Mosquito Bites/West Nile Virus Prevention tips/Dealing with bites/Zyrtec dosage

 

West Nile Virus Is Picking Up Across California

Early surveillance suggests this may be a more active season than we’ve seen over the past couple of years. It can be found year round but tends to peak in late summer/early fall. So even though some cases are expected, health officials are finding substantially more infected mosquitoes and birds than at this point last summer. This often serves as an early warning before human cases begin to increase later in the season.

It seems like a good time to update our mosquito post.

Even if they weren’t carrying any diseases, we hate mosquitoes. Yes we are aware that they are part of nature’s vast food chain but that doesn’t stop our loathing. For the record, it is a mutual dislike and fortunately we both rarely get bitten. The rest of our families? They are tasty targets, and are feasted on when given the opportunity.

West Nile History

Of all the mosquito-borne illnesses, the West Nile virus is the one that has gotten the most local media coverage. It is California’s most common mosquito-borne illness. It is thought to have originated in Africa (hence the name.) It has spread throughout the world and it was first detected in this country in 1999. Unfortunately we now have it in most states.

Transmission

Mosquitoes get this virus from feeding on infected birds. They then transmit it to humans. Humans are referred to as ‘dead end hosts’; they get the virus from being bitten by the infected insect, but then can not spread it to each other.

It is possible that it can be transmitted from blood transfusions, pregnancy or breastfeeding but there are no known cases of infants who have gotten seriously ill from these transmissions.

Incubation Period

The incubation period is usually between 2-14 days after the bite from an infected mosquito (most commonly 2-6 days.) There is, alas, no treatment beyond supportive care. It is thought that most people who have fought off the illness end up with some level of immunity. Keep in mind that any severe headache-fever-stiff neck combination always needs to be evaluated right away. If West Nile virus is suspected there are blood tests that can help with the diagnosis.

Symptoms

Fortunately, most people (around 80%) who become infected never develop symptoms. In fact, There are probably thousands of cases that go under the radar since we would never consider testing.

The unfortunate other 20% of infected folks may have

• Fever

• fatigue

• headache

• joint pain,

• muscle weakness,

• stiff neck, diarrhea,

• vomiting,

• swollen glands,

• photo-phobia

• rash on the trunk.

Not everyone will have every symptom. Most people showing these mild to moderate symptoms will recover completely, although there are reports that some of these folks can remain fatigued and achy for several weeks. 1% of infected people can get more serious neurological complications including encephalitis and meningitis. These are almost always adults over 55 or folks with compromised immune systems; it can be fatal for those with serious cases. Children under 5 seem to be at relatively low risk for getting seriously ill.

Prevention

Because there is no vaccine or specific treatment, prevention is the best protection:

• Empty standing water around your home every week (flowerpot saucers, buckets, kiddie pools, clogged gutters, bird baths).

• Use an EPA-approved insect repellent when spending time outdoors, especially around dawn and dusk. (there is a list of these below)

• Dress in long sleeves and pants if you’ll be outside when mosquitoes are most active. Light colored clothing is recommended. There are plenty of mosquito prevention clothing on the market.

  Here is nurse Judy rocking her safari hat. (How nerdy does it get?!?)

• Make sure that you have intact screens on all windows. If you are getting bites, check for holes or cracks where the insects might be getting in. If your little one is still getting bitten, check the bedroom carefully. Look at the mattress and all the corners of the room; bites could be from spiders, fleas or other culprits.

• Get rid of any standing water that is around your house; do a double check to make sure there are no pots, clogged gutters, kiddie pools, bird baths...etc. that are places where mosquitoes can breed. The larvae are dependent on water for breeding.

• Unfortunately just dumping out the water might not be good enough because it won’t dislodge the larvae that might be attached to the side. You really need to give a good scrub. Check out Mosquito bits and mosquito dunks. You can add these to any water features to keep the mosquitoes from breeding.

• There is often increased mosquito activity during dusk and dawn so that is when most of the biting happens. This seems to be true for the mosquitoes who carry West Nile Virus, not as much for Zika.

