Friday, May 23, 2014

The stuck What...Where?


While it might make an amusing anecdote well after the fact (and it keeps the advice nurse job from being far from boring) it can be quite the ordeal when you find out that your child has stuck some little object into an orifice.

By far and away the hole that gets the most inappropriate things passing through is the mouth; however swallowing non food items will be addressed in a future post.

There are other interesting places that need to be explored. Oh yes, noses, ears, butts, if there is a hole...things get stuck in there.
One of my favorite stories is told by a friend who had a child that smelled fairly horrible. No amount of baths could mask a mysterious foul odor. The child was taken to the doctor who asked the magic question.

"Honey, do you ever stick anything in your nose?"
The child shrugged and then said, "just cheese..."

We get the calls fairly regularly that a child has stuck something somewhere. Often, it is the nose.

Nurse Jen recounted the time that her daughter Isa stuck something in her nose in order to find out if the nose was connected  to the throat. While a little proud of this attempt at an early science experiment, Jen recalls that a straight jacket was needed in the ER to get it removed. Isa was absolutely right - the nose is connected to the throat, but there are all sorts of sinus cavities where something could get waylaid.

Gianna Frazee, a wonderful pediatrician shared with me the story of a memorable  five year old patient who felt the need to stick her tongue inside a Barbie Doll head, The tongue swelled up and got stuck.

First of all, please please tell your children stories about other little children who have done these things and then had to go to the doctor and it was yucky getting it fixed. Perhaps a little teaching and mild scare tactics in advance might be preventative but the urge is strong. In my immediate family we told the tale of my niece Lena who stuck a raisin in her nose, and perhaps the power of the tale kept my own kids and the other nieces and nephews "raisin free"

If prevention hasn't done the trick and there is something stuck up the nose you have several options. If your child is old enough, have them try to gently blow it out. If that doesn't work, or your child is too young to have mastered the concept of nose blowing, you can try to suck it out. Whereas I did once have a mom who successfully sucked a pea out of her toddlers nose with her mouth, (good for her but...ugh), I would suggest trying the suction with a Nose Frida.

If that doesn't work, I have another method for you that I learned from  local pediatrician Sheva Tessler. Assuming the something  is in the right nostril, push the left nostril closed with your finger and do a firm rescue breath into the mouth. If it doesn't blow the object out, reposition and try again. This works more than 50% of the time. I have seen all sorts of interesting things go into noses....peas, beads, little wads of paper, raisins, a starburst candy. Kids are creative!

It is fully possible that whatever it was was sucked up was subsequently swallowed, but never the less, if it went up in the nose and you weren't able to get it out, someone needs to look in there. As Dr Kaplan says, "if it is an object, say for instance the #3 key from a toy telephone, it needs to be removed." If it is a small organic thing like a piece of rice, she doesn't get worried if it isn't retrieved as long as it doesn't seem to be causing any issues. 

If you aren't quite sure if they stuck something in there or not, kids are often not the best historians when it comes to finding out the truth. If you ask them if they put something in their nose and they think that answering yes will either get mommy or daddy mad, or land them at the doctors the answer may well be an emphatic "Me? Something in my nose? I don't remember!"

Keep that in mind, as a constant running nose, foul odor, or signs of irritation in or around the nose could be signs that a foreign object is the source of the trouble.

The docs in our office are  willing to try to get something out, but we might not be your best choice. If there is a way to  get onto the schedule of an ENT that is usually the  better option, They have better tools for getting the job done right the first time.

We also have our share of patients who stick things in ears.
One of the more memorable  for me was the little boy whose brothers had convinced him to see how many unpopped popcorn kernels could fit in his ear. Of course this was 4:30 on a Friday...right? As he came into the office I could hear him crying "I don't want them to have to cut off my ears." Those same brothers of course were behind that as well. Ah siblings. That little fellow also ended up at the ENT, although we may be able to remove something simple from the ear.

Just the other day Dr Jessica saw a little blue bead in an ear during a routine exam which she was able to safely remove, while a little silver pellet from an ear of a different patient was referred out.  

Yes, we have had the occasional thing stuck in the butt (in fact it was a tube of mascara most recently;) those are fairly rare.


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