They put WHAT in their mouth?
Holiday seasons are especially challenging for childproofing. Christmas trees, presents, wrapping paper…..It is hard to stay vigilant 24/7. We usually get some pretty interesting calls this time of year.
Kids like to explore. Many times this involves sticking things where they don't belong.
Being fairly oral critters, most of the time the object they are handling gets placed in the mouth. When this happens there are two passages that it might go down.
If it goes into the esophagus it hopefully will make its way down into the stomach, through the intestines and then get pooped out.
If something was swallowed, here are things to consider:
Is it stuck?
How does the child look? Are they able to take a sip of water? Can they swallow just fine? Is their breathing relatively normal?
If something has gotten stuck in the esophagus they will look uncomfortable, There will be frequent coughing and throat clearing going on. You will know that something is amiss. This will necessitate a visit to the ER.
Is it poisonous?
If you have any doubt about that, call the poison control center
Is it potentially germ laden?
We get calls about kids eating things that are pretty disgusting. Young infants are the most vulnerable, but usually don’t have the dexterity to actually get something into their mouth without some help. Once they have mastered the hand/mouth coordination skill, they are old enough that a normal healthy gut has good bacteria that can be somewhat protective. If whatever it is that they ingested is going to cause trouble, symptoms will usually show up with tummy aches, vomiting and loose stools within a day or so. Persistent tummy upset will usually warrant a stool test to help us figure out what the culprit is.
Is it a battery?
Any battery can be trouble, but button batteries can be a tremendous hazard because they can be easily swallowed and they seem to be everywhere these days. Several years ago I got a call from a mom of 15 month old twins. There they were, sitting on the floor with mom's pedometer right in between them. It was open and the battery was gone. Because of the uncertainty involved, we did have to send them to get x-rays. Indeed there it was, that little battery, sitting in the stomach of one of the kids. In this case it passed safely, but if a battery gets stuck anywhere on the way it can cause a dangerous amount of damage. Please know where all the button batteries are in all of your little gadgets and make sure that your kids have no access to them. Keep a strict inventory and perhaps stick a piece of duct tape across any battery compartments.
Other objects that you need to be wary of are magnets. I am not talking about the little letters that you may have on your fridge. The ones that cause concern are the industrial strength magnets that you may find in some "grown up" toys like buckyballs or jewelry.
If more than one of those get swallowed it can wreak havoc on the intestines and be deadly. Keep them away from your kids!
Is it sharp?
If it is something that has a point or sharp edge, keep an extra close eye on your child. Make sure the tummy stays nice and soft. If your child seems to have a rigid painful belly, they will need to be seen right away. Keep an eye on the stools. Any dark, tarry poop or bright red blood would be a reason to get immediate help.
One of the sharpest things that we were keeping an eye out for some years ago was one of a Grandma's one carat diamond stud earrings. That passed through and was retrieved with no harm at all to the swallower (Grandma didn't want it back; it was reunited with the mate and is in a safe deposit box waiting until the little girl is 18.)
Most of the time, it is simply a matter of watching for the whatever it was to pass through. I have seen all sorts of stuff get swallowed and pooped out without incident. I think I have seen enough change to put a kid through college. Most coins smaller than a quarter go through fairly easily.
Let's encourage a quick passage! Increase the amounts of fluids that your child drinks. Perhaps add prunes. If your child is old enough that they are beyond simple pureed food, consider giving some corn kernels (You won't see that in any textbook). Have you figured it out yet? For those of you who need this spelled out, corn kernels are usually fairly recognizable after they have been pooped out. They can act as a marker. Corn can help you track the transit time.
If your child is old enough to know better and seems inclined to continue to put non food items in their mouth, this might be a condition known as Pica. Pica is the persistent eating of substances such as dirt or paint that have no nutritional value. This is worth pointing out to your doctor. There might be a nutritional deficit or something else going on.
If the object goes into the trachea it may block the airway and you have a choking situation on your hands or it could get aspirated into the lungs. Neither is good. Your child will clearly be having breathing difficulties if this has happened. They will likely have a color change is they are fully obstructed. If someone is obstructed, they can not speak or make sounds. Of course with any emergency you should call 911, but it is my hope that all parents and caregivers are trained to do a choking rescue.
To avoid this happening on your watch, it is SO important to keep little items away from the young kids. Anything that can fit into a toilet paper tube is too small for an infant or young child to be handling. Food pieces should be soft or cut into long strips rather than round pieces.
Encourage safe eating: sitting instead of running around, chewing and swallowing rather than shoving in wads of food. Parents, please model good behavior!
