Age-related changes to environmental exposure: variation in the frequency that young children place hands and objects in their mouths

  • A Correction to this article was published on 27 August 2019

Abstract

Children are exposed to environmental contaminants through direct ingestion of water, food, soil, and feces, and through indirect ingestion owing to mouthing hands and objects. We quantified ingestion among 30 rural Bangladeshi children < 4 years old, recording every item touched or mouthed during 6-hour video observations that occurred annually for 3 years. We calculated the frequency and duration of mouthing and the prevalence of mouth contacts with soil and feces. We compared the mouthing frequency distributions to those from US children to evaluate the appropriateness of applying the US data to the Bangladeshi context. Median hand-mouthing frequency was 43–72 times/h and object-mouthing frequency 17–34 times/h among the five age groups assessed. For half of the observations, > 75% of all hand mouthing was associated with eating. The frequency of indoor hand mouthing not related to eating was similar to the frequency of all indoor hand mouthing among children in the United States. Object-mouthing frequency was higher among Bangladeshi children compared with US children. There was low intra-child correlation of mouthing frequencies over our longitudinal visits. Our results suggest that children’s hand- and object-mouthing vary by geography and culture and that future exposure assessments can be cross-sectional if the goal is to estimate population-level distributions of mouthing frequencies. Of all observations, a child consumed soil in 23% and feces in 1%.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Change history

  • 27 August 2019

    An amendment to this paper has been published and can be accessed via a link at the top of the paper.

References

  1. 1.

    Mattioli MCM, Davis J, Boehm AB. Hand-to-mouth contacts result in greater ingestion of feces than dietary water consumption in Tanzania: a quantitative fecal exposure assessment model. Environ Sci Technol 2015;49:1912–20.

    CAS  PubMed  Google Scholar 

  2. 2.

    Laidlaw MAS, Filippelli GM. Resuspension of urban soils as a persistent source of lead poisoning in children: a review and new directions. Appl Geochem 2008;23:2021–39.

    CAS  Google Scholar 

  3. 3.

    Guney M, Zagury GJ, Dogan N, Onay TT. Exposure assessment and risk characterization from trace elements following soil ingestion by children exposed to playgrounds, parks and picnic areas. J Hazard Mater. 2010;182:656–64.

    CAS  PubMed  Google Scholar 

  4. 4.

    Wang Y, Moe CL, Null C, Raj SJ, Baker KK, Katharine A, et al. Multipathway quantitative assessment of exposure to fecal contamination for young children in low-income urban environments in Accra, Ghana: the SaniPath analytical approach. Am J Trop Med Hyg 2017;97:1009–19.

    PubMed  PubMed Central  Google Scholar 

  5. 5.

    Marquis GS, Ventura G, Gilman RH, Porras E, Miranda E, Carbajal L, et al. Fecal contamination of shanty town toddlers in households with non-corralled poultry, Lima, Peru. Am J Public Health 1990;80:146–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Ngure FM, Humphrey JH, Mbuya MNN, Majo F, Mutasa K, Govha M, et al. Formative research on hygiene behaviors and geophagy among infants and young children and implications of exposure to fecal bacteria. Am J Trop Med Hyg 2013;89:709–16.

    PubMed  PubMed Central  Google Scholar 

  7. 7.

    George C, Oldja L, Biswas S, Perin J, Lee G, Kosek M, et al. Geophagy is associated with environmental enteropathy and stunting in children in rural Bangladesh. Am J Trop Med Hyg. 2015;92:1117–24.

    PubMed  PubMed Central  Google Scholar 

  8. 8.

    Kwong LH, Ercumen A, Pickering AJ, Unicomb L, Davis J, Luby SP. Hand- and object-mouthing of rural bangladeshi children 3–18 months old. Int J Environ Res Public Health 2016;13:563–81.

    PubMed Central  Google Scholar 

  9. 9.

    Teunis PFM, Reese HE, Null C, Yakubu H, Moe CL. Quantifying contact with the environment: behaviors of young children in Accra, Ghana. Am J Trop Med Hyg 2016;94:920–31.

