Recently I caught up with a group of parents. A few commented that they think their babies are teething because babies are putting everything into their mouths. Knowing my background in children’s dentistry, one couple asked if I thought their 3mths old was really teething….
Contrary to traditional belief, mouthing is not an exclusive sign of teething.
Mouthing is a normal part of early infant behaviour and an important part of development.(1) Mouthing and sucking can be related to nutrition such as breast feeding or bottle feeding (i.e. nutritive sucking), or non-nutritive such as pacifier/dummy, fingers, thumbs, objects and clothing etc. (1,2) More specifically, mouthing refers to babies putting objects including toys, non-toy objects and items of clothing, into their mouths whereas non-nutritive sucking generally refers to pacifier/dummy, fingers and thumbs. Since non-nutritive sucking of pacifier/dummy, fingers and thumbs is a big and pretty interesting topic, let's chat about that another time? Today, let's share about mouthing...
Before babies can use their hands and fingers to properly grasp and explore objects, babies learn about the world around them by mouthing. Babies most frequently start reaching for things and bring them to mouth, at around 3mths of age.(2,3) Younger than 3mths of age, babies often fail to hold the objects of interest for long enough to bring them to mouth.(2,3) By around 9mths of age, babies begin to be able to pick up objects with their thumb and index finger.(2,3)
Younger babies tend to spend more time exploring with their mouth. As babies grow and develop, becoming more mobile and more able to use their hands and feet to explore their world, the time spent on mouthing seems to reduce.(1) Mouthing has been reported to peak between the ages of 3-9mths, which aligns with the timing of the first tooth emergence, which usually occurs at approximately 7mths of age.(1,4)
Rest assured, mouthing is not a bad thing. Mouthing is not something we, doting parents, need to deter. Mouthing is part of childhood, a growing phase.
To ensure our precious little ones pass through this growing phase of mouthing, without drama or mishaps, there are a few things to keep in mind:
There is a plethora of baby products designed and marketed for mouthing e.g. teethers, teething chews and rusks, baby toys, pacifiers. Generally these specifically designed mouthing toys go through a process of quality checks to assure parents, they are age-specific or safe for all ages. However, all parents discover sooner or later, babies have minds of their own. Babies are particularly good at getting their hands on anything and everything not intended for babies; especially parts off older siblings’ toys e.g. puzzle pieces, balloons, building blocks, non-toy objects e.g. coins, pen lids, and clothing items e.g. buttons, necklaces, beads.
Choking risks are particularly great from conforming objects e.g. uninflated balloons and balloon pieces, which can get stuck to a child’s airway and form an airtight seal over the airway.(5) Objects that are small, round or cylindrical in shape, or with moving or separable small parts, pose considerable choking risks.(5,6) According to the United States Consumer Safety Commission(6), if a toy can fit into a cylinder of 3.2cm diameter x 5.7mm height (perhaps, imagine and compare with the cylinder of a toilet paper roll which measures approximately 3-4mm diameter x 10mm height), then the toy poses choking risks for children under 3yo.
Most countries have their own standards and guidelines for toys. For example, in Australia, you can refer to the Australian Competition and Consumer Commission’s Product Safety Australia and the Australian Toy Association.(7,8) For international standards, there is also the International Council of Toy Industries.(9)
As parents, it is wise to be conscious of choking risks when babies start mouthing everything and anything.(5)
Safety standards for toys address toxicity risks and impose exclusions on constituents deemed toxic or hazardous. However, advances in technology also means new materials are being developed all the time and incorporated into products. Toxicities from new materials may remain unknown for a long time to come. Toxicity may also result from the manufacturing process and not just the product constituents. Therefore, absolute 100% risk free, is very hard to come by.
For example, phthalates and bisphenol A (BPA), both found in many products in everyday life, have received a lot of attention in the recent past, due to concerns regarding potential health risks.(10-14). Studies and reviews results have been conflicting.(10-14) Scientific evidence suggests that the risks to humans are inconclusive.(10-14)
As parents, wanting the best for our children is innate and this may include exercising precautions when selecting toys and other products used for baby, amidst controversies. For some parents, making their own, may alleviate some concerns.