Dr Kaplan advises that a rule of thumb to keep in mind is that the size of your child's airway is about the same diameter of their pinky finger or ear canal. That is pretty small!
All parents should be able to do a choking rescue!
- Head lice/ Sklice co-pay coupon
- Should you give tylenol before the shots? / vaccine reaction discussion
- Skin fold irritations
- HAND FOOT MOUTH (and butt) VIRUS
- Tips for giving medication
- Strep Throat
- The Poop series: Chapter #1 Baby poop
- Nurse Judy' Blog
- Anaphylaxis/Do you need an epipen?
- Pinworms (ugh)
Friday, December 29, 2017
Posted by Nurse Judy at 8:23 AM
Friday, December 22, 2017
Topic of the Week:
Talking to your child about Santa
Over the years several parents have asked me to weigh in on the ‘Santa discussion.’ What is the best way to keep the magic alive while not endangering the trust that is so important in any relationship?
For this general discussion, we can put Santa into the fine company of the Tooth Fairy and the Easter Bunny, but it is safe to say that Santa is usually the member of this trio that has the most emotional connection.
Let me preface this post by saying that I think it is essential to be honest with people in your lives. You don’t need to knock them over the head with the truth, but if they ask a question and press for an answer, please don’t lie.
In my Jewish family, the girls never gave too much thought to the man in the red hat or the giant bunny, but we did get routine visits from the tooth fairy every time the girls lost a tooth. When I started writing this, I checked in with my grown girls to see if they remembered any feeling of betrayal when they realized that it was daddy sneaking the money under the pillow.
Lauren tried hard to remember. She vaguely recalls that she figured it out reasonably early, but played along for several years. She wanted to make sure that the gravy train didn’t dry up. Alana says that she was too busy trying to figure out if monsters were real or not (thanks to having a big sister who teased her by making strange noises in the middle of the night) to worry too much about the Tooth Fairy.
For the young kids who ask if the mythical creature is real, you might deflect the questions fairly easily without telling a falsehood if you want to extend the magic for another year.
A simple,“What do you think?” works pretty well. Or, “It is fun to believe in magic sometimes and Santa is part of the holiday magic”
Keep in mind that once your child gets to kindergarten believing that Santa is actually going to try to fit down your chimney, rather than the ‘spirit of the holiday magic,' they might be in for a shocking disappointment when they learn the truth. There are lots of kids at school eager to share the cold hard facts with your innocent child. It is much better if this discussion comes from you before your kids find out a harder way.
I spoke to several people who recounted that they believed in Santa with all of their hearts and were completely heartbroken when they learned the truth.They felt deceived. One person told me that finding the truth was the moment they stopped believing in all magic. How sad!
Letting them know the truth gently doesn’t have to be a negative experience.
For older kids, I love a good story. Many stories start with an element of historical truth:
“Once upon a time in a far off country there was a man named Nicholas. He loved to do good things for other people. What was special about him is that when he gave people presents or did nice things, he didn’t do it because he wanted something in return. He simply wanted to do good things. Lots of times he did it in secret and no one even knew who did something nice for them. Maybe this Nicholas was big and jolly and had a white beard.He became known as Santa Claus. Santa is a symbol of love and magic and hope and happiness. He teaches children how to believe in something that they can’t see or touch. I am on his holiday kindness team and now you can be too. Really little children might believe that there is one Santa who manages to be everywhere at once. Big kids like you get to know the secret. Team Santa is all the big kids and grown ups who want to help make other people happy. “
Perhaps take the opportunity to help your child be an active member of this awesome team; an initiation of sorts. Is there someone in your life that seems like they need a little kindness? What could you do for them. Is there a little gift that might make a difference? Plotting a secret kindness is the thing that wonderful lasting holiday memories are made of.
PS: The photo on Santa's Lap should be voluntary. If your child isn't eager to go sit on a strange guy's lap, please don't force them.
Posted by Nurse Judy at 9:03 AM
Friday, December 15, 2017
Topic of the Week:
Essential equipment 2017
"stuff" that may make parents life easier
How old are my kids? They are so old that they slept on their tummies in cushy little cribs surrounded by tons of stuffed animals. They survived their early years without a cell phone or ipad to play with. The cell phone that I did have was as large as a briefcase and needed to be plugged into the car cigarette lighter for power. The baby swing that we owned was wound up with a crank. If you are a grandparent reading this, you are nodding as you remember the model that I am talking about. The babies loved it and would be lulled into a contented relaxed state for several minutes of clickety click, clickety clack. Then alas it would wind down and need to be cranked up again. This was a noisy process that more likely than not would wake the sleeping baby who had just nodded off.
