Holiday seasons can be especially challenging when it comes to childproofing. Christmas trees, presents, wrapping paper…..It is hard to stay vigilant 24/7. Pediatricians usually get some pretty interesting calls this time of year.
The fact is, 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.
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?
Advice nurses 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!
Water beads
I am glad that these weren’t around when my kids were little. They 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 it is something that 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 accidentally swallowed 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.
Nurse Judy's 'corn in the poop' tip
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.
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 hight lead levels could be part of the issue.
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 good reviews. Alas this are not geared to children less than 22 pounds, but might still be nice piece of mind for older toddlers.
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