• If you are going into a heavy mosquito area use bug spray on exposed skin and clothing. Mosquito repellent works only on the surface to which it is applied directly. Experiments have shown that they will actually bite skin only four centimeters away from where the repellent is applied, so wristbands or just spraying clothing does not offer full protection.

• Some bug experts would rather that you avoid the traditional electric bug zappers. The violet light may be irresistible to some flying insects, (and that zap is such a satisfying noise), but mosquitoes are actually not attracted to the light. Some of the innocent and beneficial insects are the ones getting fried.

• If you have a garden, consider planting some of the plants that mosquitos tend to avoid. This includes lavendar, citronella and basil.

• Mosquitoes don’t like fans! If you are looking for an alternative to the DEET, the insects are lightweight enough that a good breeze may make it hard for them to zoom in on their target. Check out products such as Off Clip on Fan.

• If you are seeing mosquitoes around your house, see if your local health department will check the area around your home (including sewers) to see if they can find any breeding areas.

• Report dead birds to California’s West Nile surveillance program: 1-877-968-2473 (1-877-WNV-BIRD), or at https://westnile.ca.gov/report. They help public health officials monitor where the virus is circulating.

Alas, long sleeves alone aren’t going to do the trick if you are out in a buggy area.

The EPA has five registered insect repellents.

• DEET is likely the most well known option. It is the only product labeled safe for infants as young as 2 months old. It comes in different concentrations. The concentration of DEET in a product indicates how long the product will be effective. A higher concentration does not mean that the product will work better; It means that it will be effective for a longer period of time. Therefore, products containing lower concentrations of DEET may need to be reapplied, depending on the length of time a person is outdoors. Despite common concerns, DEET has been studied extensively and has an excellent safety record when used as directed (it’s not great for the ecosystem, so use DEET wipes when possible rather than spraying). One practical note: DEET can damage some plastics and synthetic materials (such as certain eyeglass frames, watch faces, or phone cases), so apply it before handling these items and wash your hands afterward.

• Oil of Lemon Eucalyptus is considered one of the least toxic options but interestingly, the age recommendation for it is for 3 years and older (natural lemon eucalyptus oil is not the same as Oil of Lemon Eucalyptus). Some people are sensitive to the smell of this, so it is worth sniffing it before you buy it. This is the main ingredient in Repel brand spray.

• Picaridin is odorless and is approved for children 6 months (recently lowered from 2 years) and older. Unlike DEET, picaridin will not dissolve plastics, synthetic fabrics, sunglasses, or fishing lines. Common brand is Sawyer.

• Avon Skin so Soft Bug Guard PLUS IR3535 Insect Repellent has been around for years but seems to be more commercially available than it used to be (also for over 6 months of age.) It comes in a highly rated product that combines Avon Skin So Soft and an SPF 30 sunscreen

• Bite Blocker is a botanical formula that claims to provide protection for up to 8 hours. The reviews mention a strong odor, but otherwise it gets a high rating.

  All of the EPA recommendations are considered safe, and they are clearly better than getting bitten, but at the same time, let’s use them wisely. The EPA has created the following tool to help you find the proper product for you needs

  EPA guide to finding the right repellent

  Note: If you are also using sunscreen, apply sunscreen first and insect repellent second.

Regardless of what you try, before applying anything topical to the skin for the first time, do a little test patch on the skin to make sure there is no sensitivity before you widely spritz or wipe on any of these products. You will need to read the labels to see how often you need to reapply. Avoid contact with eyes and keep all of these safely away from kids.

We would also be cautious about getting any insect repellents on little hands, especially if your child is young enough that those hands are going into the mouth a lot.

Some products are more effective than others for certain types of mosquitoes, so the product you choose might depend on where you are going and what you might be most at risk for. It is always good to check in at https://wwwnc.cdc.gov/travel prior to any travel.

There are also plenty of natural products on the market that claim to be repellents, ranging from Vitamin B to catnip. Most of these are generally safe, but unfortunately the scientific studies show that they are mostly ineffective.

DEALING WITH A BITE

If the prevention has failed, the most important thing is to treat the itching. Scratching at a bite will make it worse.