    PubMed  PubMed Central  Google Scholar 

  10. 10.

    Haefliger P, Mathieu-Nolf M, Lociciro S, Ndiaye C, Coly M, Diouf A, et al. Mass lead intoxication from informal used lead-acid battery recycling in Dakar, Senegal. Environ Health Perspect 2009;117:1535–40.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Cantu-Soto EU, Meza-Montenegro MM, Valenzuela-Quintanar AI, Félix-Fuentes A, Grajeda-Cota P, Balderas-Cortes JJ, et al. Residues of organochlorine pesticides in soils from the southern Sonora, Mexico. Bull Environ Contam Toxicol 2011;87:556–60.

    CAS  PubMed  Google Scholar 

  12. 12.

    Mukherjee A, Sengupta MK, Hossain MA, Ahamed S, Das B, Nayak B, et al. Arsenic contamination in groundwater: a global perspective with emphasis on the Asian scenario. J Heal Popul Nutr 2006;24:142–63.

    Google Scholar 

  13. 13.

    Bankole S, Schollenberger M, Drochner W. Mycotoxins in food systems in Sub Saharan Africa: a review. Mycotoxin Res 2006;22:163–9.

    CAS  PubMed  Google Scholar 

  14. 14.

    Ercumen A, Pickering AJ, Kwong LH, Arnold BF, Parvez SM, Alam M, et al. Animal feces contribute to domestic fecal contamination: evidence from E. coli measured in water, hands, food, flies, and soil in Bangladesh. Environ Sci Technol 2017;51:8725–34.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Xue J, Zartarian V, Moya J, Freeman N, Beamer P, Black K, et al. A meta-analysis of children’s hand-to-mouth frequency data for estimating nondietary ingestion exposure. Risk Anal. 2007;27:411–20.

    PubMed  Google Scholar 

  16. 16.

    Xue J, Zartarian V, Tulve N, Moya J, Freeman N, Auyeung W, et al. A meta-analysis of children’s object-to-mouth frequency data for estimating non-dietary ingestion exposure. J Expo Sci Environ Epidemiol. 2010;20:536–45.

    PubMed  Google Scholar 

  17. 17.

    Cohen DJ, Johnson WT, Caparulo BK. Pica and eleveated blood lead levels in autistic and atypical children. Am J Dis Child 1976;130:47–8.

    CAS  PubMed  Google Scholar 

  18. 18.

    Thompson KM. Changes in children’s exposure as a function of age and the relevance of age definitions for exposure and health risk assessment. MedGenMed. 2004;6:2.

    PubMed  PubMed Central  Google Scholar 

  19. 19.

    Tulve NS, Suggs JC, McCurdy T, Cohen Hubal Ea, Moya J, Hubal AC, et al. Frequency of mouthing behavior in young children. J Expo Anal Environ Epidemiol. 2002;12:259–64.

    PubMed  Google Scholar 

  20. 20.

    AuYeung W, Canales RA, Beamer P, Ferguson AC, Leckie JO. Young children’s mouthing behavior: an observational study via videotaping in a primarily outdoor residential setting. J Child Heal 2004;2:271–95.

    Google Scholar 

  21. 21.

    Black K, Shalat SL, Freeman NC, Jimenez M, Donnelly KC, Calvin JA. Children’s mouthing and food-handling behavior in an agricultural community on the US/Mexico border. J Expo Sci Environ Epidemiol. 2005;15:244–51.

    CAS  Google Scholar 

  22. 22.

    Brinkman S, Gialamas A, Jones L, Edwards P, Maynard E. Child activity patterns for environmental exposure assessment in the home. Adelaide, Australia; 1999.

  23. 23.

    Greene MA Oral DINP Intake Among Young Children. Bethesda: U.S. Consumer Product Safety Commission; 2002.

  24. 24.

    Reed KJ, Jimenez M, Freeman CG, Lioy PJ, Freeman NC, Lioy PJ. Quantification of children’s hand and mouthing activities through a videotaping methodology. J Expo Anal Environ Epidemiol 1999;9:513–20.

