KOJO NNAMDIWelcome back. For many, the winter holidays are a time of celebration and gift-giving, but toys for children can turn dangerous if not properly vetted or used. Hover boards, once popular on Christmas wish lists, are now just as famous for catching fire due to faulty wiring. A 2016 report released by the U.S. Product Safety Commission estimated there were over 174,000 toy-related injuries treated in emergency rooms that same year. The same report listed seven deaths in children younger than 15. Joining me in studio to discuss this is Dr. Sarah Combs, an emergency medicine specialist at Children's National. Dr. Combs, thank you for joining us.

SARAH COMBSThank you for having me, Kojo.

NNAMDIAnd joining us by phone is Steven Aarons. He is the owner of Barstons Child's Play and a board member of the Good Toy Group. Steven Aarons, thank you for joining us.

STEVEN AARONSThank you for having me, Kojo.

NNAMDISarah Combs, as a doctor with a focus in emergency treatment, have you seen an increase in ER traffic around the holidays?

COMBSSo, at the Children's National Emergency Department here in Washington, D.C., we do tend to see higher numbers of children coming in around this wintertime of year. It's not necessarily toy-related, at this point. There's a lot of other things going on. As you probably know and have experienced, there is a lot of respiratory illness out there, (laugh) coughs.

NNAMDIExperiencing it myself even, as we speak.

COMBSExperiencing it right now, I can see. Yeah. So, coughs, colds, which, obviously, in smaller kids, can have deeper impacts. What I would say is we've looked at some of our data, and we see about a steady number of cases per month, and have seen that since 2015, around 50 cases per month of what we call foreign body either ingestions or aspirations. So, children either choking or mistakenly eating things, such as small toy parts, beads, coins, etcetera.

NNAMDIAre those the biggest concerns around children and toys?

COMBSSo, interestingly, the actual biggest concern around toys is thought to be balloons, which many people don't think of. The Consumer Product Safety Commission that you mentioned has decided that they are actually the leading cause of what we call aspiration-related events.

COMBSSo, aspiration is essentially something gets into your mouth, which is very common for a child. They explore their world by putting things in their mouth. And instead of it being swallowed, they cough or they breath in at just the wrong time, and essentially, the material gets stuck in either their lungs or the passages down to their lungs. So, balloons that are un-inflated or balloons that are broken are at very high risk to do this.

NNAMDISteven Aarons, as someone who determines what Barstons stocks, what do you look for in a product?

AARONSWell, what we look for, I guess, is two different things, because you're talking about safety here. But what we're primarily looking for at first is how much play value and developmental value we feel a toy has. We then do, in terms of safety -- since that's what we are discussing -- we make sure that we get all the testing papers from the company, which we keep electronically filed, because there are so much of those that we need.

NNAMDIDoes it matter where a toy is purchased? Do all products meet the same regulations, Steven Aarons?

AARONSThey do all have to meet the same regulations.

NNAMDIBut how about if you're buying a toy from a store that is not a toy store?

AARONSSo, that would be a problem. There are concerns about second-hand toys, especially if something was produced 30 years ago, that that would not have had the same testing, especially for lead and salates, if a child is sucking on a toy, that you would have today.

NNAMDISarah Combs, how can a parent tell if a toy's components are too small for their child?

COMBSThat's a great question. So, I would echo some of what Mr. Aarons just said, which is you do want to look out for a toy that is properly vetted. So, as he mentioned, toys that are very old may not have been. Currently, all toys are vetted. Regulations are passed down. And if it is marked for do not give to a child under the age of three, that is a big red flag, that there's probably a component part that is too small for those younger children.

COMBSThere are very specific rules, so you don't want anything that is less than one-and-a-quarter inch by two-and-a-quarter inches total diameter, or any ball components less than one-and-three-quarters inches. So, most marbles, for example, would fall into that, so you don't want to be giving those to those young children under the age of three.

NNAMDIHow can people prepare for a potentially dangerous situation?

COMBSYeah, that's another great question, because, obviously, you can do your best. You can buy approved toys, well-marked toys, and best intentions, kids can always get their hands on something else. I think it's never a bad idea to have some basic CPR training. We're not talking healthcare provider-level CPR, but just, you know, take a basic course, first aid, in the community.

COMBSThings to know are a couple key points. Back in the day, we used to say, if you saw the child choking on something, you should go in and try and retrieve it. We have gone away from that, because we've shown that can actually force that object further into the airway.

NNAMDINo more blind sweeps.

COMBSNo more blind sweeps, exactly. So, no blind sweeps. If you visualize something, you can go get it. Other things to be prepared for are, you know, know your CPR. If your child is truly choking, they're turning blue, they can't get breath in, you're going to have to do, if they're less than one year of age, the back thrust technique, in combination with the chest thrusts, flipping them over on your lap. For the older children, it's a maneuver akin to the Heimlich maneuver. At the same time -- ideally, there's a second adult in the home -- you want someone phoning 911, because that airway could get closed really quickly.

NNAMDISteven Aarons, what toys are expected to be exceptionally popular this year?

AARONSSo, to me, exceptionally popular are two different things. Things that are going to be heavily advertised...

NNAMDIYes.

AARONS...versus items that our staff will be recommending more because we feel like they are much more developmentally helpful. And those may not require something be brand new and have a big marketing plan. To me, the things that matter a lot are, you know, products like Magnatiles, where they're totally open-ended.