As soon as you notice a bite, giving a dose of cetirizine (Zyrtec) as quickly as you can manage, can help reduce the itching and may lessen the amount of swelling that develops. It works best when given early. 1% hydrocortisone applied early can be similarly helpful, and the combination of Zyrtec or Claritin plus topical hydrocortisone is often more effective than either alone for symptomatic relief.

Hydrocortisone cream probably works the best, but other topical treatments can include calamine lotion, or mixing up a paste of baking soda with a bit of water. A cold black tea bag compress can also be very soothing. Black tea contains tannins, which seem to help.

Be aware: some kids can have enormous reactions. Eyes and ears can be remarkably swollen. A super swollen eye along with symptoms of illness needs immediate medical attentions, but if you child seems fine other than the swollen eye, it is usually a bite. Topical treatment alone won’t be enough for these. Hopefully, the early dose of antihistamine will help. Scroll to the bottom for dosing info. It is worth being seen if the you don’t see improvement.

Zyrtec Dosage Chart

The dose of cetirizine depends on age:

· 6 - 12 months of age: 2.5 mg given once daily (maximum dose 5 mg daily)

· 12 - 24 months of age: 2.5 given once or twice daily (maximum dose 5 mg daily)

· 2 - 6 years of age: 2.5 - 5 mg given once daily (maximum dose 5 mg daily)

· Over 6 years of age: 5 - 10 mg given once daily (maximum dose 10 mg daily)

Zyrtec comes in a 1mg/ml solution (so 2.5 mg = 2.5 ml). There is also a 10mg/ml oral drops preparation (so 5 mg is 1/2 ml). Make sure you check the strength of the solution.

Benadryl tends to be an inferior treatment. It lasts ¼ the time of Zyrtec and has more side effects.

New on the market: There are some bite pens that use a combination of heat and vibration. If used properly, these are safe and potentially helpful

Here are some bonus facts about mosquitoes:

• Both males and females make that awful whining noise, but only the females bite humans.

• That whining sound comes from their wings beating an incredible 300 to 600 times per second.

• Mosquitoes are especially attracted to people who drink beer.

• Mosquitoes love the smell of sweaty feet.

• Mosquitoes can sense CO2 from up to 75 feet away.

• Mosquitoes only fly as fast as 1-1½ miles per hour.

• Some blood types may be tastier than others. O seems to be the favorite, A the least. B lands somewhere in the middle.

• Mosquitoes love pregnant women (regardless of their blood type) possibly because they emit a little extra CO2.

• Mosquito activity can spike by up to 500% during a full moon because they rely on visual cues to navigate.

• Mosquitoes are responsible for more human deaths than any other animal due to the diseases they transmit, such as malaria and dengue.

• Mosquitoes have existed for over 100 million years and have adapted to survive in a wide range of habitats, from wetlands to urban areas.

For further reading, here is some current info on some of the more common mosquito borne illnesses

West Nile Virus

https://www.cdc.gov/west-nile-virus/index.html

Zika

https://www.cdc.gov/zika/index.html

Chikungunya

https://www.cdc.gov/chikungunya/about/index.html

Rashes/ When to worry

 Rashes happen frequently. You can’t imagine the scope of the emails we have gotten from people asking for us to help them figure out what is going on. Many include photos of random, not easily identifiable body parts. It keeps things interesting.

Rashes can be spotty, blotchy, hives, and/or oozy.

They can be caused by allergies, bug bites, poison oak, contact with an irritant, virus, bacteria or fungus.

They can be on only one body part or cover most of the patient.

They can be part of a chronic condition that comes and goes, or something acute.

Once in a while we can look at a photo of a rash and have a good guess of what we are looking at, but more often things aren’t completely clear cut.

Here are some of the questions that we get all of the time:

Common Rash FAQs (a window into the daily life of a pediatrician):

• Do these spots mean I need to keep my kid home from school?

• Is this diaper rash worthy of urgent care? It looks so painful. Is it from an allergy to something they ate?

• How do I know if my baby’s rash is due to a food allergy?

• How do I treat this persistent cheek rash between ages 6 and 24 months? Does this rash mean my baby has a food allergy?

