Q. My 2-year-old is always picking things up off the floor and sticking them in his mouth or nose. I worry that he's going to choke or get something lodged so far up his nose, we'll have to take him to the emergency room! I watch him as closely as I can, but I can't watch him every second of the day. How dangerous is it for him to keep putting objects in his mouth/nose, and is there any way to discourage this habit?
A. Babies learn "oral gratification" -- the pleasure of putting objects in their mouths -- even before birth. They suck their thumbs while still in the womb, and breastfeeding or bottle-feeding further develops the association between mouthing/sucking and pleasure. Once babies discover the pincer grasp (between 6 and 8 months), they tend to pick up anything they can grab and insert it into their mouths. This predilection is more prevalent in some babies, perhaps due to temperament. It may be comforting to know that the gag reflex in infancy and toddlerhood is so strong that children who stick forbidden objects into their mouths, are likely to spit them out. Even so, choking is a valid concern, so try these preventive measures:
Shadow your toddler. Though you can't, as you say, watch your baby all the time, there's no good substitute for constant surveillance. So do the best you can to keep tabs on those exploring little hands. You should get down on your hands and knees and crawl around your home to find potential mouthable objects. And be particularly cautious when you take your baby to a friend's or relative's non-baby-proofed home. If your baby is playing with older children, warn them not to give him small objects to play with. Explain that he's too little to understand that he could choke on these toys.
Buy safe toys. Before choosing a toy, make sure it has no small parts to pull off and choke on, such as beads and buttons. If you are uncertain whether or not an object poses a choking hazard, purchase a testing tube from your local toy store, or use a toilet paper roll. If the toy or object can slide through the tube, it is considered chokable. Buy toys such as balls or blocks that are too big for your son to put in his mouth. Sit down and play with him so he can learn to enjoy playing with toys without mouthing them.
Teach him not to mouth dangerous objects. If he's about to pop something into his mouth, quickly take it out of his hands and distract him while you insert a safer object into his hands. This is called the distract-and-substitute technique. Eventually, he'll start differentiating between objects that are not to be mouthed and those that can be.
Unstuff little noses. A telling clue that your toddler has something stuck in his nose (the usual culprits being beans, peas, cotton and pebbles) is a foul-smelling, yellow-green discharge from one nostril, unlike a cold which produces discharge from both nostrils. If you suspect this problem, try one of the following: Encourage him to sneeze or blow his nose while compressing the unblocked nostril or squirt some nasal spray into the plugged nostril to ease the object's passage. If it's a water-soluble object, try to carefully remove it with blunt-end tweezers. If you can't see but suspect a stuffed object, have it removed by your child's doctor.
Avoid chokable foods. Discourage him from stuffing handfuls of food into his mouth, and avoid foods that pose a danger: raw carrots, raw apple, chunks of meat (always cut hot dogs lengthwise instead of in chunks), whole grapes, nuts, seeds, hard beans, hard candy, and popcorn kernels. Even a glob of white bread or peanut butter can pose a choking risk if he tries to wolf it down.
Take a CPR class. Besides being a potential lifesaver, a CPR course will help alleviate your fears. You'll learn how to do the Heimlich maneuver on children, as well as perform back blows on babies (often a more effective technique with infants than the Heimlich maneuver).
Children usually outgrow mouthing tendencies between 3 and 4 years of age, so your toddler should be past this phase soon enough!