Children younger than 3 years of age tend to put everything in their mouth as a way of exploring their environment, but with this comes the risk of choking. It's something I've seen often as an emergency room pediatrician. Choking on small parts, while preventable, is one of the leading causes of injury and death in infants and children younger than 3 years old. Coins and toys account for most nonfood-related choking events among children. It is notable that not all toys labeled age-appropriate are correctly labeled, as some may contain small parts that may be choking hazards. (These can get caught in their airway and make it difficult to breathe.)
The United States Consumer Product Safety Commission (CPSC) designed a small-parts test fixture (also called a choke test cylinder), which is a cylinder with diameter of 1.25 inches and depth of 2.25 inches simulating the mouth and fully expanded throat of a child under 3 years old. Toys that easily fit through this fixture are banned for children under 3 by the CPSC because they present choking hazards.
While choke tube testers can be purchased, a toilet paper roll, which approximates the size of a choke tube and is readily available at home, can be used as an alternative.
To do the toilet roll test, take an empty roll and drop the toy through. If the toy fits through the roll easily, it's too small for a young child because they could choke on it. This easily helps you eliminate toys that pose a high risk of choking for a child younger than 3 and should not be left for them to play with unsupervised.
However, it should be noted that there are toys which pass the tube test but still present a danger of choking. Use your discretion or discuss with your pediatrician if you have concerns. Over the years, there have been cases of children choking on bigger and larger objects that pass the toilet roll test. So, adult supervision is still highly advised while your child plays with toys with pieces they could swallow.
Other things to consider when choosing toys for younger children:
- Avoid latex balloons. They also pose choke risks.
- Avoid battery-operated toys with battery cases that cannot be secured tightly with screws. Swallowed batteries are very dangerous.
- Hand-me-down toys should be assessed to make sure there are no small broken parts.
- Parents should check to make sure that toys have not been recalled.
- Review toys appropriately regardless of age labels written on them.
- If you have older children living in the same home, remember to separate their toys. Some cases of choking occur with an older child offering a toy to a younger one.