Review makes parents, pediatric practitioners aware of toy age-related safety standards

Despite tight government regulation, more than 200,000 visits are made annually to U.S. emergency departments (EDs) for toy-related injuries. Parents and pediatric health providers are often unaware of how toys are assigned safety labels and suggestions for recommended age-appropriate use. Researchers from the Children's Hospital at Montefiore (CHAM) examined how toys are tested and labeled for safety concerns in a State-of-the-Art Review Article in the current issue of Pediatrics, with the goal of educating pediatricians and encouraging toy safety discussions with parents.

According to the review, one-third of all toy-related injuries occur in children under the age of five with a significant spike occurring at two years of age. Most non-fatal, toy-related, ED-treated injuries occur because of riding toys, especially scooters and tricycles. Falls are the most common incident, and lacerations, contusions or abrasions are the most common injuries, with the head and face being the most commonly injured parts of the body. The majority of fatal toy injuries are caused by airway obstruction; choking is a significant cause of morbidity in children under the age of three, and one-third of all choking episodes involve non-food items, often toys.

"Young children have small airways and practice behaviors such as exploring their environments by putting objects in their mouths. This makes small parts safety labeling of paramount importance to toy packaging," said lead author and resident at CHAM, Shuli Kulak, M.D., MBA. "However, developmental milestones can occur at different chronological ages, so they are important to consider as well, when choosing an appropriate and safe toy for a child."

Toy labeling has two components. The first, which is mandated by the Consumer Product Safety Commission (CPSC), the governmental agency responsible for oversight and regulation of the toy industry, focuses on safety labeling for hazards like small parts, balloons, or small balls that may present a choking risk. This is a mandatory regulation and is strictly enforced.

To determine if there are small parts, two tests are conducted. First, all toy components are placed into a hollow cylinder with a diameter of 1.25 inches and a depth of 1-2.25 inches. If any component of a toy fits through this cylinder, it is considered a "small part." Whether or not the toy's components fit through the cylinder's opening, it is also subject to a second test to check normal "use and abuse." If the toy breaks apart or gets damaged during this testing, all broken parts must go through the hollow cylinder used to determine if small parts exist. If the toy, or any of its broken or unbroken parts, are considered to have small parts, one of three potential outcomes is possible dependent on the chronological age of the child intended to use the toy. If the toy is determined to be appropriate for children age three or under, it cannot go to market in its current form, if the toy is determined to be appropriate for children between the ages of three and six, it must include a safety warning and if the toy is determined to be appropriate for children over the age of six, no further testing or labeling is required.

Balls and toys with magnets have separate rules and tests, and all balloons - which are commonly played with near the mouth and can mold into the shape of a child's airway - are required to bear a hazard warning on the packaging label because they are the leading cause of choking death in children under the age of six.

The second component of toy labeling is developmental age-labeling which describes the age of the children for whom the toy is intended. Developmentally age grading a toy is done to identify which safety test should be carried out on a toy but does not, by law, need to appear on a toy's packaging. This is a self-imposed industry practice that does not uniformly appear on all toy packaging and most consumers and pediatricians are unaware that this developmental age-labeling is not a legal requirement.

CHAM researchers advise that in addition to noting safety labels, it is important for parents to consider chronological age and the developmental age of their child when selecting toys, especially for children with special needs or atypical development. They advise that in addition to noting and abiding by safety labels, there are various recommendations parents can consider, to help keep their children safe. These include, but are not limited to:

• Checking toys periodically for breakage and either repairing or discarding them
• Storing toys intended for older children out of reach from younger children
• Being involved in play when toys are given to younger children so proper and safe play can be modeled
• Ensuring that ride-on toys are used in safe and appropriate environments away from dangerous places such as stairs or near traffic and swimming pools

"We recognize the importance of play for healthy brain development," said Ruth E.K. Stein, M.D., attending physician, CHAM, co-author of the paper, and professor of Pediatrics, Albert Einstein College of Medicine. "The purpose of our paper is to familiarize pediatric practitioners with the regulations governing toy age-related safety standards and how they are reflected in toy labels so we can better counsel parents and protect children from unnecessary harm."