behavior of children aged 1 month to 5 years. Inj Control Saf Promot. 2003 Sep;10(3):145-54. PubMed PMID: 12861913.
2. Jayachandra S, Eslick GD. A systematic review of paediatric foreign body ingestion: presentation, complications, and management. Int J Pediatr Otorhinolaryngol. 2013 Mar;77(3):311-7. doi: 10.1016/j.ijporl.2012.11.025. Epub 2012 Dec 20. Review. PubMed PMID: 23261258.
3. George CM, Oldja L, Biswas S, Perin J, Lee GO, Kosek M, Sack RB, Ahmed S, Haque R, Parvin T, Azmi IJ, Bhuyian SI, Talukder KA, Mohammad S, Faruque AG. Geophagy is associated with environmental enteropathy and stunting in children in rural Bangladesh. Am J Trop Med Hyg. 2015 Jun;92(6):1117-24. doi: 10.4269/ajtmh.14-0672. Epub 2015 Apr 27. PubMed PMID: 25918214; PubMed Central PMCID: PMC4458812.
4. Dawson P, Han I, Cox M, Black C, Simmons L. Residence time and food contact time effects on transfer of Salmonella Typhimurium from tile, wood and carpet: testing the five-second rule. J Appl Microbiol. 2007 Apr;102(4):945-53. PubMed PMID: 17381737.
5. Urrestarazu P, Villavicencio G, Opazo M, Arbildua J, Boreiko C, Delbeke K, Rodriguez PH. Migration protocol to estimate metal exposure from mouthing copper and tin alloy objects. Environ Health. 2014 Aug 11;13:66. doi: 10.1186/1476-069X-13-66. PubMed PMID: 25113236; PubMed Central PMCID: PMC4237810.
6. Lanphear BP, Hornung R, Khoury J, Yolton K, Baghurst P, Bellinger DC, Canfield RL, Dietrich KN, Bornschein R, Greene T, Rothenberg SJ, Needleman HL, Schnaas L, Wasserman G, Graziano J, Roberts R. Low-level environmental lead exposure and children's intellectual function: an international pooled analysis. Environ Health Perspect. 2005 Jul;113(7):894-9. PubMed PMID: 16002379; PubMed Central PMCID: PMC1257652.
7. Jayawardena I, Godakumbura PI, Prashantha MA. Migration of BTEX and phthalates from natural rubber latex balloons obtained from the Sri Lankan market. Springerplus. 2016 Jan 6;5:20. doi: 10.1186/s40064-015-1660-9. eCollection 2016. PubMed PMID: 26759759; PubMed Central PMCID: PMC4703597.
8. Hauser R, Calafat AM. Phthalates and human health. Occup Environ Med. 2005 Nov;62(11):806-18. Review. PubMed PMID: 16234408; PubMed Central PMCID: PMC1740925.
9. Litovitz T, Whitaker N, Clark L, White NC, Marsolek M. Emerging battery-ingestion hazard: clinical implications. Pediatrics. 2010 Jun;125(6):1168-77. doi: 10.1542/peds.2009-3037. Epub 2010 May 24. PubMed PMID: 20498173.
10. Teague WJ, Vaughan EM, McHoney M, McCabe AJ. Swallowed magnets and batteries: a dangerous but not unexpected attraction. BMJ Case Rep. 2013 Apr 10;2013. pii: bcr2013009073. doi: 10.1136/bcr-2013-009073. PubMed PMID: 23580685; PubMed Central PMCID: PMC3645129.
11. Hoffman RJ, Nelson LS, Hoffman RS. Pediatric and young adult exposure to chemiluminescent glow sticks. Arch Pediatr Adolesc Med. 2002 Sep;156(9):901-4. Erratum in: Arch Pediatr Adolesc Med 2002 Nov;156(11):1152. PubMed PMID: 12197797.
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