Wednesday, September 21, 2016

Broken Paint Brush and Foreign Bodies




The foreign objects may have changed over the past century, but the time-honored tradition of children getting them into small spaces has not.  Recently an article was published online about a display in the Ear Nose and Throat department at Boston Children’s Hospital with items removed from children starting in 1918.  The collection includes a screw hook, a sardine tin key, Scottie dog button, and even a political pin for FDR removed from an esophagus.  The display is a tribute to the late ENT physician who worked there for 35 years and removed the majority of the items on display. 

Children commonly stick odd things in their ears and noses or swallow toys not meant for ingestion.  My father’s favorite story of a swallowed foreign body involved ingestion of three OPEN safety pins.  He spoke to a specialist at the local children’s hospital who said the items would pass through and no intervention was necessary. 

Many of you have seen the bulletin board behind my office door where I have kept all the items removed from throats, ears, nostrils, and other locations over the years.  Each piece is cleaned with alcohol before being labelled with a date, the patient name, and location of extraction.  As you would expect, there are a lot of ear tubes up there, but also beads, buttons, and even a pussy willow from a child’s nose.  Also Play-Doh, a micro-machine, and even a gum wrapper are tacked up there too.  

Nowadays, button batteries are more commonly swallowed and pose particular risk because the chemicals in them cause esophageal damage within a few short hours.  Other high risk objects in today’s world include latex pieces (from blowing up gloves or balloons), magnets, and those dishwasher detergent pods that are so popular and look like candy. 

Children with foreign bodies requiring extraction are usually between the ages of 2-7 and I suspect they are curious as to whether or not the item will fit in the space; they never think about the inevitable removal process.  They probably swallow coins or marbles for the same reasons; not thinking about the potential consequences.  Sometimes, the foreign object ends up in its unexpected location completely by accident.

About 10 years ago, I got a phone call from a close friend of mine while on her way to my house with her husband and 13 month old daughter.  Their little girl had been walking around with a child size paintbrush in her hand when she tripped and fell down.  She was crying from the fall and on the floor was half of the broken paint brush handle.  They found the other half of the handle in her nostril.  There was a little bleeding but otherwise she looked fine.    

I still remember the expression on their faces when opening my front door.  It was a mixture of fear, guilt (not that there should be any), and a little panic thrown in for good measure.  Both mom and dad had tears in their eyes.  Their little girl was crying too, though I am not sure if it was pain or fear in all the chaos.  She was awake, breathing fine, and looked stable. 

She did indeed have a portion of a pink plastic paintbrush handle up her nose.  My brother was staying with me at the time and it was helpful to have another strong person present and able to assist.  I do keep some basic tools at my house for times when this issue comes up.  Over the years, I have removed stitches, given shots, and reduced a few nursemaids’ elbows at home too.  You just never know who or what might knock on your front door. 

I got a pair of tweezers out of the bathroom.  We laid her down on my kitchen counter and two adults held her down as I grasped the handle and removed it from her nostril.  It was much longer than expected, my brother swore during the process out of surprise, and at last the paintbrush handle was successfully extracted (to be later mounted on my bulletin board.) 

There are a lot of satisfying things we do as pediatricians and this is definitively one of them.  As physicians, we need a few tools at our disposal including a thermometer and stethoscope, but a location where we can lay a child down flat with good lighting is priceless.  I discovered the real value of my kitchen counter that night and it has seen a lot of exciting things since then.  




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