Mouthing phase of development is usually accompanied by the “oopsie daisies” (frequent dropping of things) and “let’s test my boundaries and see how many times my adult will pick this up for me” phases. While a bit of dirt and dust are unlikely to cause health concerns, mouthing toys may lead to infections, if these toys come in contact with pathogens contaminated surfaces or saliva.(15-17)
Some ways of minimizing infection risks from toys include: avoid sharing toys, cleaning toys before use and when toys get dropped, replace contaminated toy with a clean toy and replace soft toys more frequently (since soft toys are more difficult to clean and decontaminate than hard toys).(16,17)
Young babies may seem like they mouth all day long but actually, mouthing durations are usually less than 1-2hrs per day, with the exception of pacifier/dummy, thumb or fingers non-nutritive sucking.(1) Short durations of mouthing does not pose any malocclusion risks. In addition, mouthing duration generally decreases with age.(1) This is in contrast to persistent and prolonged non-nutritive sucking of pacifier/dummy, fingers or thumbs, which can increase risks of malocclusion.(18.19)
So that’s mouthing “in a nutshell”. As parents, it is good to know, mouthing is part of baby’s development, and often peaks around the time of the first tooth cutting. What a relief it is that we don’t need to come up with some game plan to stop baby mouthing. We just have to help baby explore their world safely. Phew! (mmm on second thought…that’s a big task in itself, isn’t it?).
Hugs & Smiles
- Juberg DR, Alfano K, Coughlin RJ, Thompson KM. An observational study of object mouthing behaviour by young children. Pediatrics 2001; 107: 135-142.
- Hay WW Jr, Levin MJ, Sondheimer JM, Deterding RR (Eds). Current Diagnosis and Treatment Pediatrics. 20th Edition. New York: McGraw-Hill, 2011.
- Marcdante KJ, Kliegman RM, Jenson HB, Behrman RE (Eds). Nelson Essentials of Pediatrics. 6th Edition. Philadelphia: Saunders Elsevier, 2011.
- Tsang AKL. Teething, teething pain and teething remedies. IDSA 2010; 12(5): 48-61.
- American Academy of Pediatrics. Policy Statement. Prevention of choking among children. Pediatrics 2011; 125(3): 601-607. DOI: 10.1542/peds.2009-2862.
- United States Consumer Product Safety Commission. Small parts for toys and children’s product business guidance. Accessed online: https://www.cpsc.gov/Business--Manufacturing/Business-Education/Business-Guidance/Small-Parts-for-Toys-and-Childrens-Products/.
- Australian Competition and Consumer Commission. Product Safety Australia. Mandatory Standard. Toys for children up to and including 36 months of age. Accessed online: https://www.productsafety.gov.au/standards/toys-for-children-up-to-and-including-36-months-of-age.
- Australian Toy Association. Australian toy safety. Accessed online: http://austoy.com.au/toy-safety/australian-toy-safety.
- International Council of Toy Industries. Toy safety standards. Accessed online: http://www.toy-icti.org/info/toysafetystandards.html.
- Braun JM, Sathyanarayana S, Hauser R. Phthalate exposure and children’s health. Curr Opin Pediatr 2013; 25(2): 247-254. DOI: 10.1097/MOP.0b013e32835e1eb6.
- Shea KM, American Academy of Pediatrics Committee on Environmental Health. Pediatric exposure and potential toxicity of phthalate plasticizers. Pediatrics 2003; 111(6 Pt1): 1467-1474.
- Kamrin MA. Phthalate risks, phthalate regulation, and public health: a review. J Toxicol Environ Health B Crit Rev 2009; 12(2):157-174. DOI: 10.1080/10937400902729226.
- Rochester JR. Bisphenol A and human health: a review of the literature. Reprod Toxicol 2013; 42: 132-155. DOI: 10.1016/j.reprotox.2013.08.008.
- Hengstler JG, Foth H, Gebel T, Kramer P-J, Lilienblum W,Schweinfurth H, Volkel W, Wollin K-M, Gundert-Remy U. Critical evaluation of key evidence on the human health hazards of exposure to bisphenol A. Crit Rev Toxicol 2011; 41(4): 263-291. DOI: 10.3109/10408444.2011.558487.
- Enserink R, Mughini-Gras L, Duizer E, Kortbeek T, Van Pelt W. Risk factors for gastroenteritis in child day care. Epidemiol Infect 2015; 143(13): 2707-2720. DOI: 10.1017/S0950268814003367.
- Martinez-Bastidas T, Castro-del Campo N, Mena KD, Castro-del Campo N, Leon-Felix J, Gerba CP, Chaidez C. Detection of pathogenic micro-organisms on children’s hands and toys during play. J Appl Microbiol 2014; 116(6): 1668-1675. DOI: 10.111/jam.12473.
- Merriman E, Corwin P, Ikram R. Toys are a potential source of cross-infection in general practitioners’ waiting rooms. Br J Gen Pract 2002; 52(475):138-140.
- Bishara SE, Warren JJ, Broffitt B, Levy SM. Changes in the prevalence of non-nutritive sucking patterns in the first 8 years of life. Am J Orthod Dentofacial Orthop 2006; 130(1): 31-36.
- American Academy of Pediatric Dentistry. Clinical Practice Guidelines. Guideline on management of the developing dentition and occlusion in pediatric dentistry. 2014. Accessed online: http://www.aapd.org/media/Policies_Guidelines/G_DevelopDentition1.pdf.