    CAS  PubMed  Google Scholar 

  25. 25.

    Freeman N, Jimenez M, Reed K, Gurunathan S, Edwards R, Roy A, et al. Quantitative analysis of children’s microactivity patterns: the Minnesota Children’s Pesticide Exposure Study. J Expo Anal Environ Epidemiol. 2001;11:501–9.

    CAS  PubMed  Google Scholar 

  26. 26.

    Groot M, Lekkerkerk M, Steenbe. Mouthing behaviour of young children: asn observational study. Wageningen, The Netherlands: Agricultural University Wageningen, 1998.

  27. 27.

    Smith SA, Norris B. Reducing the risk of choking hazards: mouthing behavior of children aged 1 month to 5 years. Inj Control Saf Promot. 2003;10:145–54.

    PubMed  Google Scholar 

  28. 28.

    Zartarian VG, Ferguson AC, Leckie JO. Quantified dermal activity data from a four-child pilot field study. J Expo Anal Environ Epidemiol 1997;7:543–53.

    CAS  PubMed  Google Scholar 

  29. 29.

    Ko S, Schaefer PD, Vicario CM, Binns HJ, Safer FORTHE, Project Y. Relationships of video assessments of touching and mouthing behaviors during outdoor play in urban residential yards to parental perceptions of child behaviors and blood lead levels. J Expo Sci Environ Epidemiol. 2007;17:1747–57.

    Google Scholar 

  30. 30.

    Tsou M, Özkaynak H, Beamer P, Dang W, Hsi H-C, Jiang C-B, et al. Mouthing activity data for children aged 7 to 35 months in Taiwan. J Expo Sci Environ Epidemiol 2015;25:388–98.

    PubMed  Google Scholar 

  31. 31.

    Beamer P, Key ME, Ferguson AC, Canales RA, Auyeung W, Leckie JO. Quantified activity pattern data from 6 to 27-month-old farmworker children for use in exposure assessment. Environ Res 2008;108:239–46.

    CAS  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Beamer PI, Luik CE, Canales Ra, Leckie JO. Quantified outdoor micro-activity data for children aged 7–12-years old. J Expo Sci Environ Epidemiol 2012;22:82–92.

    PubMed  Google Scholar 

  33. 33.

    Arnold BF, Null C, Luby SP, Unicomb L, Stewart CP, Dewey KG, et al. Cluster-randomised controlled trials of individual and combined water, sanitation, hygiene and nutritional interventions in rural Bangladesh and Kenya: the WASH Benefits study design and rationale. BMJ Open 2013;3:e003476.

    PubMed  PubMed Central  Google Scholar 

  34. 34.

    Ruff HA, Mccarton C, Kurtzberg D, Vaughan HG, Ruff HA, Mccarton C, et al. Preterm infants’ manipulative of objects exploration. Child Dev 1984;55:1166–73.

    CAS  PubMed  Google Scholar 

  35. 35.

    Ruff HA. Components of attention during infants’ manipulative exploration. Child Dev 1986;57:105–14.

    CAS  PubMed  Google Scholar 

  36. 36.

    Leckie J, Naylor K, Canales R, Ferguson A, Cabrera N, Hurtado A, et al. Quantifying children’s microlevel activity data from existing videotapes. Research Triangle Park, NC; 2000.

  37. 37.

    Freeman NC, Hore P, Black K, Jimenez M, Sheldon L, Tulve N, et al. Contributions of children’s activities to pesticide hand loadings following residential pesticide application. J Expo Anal Environ Epidemiol 2005;15:81–8.

    CAS  PubMed  Google Scholar 

  38. 38.

    Davis E, Cumming O, Aseyo RE, Muganda DN, Baker KK, Mumma J, et al. Oral contact events and caregiver hand hygiene: Implications for fecal-oral exposure to enteric pathogens among infants 3–9 months living in informal, Peri-Urban communities in Kisumu, Kenya. Int J Environ Res Public Health 2018;15:192.

    PubMed Central  Google Scholar 

  39. 39.