• Does this diaper rash need an antifungal or regular desitin/vaseline/barrier cream? Should I change what they’re eating?

You may notice a theme in the most common questions we get from parents, but all kidding aside, the most important thing really comes down to one very important and basic question: “Do we need to be curious about this rash, or actually worried?“

If you learn nothing else:

A child with a random rash who is running around, playing, eating, and acting like themselves is very unlikely to have something serious.

Rashes that we are curious but not worried about

If the rash bothers you more than your child, it likely isn’t urgent, but let’s do some problem solving.

• Are there any new medications? Especially antibiotics; even if it is the end of a course or they just finished. This is important information.

• Was there a recent illness/fever? If they just had a mystery fever and then a rash comes out once the fever is gone, we are NOT as concerned about it. There are quite a few viral syndromes that wave goodbye with a rash

• Do they have a history of eczema or atopic dermatitis. This tends to be a common culprit.

• Are there any new foods? Yes sometimes they are the cause, it’s just not as often as you think.

• Have they been enjoying lots of citrus or berries lately? This is a mild, temporary irritation due to acid, not an allergy. The anus might also have a characteristic red ring around it.

• Are there any new soaps, detergents, bubble baths?

• Have you used a new sunscreen or lotion of any sort?

• Do you have pets? Flea bites love the ankle areas, but for a crawling toddler, anywhere is fair game.

• Has there been an exposure to a new animal? Keep in mind that allergies are more likely if kids are older than 2. It is certainly possible as early as age 1, but unlikely to show up before then.

• Have they had a MMR or chicken pox vaccination within the past 2 weeks?

• Has your child been in a hot tub 1-3 days ago?

• Is the weather very warm? (babies don’t like the heat, especially if they’re over-bundled)

• Has your child been laying in the grass or sand?

• Any recent hiking? (think poison oak)

• Has your child done a recent art project with a new substance?

• Have you checked the mattress and area around the bed to see if there are any spiders or insects hanging around? (shudder)

If your detective work has given a promising clue, make the common sense adjustments, use some of the tools below and see if you see any improvement.

Regardless of what is causing a rash, there are several basic staples that are worth keeping on hand.

• Neutral cleanser (Cerave, Cetaphil, Vanicreme, Eucerin are all great, minimal water needed, apply and wipe off with lukewarm water and no rubbing).

• Aquaphor or Cerave ointment for broad dryness or redness.

• A good moisturizer (Tubby Todd All Over Ointment is fantastic albeit expensive)

• You all know that we love adding a splash of apple cider vinegar or baking soda to the tub for all sorts of rashes.

• Oatmeal bath (don’t clog your drain with real oatmeal, there are special products used for this).

• Bleach! Believe it or not, many dermatologists will suggest a diluted bleach bath for helping clear up eczema or bacterial infections. Directions for this are below.

The following items are worth having in a well-stocked medicine cabinet.

These are targeted treatments for allergic, fungal, and bacterial skin issues, and are usually worth a brief consultation to figure out which ones are appropriate for the situation.

• Over the counter Neosporin/Bacitracin or prescription Mupiricin for anything red and painful or yellow crusty.

• Over the counter anti fungal cream/ointment for any possible yeast rashes (photos below in the diaper yeast section, but these have a characteristic look).

• Over the counter hydrocortisone cream/ointment for itchy areas.

  • One clear exception to the use of hydrocortisone: discrete red or pink dots in dark wet places, usually the crotch or diaper area, should always start with an antifungal before hydrocortisone. Fungal rashes “eat steroids for breakfast.” They’re likely to make things worse. Not dramatically, but don’t start with them.

• Zyrtec, Claritin, or Allegra are antihistamines to have on hand. Benadryl is absent from this list because it lasts ¼ the time but has all the unwanted side effects, especially drowsiness (We see you parents, saying, ‘Hey wait, who said drowsiness is unwanted!?”)

Of course feel free to call your advice nurse or doctor’s office to help you troubleshoot. If a rash is persistent and your best attempts at clearing it with a variety of OTC creams isn’t helping, you may be sent to the dermatologist.