Parents of young children have a much wider variety of “parenting hacks” to choose from. There are plenty of new things constantly coming onto the market that parents will refer to as “game changers”. These are the item that really make things feel more manageable. The following products are not personal endorsements; I am simply sharing wisdom from others that may be useful to my patients and readers. This is the third year that I am doing this post. Every year I have added more items. Thanks to all of you who have chimed in.
Having a safe place where where your baby can comfortably hang out is essential.
For the Crib:
Putting them down outside of a crib
Blankets and Swaddles
For some of our toddlers and preschool kids working on their sleeping skills, thanks to Tila for sharing the sleeper hero. After she told me about it, I have passed this tip along and many parents have called it a difference maker
Please never leave kids unattended. Just this week I had a call involving a baby not fully strapped into a little bouncer who managed to flop himself forward and bonk his head (he’s fine.)
Don’t put carriers up on a high surface. Trust me, they manage to fall. You don’t want to be the person calling me about that. This is more dangerous if there is a toddler or large dog that can 'help' the baby get knocked over.
This is especially helpful for a family with twins who are mixing larger quantities of formula at a time
You can wipe it clean and it cuts down on messes
Other Random tips
My lovely patients Rita and Ricardo spend a recent date night trying to brainstorm for me. They reminisced and thought about the most essential baby equipment (especially the first time around). Here's their list:
Other parents let me know about
Thanks Caroline for letting me know about another towel suggestion: I have a pretty random suggestion for essential equipment, but it made my life so much easier that now it’s my go-to gift for new parents. I absolutely loved my apron towel. Especially when Jack was a squirmy, wet baby. It made me feel so much more comfortable bathing him by myself.
You clip the towel around your neck before the bath, and after the bath you just pick up the baby to your chest and flip the hood up.
I couldn’t do a post like this without checking in with Jennifer of Hint Mama. She sent along the following tips
Clive’s mom Kylie says favorite toy as infant and now great distracter in car seat is baby Einstein take along tunes.
(Bells and whistles are fine and entertaining. Not everything needs to be high tech. There is nothing as great as a cabinet full of food storage containers and lids!)
Beyond equipment, there are now all sorts of apps
I don't advocate trying to live in a germ free world, but I imagine that most of us have disgustingly dirty cell phones that would benefit from a good cleaning, especially before we let our babies chew on them.
The book "Baby Bargains" another recommendation from Rita and Ricardo was a great resource to help them find general baby equipment (strollers, car seats, cribs, etc). It's not just about bargains - it's about quality, and they test and know about all the latest products.
Bonus Wisdom tip from mama Megna
One of the things I realized when I was nursing was that if I was stressed my son almost always 'absorbed' the tension especially when I was nursing. This was one of the most direct osmosis affects I've seen of stress hormones. It was a reminder of always being cool calm and composed especially when around your child.
We traveled a lot with our son the first year and although traveling with the a baby it's no picnic, each time we did a trip he grew emotionally so much. We never regretted a single trip that we took whether it was Europe or to see great-grandparents. Traveling is an amazing thing for a child even that age. It made us as parents more flexible and not as regimented about having things a certain way, and socialized our son at a very early age.
This post lives forever on my blog. If you have some magic tips to share, let me know and I will update the post.
Amanda checked in and added her 2 cents.
Posted by Nurse Judy at 9:38 AM
Friday, December 8, 2017
I saw a bumper sticker a while ago that said:
Good parenting requires twice as much time and half as much money.
This is the season for gift giving, but we all actually could do with a lot less stuff!! The best present I think that families can give to each other is the gift of self (otherwise known as time and attention.)
For kids who are old enough to understand, give a certificate that promises a special activity that you might do some time in the future. For older kids, escape rooms are a ton of fun. A membership to one of the local museums or the Exploratorium is another good gift to give to the family.
It is great for families to do outings all together, but one-on-one time is so important if you can manage it. Mix and match so that you make sure that everyone gets special time with one other family member. This includes one on one time for you parents as well.
The list of Nurse Judy's inexpensive and creative activities has some old and new ideas.
For Those lucky enough to live in or near the Bay Area, here is my list of quirky, only in SF things to do.
Happy Holidays...go out and make some wonderful memories!
If you have something that you think would be a good addition to this list, let me know!
Posted by Nurse Judy at 9:24 AM