bItalian Institute for Toy Safety, Como, Italy
cEar, Nose and Throat Department, San Giovanni Battista Hospital, Turin, Italy
Abstract
Background: Choking is an important cause of children's injury and death; food products and common objects are the most frequent offending bodies and small-part toys are responsible for a minor number of accidents. Up to now, few data are available regarding the hazards posed by toys sold in combination with food. Method: We evaluated children's ability to recognize the "double nature" of the products (Aim 1) and compared the manipulation-play approach (in particular mouthing activity) into two different settings called food products containing inedibles (FPCIs) session and Simple toys session (Aim 2). Forty-eight children aged 3–6 were presented with three different FPCIs in a randomised cross over design. Results: (1) children show a good ability to recognize the "double nature" of the FPCIs products, especially of the more familiar and physically well separated ones (i.e. chocolate egg); (2) children interact with toy contained in FPCIs in the same way as with toys alone. Conclusions: Our experimental data show that FPCIs do not exhibit a higher risk for accidental ingestion (and possible choking) than simple toys.
E-mail address: [email protected]
doi:10.1016/S0531-5131(03)01038-0
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Contents
1. Introduction
The analysis of the literature on FPCIs (e.g. Morra et al. [1]) shows that all the studies are weak, often invalidated by some methodological faults and incomplete, due to the absence of any comparison to the risk exhibited by simple toys. Since FPCIs are a category of products very widespread on the market, it seems important to collect other epidemiological and experimental data regarding risks possibly associated to their consume.
2. Material and method
Forty-eight children at four different age levels (from 3 to 6) were selected by means of a questionnaire distributed in a kindergarten and an elementary school of the suburban area of Milan. In order to form two groups at different level of daily exposure to Food Products Containing Inedibles – FPCIs (low and high), the questionnaire investigated children FPCIs direct exposure (frequency of purchase and consume) and indirect exposure (time spent watching TV and perception of other children consuming FPCIs). Three FPCIs were tested and each item was tested 32 times: every child took part in two videotaped experimental sessions in two different days. Half the children started with FPCIs condition (A) and the other half with the simple toy condition (B). Children's actions revealing awareness of the "double nature" of each FPCI used in the test have been previously determined in a pilot study by videotaping 30 children freely playing with many different toys and FPCIs in a familiar environment. A three-level scale was devised concerning the accuracy of the children's recognition of the double nature of the experimental objects.
3. Results
As regards Aim 1, Repeated Measure Anova applied to the score of the scale points out that the ability to recognize the "double nature" of chocolate egg (m=2.94) is significantly different (p=0.004) from that of chips (m=2.29). Exposure level to FPCIs (low exposure recognition score m=2.56, high exposure m=2.70), sex (males m=2.67, female m=2.60) and session sequence (A: m=2.54, B: m=2.58) did not affect this ability whereas 3-year-olds (m=2.04) differed significantly (p=0.001) from 5- and 6-year-olds: m=2.79 and 2.87, respectively.
As shown in Table 1, Chocolate egg was recognized as a product which has a double nature by 100% of the total sample (32 children), Bag of chips with surprise was recognized by 72% of the children tested and Chocolate spread and bread sticks with surprise was recognized by 87% of the children.
| Verbal responses | Chocolate egg | Bag of chips with surprise | Chocolate spread and bread sticks with surprise | |||
|---|---|---|---|---|---|---|
| Non-verbal responses | ||||||
| Behavioural recognition (%) | Non-recognition (%) | Behavioural recognition (%) | Non-recognition (%) | Behavioural recognition (%) | Non-recognition (%) | |
| Early verbal recognition as the specific FPCI | 94 | 0 | 13 | 0 | 9 | 0 |
| Late verbal recognition as the specific FPCI | 3 | 0 | 47 | 0 | 19 | 0 |
| Verbalisation of a general double nature | 0 | 0 | 0 | 0 | 44 | 0 |
| Emphasis on the non-edible part only | 0 | 0 | 6 | 28 | 6 | 0 |
| Emphasis on the edible part only | 0 | 0 | 3 | 0 | 6 | 3 |
| No verbal recognition | 3 | 0 | 3 | 0 | 3 | 10 |
| Total percentages | 100 | 0 | 72 | 28 | 87 | 13 |
The plausible reasons for these differences could be summarized in this way: chocolate egg has food and non-food parts physically and perceptually well separated whereas in a bag of chips with surprise chips and toy are physically mixed and could be at first confused. Moreover on the market, there are different brands of chips not containing surprise gadget; therefore, children expectations to find some surprises are never as certain as with a chocolate egg. The recognition results of the third FPCI tested gives us additional information about how important familiarity is in facilitating double nature recognition of a given product. In fact, even if chocolate spread and bread sticks with surprise is a "side by side" FPCI, it has been less frequently recognized than the chocolate egg; a reason could be that the chocolate spread has been put on the market more recently than chocolate egg and it is therefore less familiar. As regards Aim 2, the approach to toys did not differ in the two conditions (FPCIs and simple toy sessions): neither the presence of food nor the activity of eating the edible part affected frequency of mouthing. The only case of mouthing in which a piece of toy was put into mouth occurred during a simple toy-session, in a child aged 3.
4. Conclusions
Our experimental results suggest that FPCIs do not represent a higher risk of accidental ingestion (and possible choking) when compared to toys alone, since: children aged 3 to 6 showed a good ability to recognize the "double nature" of the FPCIs products, especially of the more familiar and physically well separated ones (i.e. chocolate egg); children apparently interacted with FPCIs as they did with toys presented alone, at least as far as mouthing is concerned.