Rashes that need to be seen/Now we are worried

Any purple rash could be an emergency. These rashes don’t lighten up when you press firmly on them. If you have a child who has a purple rash and also has a fever and looks ill, they need to get to an emergency room immediately to rule out meningitis. A stiff neck, vomiting and headache would make us even more concerned. These kids are not happily playing.

Hives are scary because most people associate them with a severe allergic reaction. If the hives come along with sudden coughing, vomiting, diarrhea, swelling of the lips or tongue, or altered mental status, they need to be seen ASAP.

Once they have a history of severe allergy to something, you should always have an epi-pen, AuviQ, or Neffy (nasal epinephrine) on hand. Treat immediately at first sign of a reaction, but then head right to the ER for some close monitoring. Luckily, hives alone, are not usually urgent. (more on that below)

Urgent, but extremely rare:

One final rash deserves special mention: the rash that comes with Kawasaki disease or MIS-C (Multisystem Inflammatory Syndrome in Children). The good news is that the rash itself is usually not the most important clue. These rashes can be blotchy, widespread, or just plain hard to describe. What matters more is the whole child. These kids have persistent fever and they look sick. They often have very red eyes without any discharge, bright red or cracked lips, a red “strawberry” tongue, swollen lymph nodes in the neck, or redness and swelling of the hands and feet. Belly pain, vomiting, diarrhea, or unusual fatigue are especially common with MIS-C.

These are conditions that need prompt medical evaluation. Fortunately, they are uncommon, and with early recognition and treatment, the vast majority of children recover completely.

It is worth repeating: if your child has a rash but is running around, playing, eating, and acting like themselves, Kawasaki disease, MIS-C, or anything else worrying are much less likely.

Not urgent but potentially worth a visit:

Confer with your provider before just showing up. Some offices may take steps to avoid having someone who is potentially contagious hanging out in the waiting room.

Measles would also present with a high fever and a rash. It is very sad that it needs to be back on this list. Click the link for a full description of symptoms but these patients look sick! It is essential to have it identified as quickly as possible to prevent spread.

Strep throat often presents with fever and a rash, usually there is no congestion. While it will often go away on its own, it is worth treating to avoid potential complications.

If the rash is oozy and crusty it might be bacterial. Impetigo is fairly common. It often presents with a sore around the nose or mouth that doesn’t seem to heal. A yellow crust makes it pretty easy to figure out. If your child has a history of impetigo, you don’t need to rush in. If you already have Mupirocin, you can try to treat a small area. However, if it isn’t clearly taking care of things, an appointment is warranted. Sometimes oral antibiotics are indicated.

If a rash seems to have lots of clear fluid filled centers, it could be chicken pox or herpes!

Any painful rash that is only on one side of the body and doesn’t cross the midline could be shingles. It is rare for children to get this, but it can happen.

Some viral syndromes that may have the rash and fever concurrently are Slapped Cheek and Hand Foot and Mouth. Neither of these are urgent, but it’s nice to be seen to differentiate from the others. We don’t have anything other than suggestions for symptomatic relief for those. You simply will need to ride them out.

Hives without signs of anaphylaxis are usually not a big deal, but may be worth a visit. They are a signal that the body is reacting to something, but often it is viral. We have had patients with mystery hives that have cycled on and off for several weeks before finally fading. This is actually pretty common 1-2 weeks after an illness in children, and sometimes kids didn’t show any signs of being sick (i.e. there weren’t any symptoms).

Even if they don’t look terribly sick, if your child has several days of fever, a rash, and that little voice in your head is saying, “Something isn’t right,” trust that instinct. Going in for a little reassurance is never the wrong answer.

If the rash seems very painful or itchy certainly try Zyrtec or Claritin, but if your child is uncomfortable let’s get them seen to see if we can help. Some itchy rashes like poison oak may need oral steroids.

Photos

Disclaimer : You may not want to be eating if you scroll down. Seriously, rash pictures can be tough. (Our editor, Sandy, says we needed a stronger warning)

Welcome to our world!