AARONSWe try to look for a lot of things where the child's imagination is going to be driving what the toy does, rather than a television show or pictures that push them into doing something a certain way.

NNAMDIWhat do you do when a Disney movie comes out?

AARONS(laugh) We're still going to bring in products like “Frozen,” because the kids are still going to want those. I guess we're hoping that when we talk to people, there can be a mix, sort of the same way that you think of when you have a diet. You wouldn't just eat dessert. So, within the mix of toys, maybe there's a “Frozen” puzzle, you know, where they'll have to be doing organizational planning. My issue sometimes becomes with the make-pretend toys is that the characters already have a personality. So that drives the way the toys are played with. So, I would want to look for something else within the collection of toys that wasn't just “Frozen.”

NNAMDIAre you seeing an increasing demand for electronic toys, and/or toys with screens?

AARONSI think that's been going on for a while, which is interesting, given all the research that is out there on screens in adults and children.

NNAMDIYeah. Dr. Combs, do healthcare professionals have safety concerns about electronics?

COMBSYes. So, there's a couple different aspects with the electronics. One thing to bear in mind, talking about toy safety, is you don't want to give any wired toys -- so, toys that need to be plugged in -- to children under the age of 10. So, this is partly a concern of children either electrocuting themselves at the socket or, again, exploring world by mouth. That little electric wire goes straight into the toddler's mouth, and we have seen cases where that can result in pretty bad injury. That's on one side.

COMBSThe other side is, indeed, the developmental side, which is we want children to explore their world by imagination. We don't want them to just be stuck in front of a screen for hours on end.

NNAMDIAnd it's my understanding that we should be careful about button batteries.

COMBSAbsolutely. So, button batteries has been a big thing for a while. I will say I think most manufacturers are increasingly aware of this with a lot of work by various groups. So, they're not generally in children toys, but beware of if you have grandma, grandpa visiting for the holidays, button batteries are often in hearing devices, things like that. If they're lying out, a child will get his or her hands on it. If that button battery is swallowed, that can cause major issues. You do need to come to the emergency room.

NNAMDISteven Aarons, are high-powered magnets a concern? Does Barstons sell products with strong magnets?

AARONSWe do sell some, but where the products have actually been approved by CPSC. So, for example, Magnatiles that I recommended, those magnets are encased in a way that they are not going to come out. We actually even have some samples in the store that have been out for 20 years, and they're still encased safely inside those.

NNAMDIIt's my understanding that CPSC issued a rule prohibiting the sale of high-powered, rare earth magnets back in 2014, but a court decision in 2016 overturned the CPSC's ban. And since then, a lot of these types of sets have returned to the market?

AARONSWell, that's a different thing.

NNAMDIOh, okay.

AARONSThose are -- there was a product out, the precursor to a product called Speks -- I'm trying to remember the exact name, but it's not coming to my mind. But that was a larger, rare-earth magnet that had so much force, because of the size, that it was unsafe. And that product got redesigned, along the way, working with CPSC, as I understand from both of them, that the company and CPSC, that they worked down the size to decrease the strength of the magnet.

NNAMDIKids can be very persuasive and persistent, Dr. Combs. What do you recommend for a parent who has concerns about the toy their child is asking for?

COMBSKids are indeed both persuasive and persistent. We have seen that in our own work every day here at Children's National. I think, as a parent, it's always a balance between wanting your child to have some autonomy, wanting them to have the choice of toy. But also, of course, you have to play the parent role. So, if it is something that is unsafe, that's something you can try and explain to a child.

COMBSBear in mind, toddlers' powers of reasoning aren't the best, but sometimes you will just have to enforce a certain rule in your house. And hopefully you can steer them in the direction of one of these CPSC-marked, approved, child-friendly and developmentally enriching toys.

NNAMDISame question to you, Steven Aarons. What do you recommend for a parent who has concerns about the toy that their child wants? (dog barks)

AARONSSo, I think actually developmentally it is (dog barks) important for a child not to receive everything they want. (dog barks) You know, it's not great for them to receive everything that's on their list. You also don't want too many (dog barks) things in front of them, because it's overwhelming to a child to receive too many things.

NNAMDICan you explain the dog in the background? (laugh) Was that a request from a child? (laugh)

AARONSSorry about that. (laugh)

NNAMDIOr does that happen to be your own dog?

AARONSI don't have control of the noises that are coming from out there. (laugh)

NNAMDIOh, I see. We can understand that. It is Barstons Child's Play. Steven Aarons is the owner of Barstons Child's Play and a board member of the Good Toy Group. Thank you so much for joining us.

AARONSThank you for having me.

NNAMDIDr. Sarah Combs is an emergency medicine specialist at Children's National. Thank you for joining us.

COMBSThank you for having me.

NNAMDIThis conversation about holiday toys was produced by Laura Spitalniak, and our segment about SNAP benefits was produced by Lauren Markoe. Next week is our winter book show, and we want to know, what was the best book you read this year? Record a voice memo on your phone, no more than 30 seconds, and send it to kojo@wamu.org with the subject line, Best Book. We'll play a selection of your responses next week.

NNAMDIComing up tomorrow on The Politics Hour, Montgomery County Executive Marc Elrich. We look back at his first year in office and ask him about his recent remarks about affordable housing, which had some people scratching their heads. That all starts tomorrow, at noon, on The Politics Hour. Until then, thank you for listening. I'm Kojo Nnamdi.