1. Home/Toy Safety Elizabeth C. Powell, MD, MPH Pediatric Emergency Medicine Children’s Memorial Hospital Feinberg School of Medicine Northwestern University

2. Objectives To describe types of injuries to children in the home Baby and toddler equipment Toys Small parts, balloons, and magnets Lead, phthalates, cadmium

3. Injury rates in US children – hospital < 1 yo 3.4 per 1,000 1 yo 5.0 per 1,000 2 yo 3.9 per 1,000 3, 4 yo 2.9 per 1,000 15-19 yo 6.6 per 1,000 17 hospitalizations per death ED care-far more

4. Types of injuries Common Falls Struck by/against Poisoning/transportation Serious Suffocation Choking Falls Burns

5. Children’s equipment and toy safety Parent perception that equipment and toys on the market for children are safe Children often cannot recognize and avoid hazards Parent education important

6. Falls Furniture Other from height Stairs Buildings Playground equipment

7. Fall prevention Education window guards, stair gates behavior restraint use Engineering equipment design (infant chairs, strollers) Building codes

8. Suffocation/strangulation Beds Portable cribs Drop side cribs Bedding and bumpers

9. Burns Thermal – common Scalds – serious Developmental capabilities younger vs older children Prevention - Microwave oven latch

10. Drowning Fatal Prevention-fencing, covers, alarms

11. Toys Estimated 15 to 30 deaths per year, but reporting is incomplete Airway obstruction/suffocation from small toys, balloons

12. Small Parts Regulation Bans toys intended for use by children <3 yo that have small parts Small parts present a choking, aspiration and ingestion hazard “Small part” defined using a truncated cylinder of designated diameter (1¼ in) and depth (1-2 ¼in) Small balls (diameter < 1 ¾ in) are also banned for children < 3 yo

13. Small Parts Test Cylinder

14. Toy Safety Labels Explain that a hazard exists if the toy is used by a child outside the recommended age range. The cautionary labeling for a toy or game is: Warning: CHOKING HAZARD – Small parts. Not for Children Under 3 yrs

15. Marbles and small round objects Small round objects can easily block the back of the throat and be a choking hazard for children as old as 5 years old Compared to other shapes, toys with a round shape pose the highest risk of choking death

16. Foreign Body aspiration Peak age is between 1 and 3 yrs Toys/small plastic objects account for 5- 15% Diagnosis may be delayed History not diagnostic Physical examination normal Plain films insensitive

17. Toys with small parts Many parents aware of choking danger Older/younger siblings and shared toys Small parts that detach

18. Deaths from Toy Balloons 1970’s 3-11 deaths/year 1980’s 2-11 deaths/year 1990’s* 4 deaths/year 2000’s 1-4 deaths/year In US, cases appear to be decreasing *limited data

19. Small magnets Current technology allows the manufacture of small powerful magnets that are inexpensive Single magnet similar to other small FB that are ingested-pass Multiple magnets or magnet + other metallic object-potential for bowel complications

20. Toys and toxins Lead – neurotoxin Learning, behavior, seizures Phthalates - ?Abnormal genital development, lower sperm counts Cadmium ?Kidney, bone

21. Home/Toy safety issues- Summary Injuries are common; deaths less so Safe toys and equipment Education

22. Thank you