Common Baby Rashes

Diaper yeast/fungal infection:

We suspect a diaper rash is caused by yeast/fungus/candida when we find the classic “satellite lesions” red dots that are thrown off the main rash. There tend to be lots of little bumps or dots instead of broad smooth red areas.

Diaper “Dermatitis” (not caused by fungus/yeast)

Source: Uworld Medical

Severe diaper rash (note the skin breakdown, this needs a high concentration Zinc-based barrier cream like Desitin applied like icing on a cake, so you can’t see the skin). Nurse Judy likes Bag Balm for this:

Drool rash (“irritant contact dermatitis”)

Neonatal Acne

Infant Eczema (note the predominance on cheeks and trunk, not behind the elbows and knees like the older kids)

Illness rashes:

Hand Foot Mouth

“Slapped Cheek” (parvovirus B19)

Antibiotic rash (amoxicillin measles)

Poison Oak or other “contact allergy” rashes (note the streaks where the plant was brushed on the skin):

Hives/allergic rash (they are raised welts. Lots of little red dots are not hives):

Impetigo

References

Bleach Bath Recipe & Dilution

• For a full tub: ¼-½ to cup of regular, plain, unscented household bleach (around 5%-6% sodium hypochlorite).

• For a half tub: ¼ cup of bleach.

• For a baby tub (about 4 gallons): 1 tablespoon of bleach.

• Water Temperature: Lukewarm.

Instructions

1. Mix: Fill the tub with lukewarm water and thoroughly stir in the bleach before getting in.

2. Soak: Soak only the torso or affected areas for 10–15 minutes. Do not submerge the head or face.

3. Rinse: Thoroughly rinse the skin with fresh, lukewarm tap water.

4. Dry & Moisturize: Gently pat the skin dry with a towel (do not rub). Immediately apply any prescribed medications and moisturize

   Helpful for eczema or rashes caused by bacterial source (Staph)

Baking Soda Bath

Recipe

• Full bathtub: ¼-½ cup baking soda.

• Baby bathtub (about 4 gallons): 1-2 tablespoons baking soda.

• Water temperature: Lukewarm.

Instructions

1. Fill the tub with lukewarm water and dissolve the baking soda completely.

2. Soak for 10-15 minutes.

3. Gently pat the skin dry (don’t rub).

4. Immediately apply moisturizer or any prescribed creams.

Helpful for: Itchy skin, nonspecific irritant rashes, eczema flares, and viral rashes.

Apple Cider Vinegar Bath

Recipe

• Full bathtub: 1 cup apple cider vinegar.

• Half-full bathtub: ½ cup apple cider vinegar.

• Baby bathtub (about 4 gallons): 2 tablespoons apple cider vinegar.

• Water temperature: Lukewarm.

Instructions

1. Add the vinegar after filling the tub and mix well.

2. Soak for 10-15 minutes.

3. Rinse briefly with clean water if the smell bothers your child (optional).

4. Gently pat dry and immediately apply moisturizer.

Helpful for: Mild eczema, irritated skin, folliculitis, and helping restore the skin’s natural acidic barrier.

Do not use on large open wounds, severe skin breakdown, or if it causes significant stinging.

The stuck WHAT in their mouth? Coby swallows a penny

 Last week my 28 month old grandson Coby swallowed a penny.

Lauren heard something in his mouth that didn’t sound normal.

“What’s in your mouth?”

“A coin!”

“What?! Open your mouth!”

“I swallowed it.”

“Did you really!?!?”

“Yes”

“What kind of coin was it?”

“The gold one.”

As I told him over the phone the next day, when you are smart enough to inform your mommy, “I swallowed the gold one,” you should also be savvy enough NOT to put things in your mouth that don’t belong.

When it happened, Lauren knew to refer to my old blog post, but as a nod to Coby I figured this is one worth updating and refreshing.

They put WHAT in their mouth?

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 where something might go down.

If it goes into the esophagus, that is the beginning of the digestive tract. It hopefully will make its way down into the stomach, through the intestines and then get pooped out.

If something was swallowed, here are some 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.

(In Coby’s case, he was able to easily drink water and eat an applesauce pouch, which was very reassuring)

Is it poisonous?

