Prescriptions
Parents must be aware of what kids stick up their nose
By Landis Lum
I ran into Dr. Marcello Obando in the hospital recently, and he said, "Landis, you've got to warn your readers about their kids sticking things into their mouths, ears and noses. In the past week alone, I must have removed things from six different screaming kids, the worse being a dime-sized camera battery way up in the nose of a 5-year-old. It was corroding into his nasal septum because of some electro-chemical reaction."
Obando is one of our ENT (ear, nose, throat) specialists, and I promised him that I would.
It's truly amazing what things kids will stick up their noses: food, beads, crayons, small toys, erasers, paper wads, beans, pieces of sponge, stones, you name it.
Signs that your keiki may have stuck something up there nose are sneezing, fussiness and sometimes crying. Later on, a foul smelling or bloody nasal discharge occurs. Sometimes the only hint that your keiki has something in his nose is a general unpleasant body odor. Doctors even have a name for this - bromhidrosis!
You should take your child to a doctor right away before the object can cause nasal ulcers or dangerous choking.
While objects in the nose are usually more of an annoyance than a threat to life, choking on food or other items kills more than 100 children each year. Keiki between 6 months and 5 years of age are at highest risk, with many fatalities occurring during the first year.
Peanuts are the most notorious objects to be sucked into the wrong tube, accounting for almost half of choking cases in some studies. Why peanuts are breathed into the lungs so frequently while objects of similar size such as raisins are rarely aspirated is unclear; it may have something to do with the peanuts' hard, slippery surface.
Other culprits frequently choked on are sunflower seeds, pieces of apple or hot dogs, teeth, toy parts, pen tops, crayons, popcorn, tacks, candy and pins. Examples of things recovered at autopsy are the plastic cap of a water pistol, a balloon fragment and a piece of bubble gum.
If, heaven forbid, your child is choking, what should you do?
Don't do anything if your child can still speak, breath or cough. A child often will be able to cough the object out on their own (though in the interim, I'd start arranging for emergency transport to the nearest emergency room).
However, if your keiki truly is unable to breath or speak, then the rule to remember is to do abdominal thrusts, also known as the Heimlich maneuver, on the child if he or she is at least 1 year old. Or, you should try back blows and chest thrusts if the child is younger than 1.
The Heimlich maneuver is done on a sitting or standing child (or adult) by standing behind him or her with your arms wrapped around the body, making a fist with one hand slightly above the belly button of the victim, cupping and grabbing your fist with your other hand, and then forcing your fist into the victim's abdomen with several quick upward thrusts.
If the victim loses consciousness, you'll have to lay the person on his or her back, kneel next to him or her (facing the head) and, using the heel of one hand, do six to 10 abdominal thrusts, pushing upward and inward from midway between the belly button and the rib cage.
Of course, it is ideal to sign up for a cardiopulmonary resuscitation class to learn such techniques firsthand from a trained professional.
However, it's far better to prevent these things from happening in the first place.
Beads, button boxes and coins should not be given to keiki as playthings. Safety pins should always be closed and should not be left near a baby or within reach of small children.
Children who are too young to chew and swallow carefully should not be given small pieces of candy, nuts, etc. Toys containing small or loosely attached parts should not be given to children who are still putting such objects into their mouths. Nuts and popcorn are particularly attractive to our keiki, and we should not be tempted into providing them with these potential killers. And don't forget about what Obando said about those darn camera batteries . . .
Dr. Landis Lum is a family practice physician with Kaiser Permanente and an associate clinical professor of family and community medicine at the University of Hawai'i's John A. Burns School of Medicine.
Hawai'i experts in traditional medicine, naturopathic medicine, diet and exercise take turns writing the Prescriptions column. Send your questions to: Prescriptions, 'Ohana Section, The Honolulu Advertiser, P.O. Box 3110, Honolulu, HI 96802; e-mail ohana@honoluluadvertiser.com; fax 535-8170. This column is not intended to provide medical advice; you should consult your doctor.
