Monday, 22 August 2011

Why do children swallow objects?

Children will swallow some crazy things. A recently-reported Montreal case of a toddler who ingested an entire ball-point pen may be a record of sorts, but doctors and medical studies suggest imbibing foreign bodies is a regular occurrence, with some remarkable examples.

There has been cases where teenagers have swallowed whole toothbrushes, combs and in one case, even a blow dart. Younger children have swallowed various pins, nails and even a pacifier inside its plastic bag. Swallowing a battery, with its corrosive potential, is frequently considered a medical emergency. Other times, though, even sharp objects can be naturally expelled by the young bodies.

“I have certainly seen a lot of different things over the years,” said Dr. Bruce Minnes, an emergency physician at Toronto’s Sick Kids Hospital. “Do I continue to be surprised? No.”

Physicians often have to put the patients under general anesthetic and retrieve the object with an optical scope and remote-controlled instruments. One memorable case Dr. Minnes encountered involved a teenage girl who tripped and fell while holding an afro pick, which she then proceeded to inadvertently choke down.

In another case, a child swallowed a heart-shaped brooch, which showed up on the X-ray part-way down the esophagus, a perfect heart shape in the middle of the chest, he recalled.

Less than a year ago, Dr. Neil Chadha of the B.C. Children’s Hospital retrieved an entire toothbrush, lodged partly in the esophagus and partly in the stomach of a teenage girl. She had been using the brush to try to make her vomit when she pushed too far, he said.

There was a Canadian case involving a girl who swallowed a sports pendant that showed up on the X-ray as a perfect ice-skate shape.

Doctors are more concerned, though, about batteries, especially the button-size ones that are easy to swallow then can release corrosive material with the potential to perforate the esophagus, causing infection in or around the heart, said Dr. Chadha.

Another serious danger is aspirating objects – drawing them into the airways, with the danger of cutting off breathing. Dr. Chadha urges parents to not give children under four carrots or nuts that they cannot chew property – and which can end up blocking air pipes.

Montreal doctors have reported what may be the longest rigid foreign object ever retrieved from inside a young child - a 15-centimetre ballpoint pen that a two-year-old girl somehow managed to swallow. An X-ray image of the toddler showed the faint but unmistakable outline of the writing implement, partly in her esophagus and partly in her stomach, extending about half the length of the child's body. Physicians removed the pen with an endoscope - an instrument threaded down the girl's throat and equipped with tiny alligator forceps to grasp the object and pull it out. They describe the procedure in a case study just published in the Ear, Nose and Throat Journal.

Ingesting foreign bodies is a surprisingly common pediatric complaint, but it seems such a long, inflexible article has never been described in the scientific literature before, the authors say.

The fact the patient was able to consume it may mean that safety standards for children's products need to be revised.

"The first thing that enters the head is 'How on earth could she have swallowed something so long?" Dr. Lily Nguyen, the ear, nose and throat specialist who led the removal procedure, recalled in an interview. "I had initially thought it was physically impossible. The next thing I was worried about was that it would puncture through either the esophagus or the stomach, so we took her to the operating room very quickly."

The girl's father was a doctor from the Middle East visiting Montreal for a conference about two years ago; he did not see her ingest the pen but the toddler told him what she had done and he hurried her to hospital. Apart from a little pain, though, the girl had no trouble breathing or any other symptoms, said Dr. Nguyen, based at Montreal Children's Hospital.The child recovered without complications.

Dr. Neil Chadha, an ear, nose and throat specialist at B.C. Children's Hospital, said he has removed toothbrushes from the innards of teenagers and adults, but has never heard of such a long object being fished out of such a small child.

"It wouldn't surprise me if that was a unique case," he said. "Odd things crop up from time to time, but that's quite exceptional."

The number of foreign-body injuries has actually dropped in recent years because of better treatment options, education campaigns and improved regulation of consumer products, the journal article notes.

The influential U.S. regulations that govern the size of objects meant for use by children under three, however, permit articles that are longer than 5.7 centimetres—barely a third the length of the pen—on the assumption no little boy or girl could swallow them."Our case illustrates the possible shortcomings of existing manufacturing regulations," the paper concludes.

We’ve all eaten something that other people think is strange, whether it’s an odd food combination or just plain gross. However, some children take weird eating to a whole new level, swallowing items that shouldn’t even have been in their mouths.

A seven year old boy was rushed to the hospital after accidentally swallowing his “grill,” a decorative piece of mouth jewelry his mother purchased for him at a flea market. The grill fell out of his teeth and he started choking on it, eventually swallowing it. Doctors recommended that he allow the mouth piece to pass through his body naturally.

