Elizabeth Powell, MD, MPH, FAAP

Most fatalities associated with toys are entirely preventable. With parental education, proper product warnings and better awareness, they could easily be minimized or eliminated, said Elizabeth Powell, MD, MPH, FAAP, associate professor of pediatrics, Children's Memorial Hospital, Northwestern University, in Chicago.

During the October 20 session "Children's Toys and the Parade of Hazards" (S4024), Dr Powell pointed out that the majority of toy-related deaths in the U.S. are caused by airway obstructions/suffocation from small toys or balloons. She tagged small parts, balloons, magnets, riding toys and chargers/adapters as the leading causes of injuries/fatalities in children.

Toys with small parts — objects roughly 1-1/4 inches x 1 inch to 2-1/4 inches — were first banned for use by children under age 3 in 1979. Small balls with a diameter of less than 1-3/4 inches are included in that small-parts regulation. 

"Compared to other shapes, toys with round shapes (including marbles) pose the highest risk of choking death," Dr Powell said. All toys with small parts are required to have a warning that a hazard exists if the toy is used outside the recommended age range.

Small round objects easily can block the back of the throat and be a choking hazard for children as old as age 5. Most of these objects lodge in the upper airway and can be removed in conscious children with the Heimlich maneuver, or with CPR if the child is unconscious and the foreign body has been removed.

We often think of food items for choking incidents when in fact small plastic objects (such as Legos, which don't show up on X-rays) account for up to 15 percent of the foreign body aspirations, Dr Powell said.

Atypical small parts products, such as children's beaded jewelry, also pose hazards, especially when the elastic breaks.

Toy balloons, which account for up to four deaths a year, can lodge anywhere along the airway and often are found farther down because the child keeps sucking, Dr Powell said.

"As I was researching cases, there were several cases where children aspirated condoms," she said, adding that the latex product acts the same as balloons.

Other hazardous small parts that are found in building sets and some jewelry are magnets. If a child swallows a single magnet, it is relatively harmless, Dr Powell said. "Unfortunately, the issue is where there are multiple magnets or a magnet and a metal object because they can cause bowel complications."

Riding toys, particularly two-wheeled scooters, present the next largest danger, with eight to 13 deaths a year over the last decade. The deaths usually occur when the scooter-riding child collides with a vehicle.

Finally, Dr Powell warned of the dangers of toys that use chargers and adapters.

The compact high energy of lithium can overheat, catch fire or explode; youths are at risk for thermal burns.

Although not on her infamous list of five, Dr Powell said doctors need to be aware of lead in toys, antique as well as new. Recently, Mattell and Thomas the Train faced recalls because of unsafe lead levels in their toys. "These cases happened because they have facilities overseas that sometimes have different safety standards, and post-production testing is cumbersome and expensive."