If you have any doubt about that, call the poison control center

1-800-222-1222 . For more info about dealing with poison, here is my blog post.

Is it potentially germ laden?

The answer is most likely yes, but that doesn’t mean you need to freak out.

When I was still working in the pediatrician’s office, I would get calls all the time about kids eating things that are pretty disgusting. More often than not, there were no actual consequences.

Young infants are the most vulnerable to germs, but the good news is that they don’t usually have the hand/mouth coordination to actually get anything into their mouth.

Once they have mastered that milestone, 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 an evaluation.

Is it a battery or magnet?

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.

As an important safety measure, pay attention to where any 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!

Water/Agua beads

I am glad that these weren’t around when my kids were little. Coby is such a little goat, that Lauren has wisely not let them anywhere in her house.

These are little sensory beads that can grow to almost 100 times their original size when wet. They claim to be non-toxic, but they can be very dangerous if swallowed. These beads are associated with thousands of ER visits every year. If the beads are ingested they can continue to grow inside the body. This can cause severe discomfort, vomiting, intestinal blockage and life-threatening injuries.

As an aside, they are probably helping put many plumbers’ kids through college. Your pipes will thank you for not letting these into your home.

Is it sharp?

If the something that they have swallowed has a point or sharp edge, keep an extra close eye on your child. Feel the tummy to see if it is nice and soft. Look for blood in spit up or drool. Keep an eye on the stools.

If your child seems to have a rigid painful belly or has any dark, tarry poop or bright red blood they will need to be seen right away.

You may as well laugh

Some of the stories of what kids ingest are worth a giggle once everyone gets the all clear. One episode that I remember was a 3 year old patient who managed to swallow one of her Grandma’s one carat diamond stud earrings. It did pass through and was retrieved with no harm at all to the swallower. However, 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, like the earring, it is simply a matter of watching for 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.

Here is a fun fact. I am more concerned about a penny that is newer than 1982. Why? Because these newer pennies are more zinc than copper, and the Zinc can be more reactive with the stomach acid.

However, when a worried parent would call me to report a swallowed penny, asking them what year it was, was unlikely to be helpful.

Nurse Judy’s ‘corn in the poop’ tip

Okay, so they have swallowed something, what’s the next step?

Once it is clear that nothing is stuck, let’s encourage a quick passage! Increase the amount 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. That bright yellow kernel of corn can help you track the transit time.

(Lauren gave Coby corn as directed, but then didn’t look too carefully to see if the penny passed. In all fairness, Coby was in the process of potty training himself, so some poops were in the potty, and one was messy enough that she ended up simply tossing the training underwear rather than having to deal with it.)

When do we need to start paying extra attention to this ‘oral’ behavior?

Once in a while just about every kid is going to do some exploration, but 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. Low iron levels or high lead levels could be part of the issue.

Choking

Up until now, we were discussing things that went into the esophagus.

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. It is important to note that if someone has a blocked airway, they can not speak or make sounds. They will likely have a color change and look pale or blue.

It is critically important that all parents and caregivers are trained to do a choking rescue. Of course with any emergency you should call 911

Prevention!

To avoid this happening on your watch, do your best 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!

So what about the new devices that can help if your child is choking? These are relatively new and get mixed reviews. Alas these are not geared to children less than 22 pounds, but might still be a nice piece of mind for older toddlers.

A final note on the penny.

I had seen countless patients who swallowed pennies without any complications, so I was not terribly concerned.

But then….Coby got a fairly significant rash.

There were a few Xs in the equation. He had just finished a course of Amoxicillin, which was the likeliest culprit. It also could have been viral. But just to make things interesting, there was also the remote possibility that it could have been a reaction to the zinc or copper.

Fortunately the rash resolved and we are assuming that the penny is somewhere in the plumbing system as opposed to being stuck somewhere.

And now Coby is eagerly retelling his version of this story: “mama heard something in my mouth… it was a coin…. I swallowed it!”

Me: Lauren, can I get a photo of Coby holding a penny, for my blog?

Lauren: You think I would trust him with a penny!?!?

This photo will have to do.