A meta-analysis of children's object-to-mouth frequency data for estimating non-dietary ingestion exposure

To improve estimates of non-dietary ingestion in probabilistic exposure modeling, a meta-analysis of children's object-to-mouth frequency was conducted using data from seven available studies representing 438 participants and ∼1500 h of behavior observation. The analysis represents the first comprehensive effort to fit object-to-mouth frequency variability and uncertainty distributions by indoor/outdoor location and by age groups recommended by the US Environmental Protection Agency for assessing childhood exposures. Weibull distributions best fit the observed data from studies with no statistical differences, and are presented by study, age group, and location. As age increases, both indoor and outdoor object-to-mouth frequencies decrease. Object-to-mouth frequency is significantly greater indoors (2-32 contacts/h) than outdoors (average 1-9 contacts/h). This paper compares results to a similar hand-to-mouth frequency meta-analysis. Children who tend to mouth hands indoors also tend to mouth hands outdoors; children who tend to mouth objects indoors tend to mouth objects outdoors. However, children who tend to mouth objects do not necessarily have a tendency to mouth hands. Unlike for hand-to-mouth frequency, a statistical difference was found among the various studies for object-to-mouth frequency. This could be due to different definitions for object mouthing across the studies considered. The analysis highlights the need for additional object-to-mouth data (indoors and especially outdoors) for various age groups using standardized collection and analysis.