    Ferguson AC, Canales Ra, Beamer P, Auyeung W, Key M, Munninghoff A, et al. Video methods in the quantification of children’s exposures. J Expo Sci Environ Epidemiol 2006;16:287–98.

    PubMed  Google Scholar 

  40. 40.

    U.S. Environmental Protection Agency. Guidance on Selecting Age Groups for Monitoring and Assessing Childhood Exposures to Environmental Contaminants [Internet]. Washington, DC; 2005. Available from: EPA/630/P-03/003F.

  41. 41.

    Greene MA Mouthing Times Among Young Children From Observational Data [Internet]. Bethesda, MD; 2002. Available from: https://hero.epa.gov/hero/index.cfm/reference/details/reference_id/1005571.

  42. 42.

    Rodes CE, Newsome JR, Vanderpool RW, Antley JT, Lewis RG, Antley T, et al. Experimental methodologies and preliminary transfer factor data for estimation of dermal exposures to particles. J Expo Anal Environ Epidemiol 2001;11:123–39.

    CAS  PubMed  Google Scholar 

  43. 43.

    Bauza V, Byrne DM, Trimmer JT, Lardizabal A, Atiim P, Asigbee MAK, et al. Child soil ingestion in rural Ghana: frequency, caregiver perceptions, relationship with household floor material, and associations with child diarrhoea. Trop Med Int Health 2018;23:558–69.

    PubMed  Google Scholar 

  44. 44.

    Kinnell HG. Pica as a feature of autism. Br J Psychiatry 1985;147:80–2.

    CAS  PubMed  Google Scholar 

  45. 45.

    Cohen Hubal EA, Suggs JC, Nishioka G, Ivancic WA, Cohen Hubal EA, Suggs JC, et al. Characterizing residue transfer efficiencies using a fluorescent imaging technique. J Expo Anal Environ Epidemiol 2005;15:261–70.

    CAS  PubMed  Google Scholar 

  46. 46.

    Julian TR, Bustos C, Kwong LH, Badilla AD, Lee J, Bische HN, et al. Quantifying human-environment interactions using videography in the context of infectious disease transmission. Geospat Health 2018;13:195–7.

    Google Scholar 

  47. 47.

    Gibson EJ. Exploratory behavior in the development of perceiving, acting, and the acquiring of knowledge. Annu Rev Psychol 1988;39:1–41.

    Google Scholar 

Download references

Acknowledgements

We gratefully acknowledge the participating study families, as well as collaborators responsible for video translation software, data collection and video translation: Robert Canales, Carla Bustos, Rita Chowdhury, Nisa Sultana, Eashmat Annay, Shamima Islam Mina, Nusrat Jahan, Akhe Nur Begum, and Md. Sajjad Rahman. This study was funded by the Stanford Center for Innovation in Global Health and the World Bank; the WASH Benefits Study, in which it was embedded, was funded by the Bill & Melinda Gates Foundation. This material is based upon work supported by the Stanford Wood’s Institute for the Environment Goldman Graduate Fellowship and the National Science Foundation Graduate Research Fellowship under Grant No. DGE-114747. Any opinion, findings, and conclusions or recommendations expressed in this material are those of the authors(s) and do not necessarily reflect the views of the National Science Foundation.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Laura H. Kwong.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Caregivers of the participating children provided informed written consent before the observations. The study was conducted in accordance with the Declaration of Helsinki and received ethics clearance from Stanford University (Protocol 25863), University of California, Berkeley (2011-09-3652), and the International Centre for Diarrhoeal Disease Research, Bangladesh (PR-11063).

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kwong, L.H., Ercumen, A., Pickering, A.J. et al. Age-related changes to environmental exposure: variation in the frequency that young children place hands and objects in their mouths. J Expo Sci Environ Epidemiol 30, 205–216 (2020). https://doi.org/10.1038/s41370-019-0115-8

Download citation

Keywords

  • micro-level activity time series data set (MLATS)
  • exposure factors
  • indirect ingestion
  • mouthing
  • microactivities
  • Bangladesh

Further reading