A little girl in Indianapolis recently ingested about 30 magnetic pieces from a Magnetix toy. It was one of her favorite toys, given to her for Christmas by her adoptive father. The magnets created a life threatening situation for her, as the magnets can come together and rip through intestines, causing damage comparable to a gunshot or stab wound. She suffered from tearing in eight areas of her intestines but eventually pulled through after surgery. The girl had a history of swallowing foreign objects in her home country of Russia. The toy company has since recalled the item to add a warning label about magnetic ingestion.

A 3 year old girl was brought to a doctor by her parents after she swallowed a foreign object, and was quickly found to have swallowed a mercury battery. This created an incredibly dangerous situation, as mercury is very poisonous to humans. Unfortunately, the girl’s gastric acids had already corroded the battery, despite endoscopic removal and chelation therapy and as a direct result, she developed renal failure. Batteries are now designed to be more resistant to acid.

One woman’s child swallowed a screwdriver bit, but everything came out alright. A young girl swallowed a smokey quartz, which came with a Treasure of the Earth magazine. Her mother told her to put it somewhere safe, and apparently, she did. Everything came out bit by bit. Now that really is a play on words.

When I was about four, I placed the base of a small metal soldier in my mouth and accidentally swallowed it. My mother rushed me to the hospital when I kept gagging and they X-rayed me and discovered what it was. There was fear that it may have been made of lead so she had to return home and bring back the metal soldier. Lucky for me, it wasn’t made of lead. They would have had to cut me open if it was lead. When I was seven, I foolishly place two pennies in my mouth while lying in bed. Naturally, I accidentally swallowed them. My youngest daughter when she was around nine years old accidentally swallowed one of her mother’s rings. We took her to the hospital and I saw the X-ray. It was still in her esophagus. They managed to remove it.

Why do children put things in their mouths when they shouldn’t?

Foreign body ingestion is a common problem in the pediatric age group. Infants and young children explore objects by putting them in their mouths.

Sensations from the gums draw the child's awareness to the mouth during teething. This increases the desire to put things in the mouth. Children discover sensations that increase comfort, and increase their biting, chewing, and oral exploration of toys.

Children enter the world with no worries or concern for their safety and survival. Children enter the world intending to explore, driven to discover and investigate everything. Children want to put everything in their mouths, touch everything, jump on it, roll in it, shove it up their noses and see what happens when they push that button. In fact, many adults spend much of their time with children asking and directing them not to touch that, not to do jump on this or not to eat the dirty something. Children are driven by curiosity, wanting to learn and explore the world and themselves in the world.

Isobel Kearl, first aid development officer for St John Ambulance says that one in two people don't know what to do when someone chokes. She adds that if it's your own child choking, you are inevitably going to panic. If the child is over 12 months old and coughing, you should always let them continue. It's the body's way of ridding itself of the object. The problem comes if they can't make any noise. That's the point at which to lean them forward, support them with your arm and hit them between the shoulder blades using the heel of your hand.Unfortunately, that doesn't always work. In 2011, an old friend of mine who was in his eighties, choked to death after swallowing some food that had accidentally gone down his trachea. No amount of slapping him on his back or putting pressure on his diaphragm saved him.

The desire to put things in our mouths can extend right into adulthood. If you doubt that, consider why some adults who put their pens or unlit cigarettes and/or pipes in their mouths when they are thinking.

Before a baby is born, more often than not, it has one of its thumbs in its mouth. As a small baby being fed, it has its mother’s breast in its mouth, then the nipple of a feeding bottle and soon after that, the nipple of a pacifier in its mouth. As a small child, it still sucks on its thumb.

The term ‘oral stage’ denotes the first psycho-sexual development stage wherein the mouth of the infant is his or her primary erogenous zone.

Obviously, the desire to place something in our mouths is psychological. As we grow older, we for the most part, grow out of it. We find some other means of finding relief from our worries. Unfortunately, many people shove food into their mouths to find relief. Others place foreign objects into their mouths. These problems can go and often do go right into adulthood. So don’t be surprised when you discover that your child has placed a foreign object into his or her mouth. Aside for the need to explore, it could be attempting to pacify itself when baby pacifiers are no longer appropriate to put in their mouths.

Because it is the infant’s first human relationship — biological (nutritive) and psychological (emotional) — the duration of a child placing something in its mouth depends a great deal upon the child-rearing by the child’s mother.

I don’t believe that small children purposely attempt to swallow foreign objects but it happens nevertheless. This is why pacifiers have a guard at the base of the nipple. Make sure that when you child is lying on his or her bed, there is nothing within reach that your child can grab and place in his or her mouth. It is while small children lying on their backs on their beds that foreign objects can so easily fall into their esophagus and in some instances fall dangerously into their trachea causing them to suffocate.

No comments: