Your Child’s Mouth and Throat – PediaCast 484
- Our Plain Language Panel returns to the studio as Dr Mary Ann Abrams and Dr Alex Rakowsky explore common conditions affecting the mouth and throat. We cover choking, swallowed objects, teething, sore throat and thrush. We hope you can join us!
- Mouth and Throat
- Swallowed Objects
- Sore Throat
- Primary Care Pediatrics at Nationwide Children’s
- What To Do When Your Child Gets Sick
Discount Code: POD719 (40% Discount)
- Pediatrics in Plain Language Survey
- Pediatrics in Plain Language Playlist – SoundCloud
- American Red Cross Training Classes
- Infant Teething and Toddler Tooth Care – PediaCast 423
- Tooth Care for Kids and Teens – PediaCast 439
- Dental Trauma and Emergency Tooth Care – PediaCast 429
Announcer 1: This is PediaCast.
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children’s, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello, everyone, and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We are in Columbus, Ohio.
It's Episode 484 for February 16th, 2021. We're calling this one "Your Child's Mouth and Throat". I want to welcome all of you to the program.
So we have another Pediatrics in Plain Language edition of our podcast this week. And you'll recall that our Plain Language Panel consists of Dr. Mary Ann Abrams and Dr. Alex Rakowsky, both with Primary Care Pediatrics at Nationwide Children's Hospital.
When they visit the studio, we double down on our efforts to avoid medical jargon and we use plain language at least to the best of our ability, as we cover some basic elements of child healthcare. And when medical jargon cannot be avoided or when we let it slip through, we do our best to explain. Well, first, we do our best to catch that we actually use something other than plain language. So we do try to hold each other accountable and correct any jargon that might creep in and explain exactly what we mean when that jargon does pop up.
So, in other words, we really try to keep things in plain language as much as we can. And it does tend to make our conversation interesting as we listen carefully to the words we are using. Because I'll tell you, letting medical jargon slip in, it's a really easy thing to do.
And last week, when we talk about congenital heart disease and hypoplastic left heart syndrome, as I listen back to that program, there was definitely some medical jargon that did creep in. And I apologize for that.
We do try to keep things as understandable as we can, but doctors are also people. And for us, medical jargon does slip off the tongue very easily. We don't do it on purpose but there it is. And of course, when we fail to catch it, parents and our patients might not understand exactly what we mean or you might miss the importance or the significance of what we are saying.
And this is actually where moms and dads come into play. If you don't understand what your doctor is saying, maybe you can't quite place the meaning of a word or phrase. Or you're getting the impression that there is greater importance or significance to the topic at hand, and yet you feel like you're missing, maybe you can't quite put your finger on it, please step in, interrupt right there on the spot. And let your provider know that you need some clarity.
Get your questions answered or have them explain it in a different way or place the new information within the context of what you already know. We're all in this together, folks.
So as pediatric providers, we'll try to stick with plain language and explain clearly what we mean. And when we fail, despite our best efforts, moms and dads, please jump in, ask us to clarify. Because at the end of the day, we really do want to communicate effectively.
We want your child to receive the absolute best care possible. And we want you to understand why we are suggesting specific treatments. And we want you to know what to watch for should any complications arise or what to do if treatment is not working as expected. But we do need your help from time to time to keep us in check as we improve our own communication skills.
All right, the topic of our Plain Language Edition of PediaCast this week is your child's mouth and throat. So we're going to explore choking, swallowing objects that are not food, which children sometimes do. Teething, tooth pain, sore throat, and thrush which is a fungal or yeast infection inside the mouth. All of this is coming your way shortly.
Before we bring our panel in and get them connected to the studio, just a couple of quick housekeeping items for you. Don't forget, you can find PediaCast wherever podcasts are found. We are in the Apple and Google Podcasts apps, iHeart Radio, Spotify, SoundCloud, Amazon Music and most other podcast apps for iOS and Android. If you like what you hear, please remember to subscribe to our show so you don't miss an episode.
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And, of course, we have a Contact link over there at the website. Just click on that if you'd like to suggest a topic for an upcoming episode of the program. Again, that's over at pediacast.org.
Also, I want to remind you, the information presented in every episode of our podcast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you have a concern about your child's health, be sure to call your healthcare provider.
So, let's take a quick break. We'll get Dr. Mary Ann Abrams and Dr. Alex Rakowsky connected to the studio. And then, we will be back to talk about your child's mouth and throat. It's coming up right after this.
Dr. Mike Patrick: Our Pediatrics in Plain Language Panel is in the house once again. You'll recall that Dr. Mary Ann Abrams is an assistant professor of Pediatrics at the Ohio State University College of Medicine and a pediatrician with Primary Care Pediatrics at Nationwide Children's Hospital.
Dr. Alex Rakowsky, also an assistant professor of Pediatrics at Ohio State and a pediatrician with the Olentangy Primary Care Clinic at Nationwide Children's.
Let's give a warm welcome back to our friend, thanks both of you for stopping by again today.
Dr. Alex Rakowsky: Hi, Mike. And thank you.
Dr. Mary Ann Abrams: Hi, Mike. Great to be here.
Dr. Mike Patrick: Great to see you guys and your smiling faces. We are doing this virtually but no masks since we're on video screens with each other. And so it's great seeing both of you.
Mary Ann, let's start with you. Remind us exactly why plain language is important.
Dr. Mary Ann Abrams: Well, thanks, I think about this all the time, frankly, and especially when we're getting ready to do one of our podcasts, and why we're doing it. It's just so important that I think it's something that we take for granted.
And I have to point to COVID. I think it's such a great poster child if you will for why it's so important that we use plain language or everyday words that people understand and use in their common everyday conversations at home or with their families. Because health information in particular is very important to really understand so that you know what to do and how to do it for yourself or for your family.
And example after example, I think comes cascading, just pouring out about so much confusion around some of the terms that are now in everyday use around the coronavirus pandemic. And some of this are almost now common everyday words, but there's still a lot of confusion.
And now, we're talking about words like vaccine efficacy and herd immunity and antibodies and neutralizing antibodies and variance. And there's just so much confusion in these words that most people maybe never even heard of two weeks ago are now front and center on the news, in the papers, on their social media accounts.
And we have to remember that not everybody speaks this language day in and day out but these words have meanings outside of the health world and we need to communicate really clearly what we mean and what these words mean because it's important.
And I think that the flip side of this is when people really need to understand and want to understand, don't be afraid to ask. We talked about a technique called teach back that we want all of our healthcare providers to use. Which means that when I explain something, I then say something like "I want to make sure I did a good job being clear. To make sure that I was clear, can you please explain that back to me in your own words, so can make sure I did a good job."
And what I would like to encourage people to feel comfortable doing is to say, "You know, this is what I heard you say, Dr. Smith. Let me go through it and you tell me if I got it right." In that way, if Dr. Smith doesn't ask you to explain it back, you have a chance to explain your understanding and then Dr. Smith can correct it or say you got it.
So that's my little extra tip today in the face of some of those complexity. Don't be afraid to sort of put it out there, what your understanding is and confirm it. Make sure you got it right.
Dr. Mike Patrick: Yeah, I think that is so important and as providers and clinicians, if we take the time to really incorporate that into each and every one of our encounters, not just to say, "Hey, do you have any questions?" And they kind of shake their head no and you're out the door, is really take time to make sure that they've understood exactly what you said. And anticipate what questions they may have, and maybe even suggest some questions that they may have for you before you walk out of the room.
I just want to remind everyone that we are going along with the book called What to Do When Your Child Get Sick? That's why we're talking about the mouth and the throat today, because it's one of the chapters in that book. It's from the Institute for Healthcare Advancement. They are a non-profit organization. We actually have a 40% off discount code for this book. It's POD719, and we'll put that in the show notes with a link to how you can get the book.
But it ends up like being $7 and some change. And it's just a really good, well-written plain language book for parents and it talks all about your child's health. And that's what we've been kind of following along within our series.
Also, I want to remind you that we have a survey. It's our Pediatrics in Plain Language survey where just want to get your feedback on how these episodes are going for you, if you're enjoying them, not enjoying them, suggestions for how we can improve. And that's available in the show notes for this episode over at pediacast.org as well.
And then, we have our Pediatrics in Plain Language playlist over on SoundCloud and really all of the episodes that we've been doing on Plain Language can be found grouped together there in a playlist. And we'll put a link to that playlist in the show notes. But we've talked about your child's eyes, their ears and their nose. And now, we're going to talk about the mouth and the throat.
And one good place to start with that is choking because kids do tend to put little things in their mouth. That's one of the reasons you have to really watch you kids and when they're playing and watch what they have access to. But Mary Ann, tell us why choking, why is that an important consideration?
Dr. Mary Ann Abrams: Well, choking is important because it can be a life or death situation. Either you can maybe choke if you're drinking some water or a toddler might choke if they're drinking a little cup of milk or juice or something and kind of cough a few times and they're fine.
However, choking is also can be, like I said, a life-threatening event. And especially, for little kids, for a couple of reasons, as you said, it's normal for young children in particular to learn about their world by moving them round with their fingers and hands and then putting them in their mouth. That's just normal development of young children.
So a lot more things are going to go in their mouth, then hopefully would go into one of our mouth. And also, everything is so exciting and new and noble and different. So it could be bright, it could be rolling, it could be a bug for that matter, but it's whatever it is that they want to explore.
So they put it in their mouth, or they're eating, and something that they're eating is too big or too hard. And their little mouth and their little throat are small. And it's very easy for something to get caught in the back of their mouth and throat. And because that size is so narrow, and whatever that could be, whatever's in their mouth, it can get stuck there and block off what's commonly called the windpipe, the larynx and the trachea that lead to the lungs and help them breathe.
And then, the other thing, to cough that out which is the normal body's way of protecting against choking, we cough and gag and cough when we choke, it takes some force in your chest, in your lungs, to generate enough air to cough that out. And a little child may not have that much air or force to cough it out or to be able to kind of hold their breath enough that they can sort of cough it out consciously the way maybe an adult might.
So it's a real hazard for children and as we know, if you don't get enough oxygen, that can lead to very serious consequences.
Dr. Mike Patrick: Absolutely. So you basically plug up the hole with an object and then air can't get in. And you're not able to get oxygen, we're not able to breathe out the waste products, the carbon dioxide that we normally breathe out and those start to build up in the blood. Then your heart rate drops and you can pass out and death ensues next. And so this is a very serious thing.
So obviously, we want to prevent choking. What's the best way to do that?
Dr. Mary Ann Abrams: I always like to think of just being on a hyperalert, always thinking about and looking for hazards, which some sort of like a negative way to live. But think of it as a positive because every time you find the hazard and do something about it, you're maybe saving someone's life.
So kind of put yourself in the shoes or in the booties or on the hands and feet of a toddler and look around on what's laying on the floor and get it out of their way. Think about what age they are and how well they're able to drink and eat and chew their food. And there are a lot of guidelines about what foods are appropriate and what to and not to feed young children.
Some of the highest risks foods are small little round things that people tend to think, "Oh, that's just the right size for the baby." Well, it's the right size to plug up a baby's windpipe, right?
So a little hotdog cut like a coin is very dangerous. Peanuts are so easily breathed in. They can get stuck in the windpipe and really has a lot of problems even if you don't choke right then. Grapes, other nuts, things like that. So thinking about the right foods to feed the child and how and where they eat. They should be sitting down in a high chair or a table, not walking around, eating out of a bag of chips or something like that.
And then, also watching what others give children to play with or to eat or to entertain them. A lot of people, if they haven't been around children for a while, don't think about it that way. Or they don't realize something can come apart or that things can come out like batteries or small parts.
And I think the packaging in stores is pretty good nowadays that talks about small parts. But sometimes, those labels are hard to read or people skip over them or don't pay attention to them. So those are I think some of the ways to really look for hazards and get them out of the way or don't let them be there in the first place.
Dr. Alex Rakowsky: Mary Ann, if I can just add a couple situations that are at higher risk. And we're all senior docs here, I hate to put it that way. But we've all had 20+ years of experience and we've seen our fair share of choking.
And one of the more common places is a child in the back seat where mom or dad are on the rush to drop off all the kids at school. And there is junior sitting in an inappropriate car seat eating breakfast. Then, all of a sudden, they turn around and the child is choking. So that's something where really avoid eating in the car unless there's somebody watching that child.
Number two, you mentioned a family meal sitting in a high chair. Just basically turn off TV, turn off radio. I don't think anybody listen to radio much anymore, but TV computers, having the dog running around, really try to keep food in the table clear just for eating.
And then, the one I think I've seen the most disastrous were family events where people are very guarded with your child all the time. And also, you're having a Fourth of July party and little man goes and gets himself a hotdog when he shouldn't or somebody should be watching him. And then they gagged.
I've seen that a dozen times where it was like very well-intentioned, good family who did everything right for their child but had that one picnic where people lost sight of their child or the kids. And they're expecting a seven or ten-year-old to basically monitor this one child.
Again, I think picnics were something that was such a high risk, just keep an eye on it. Don't stop picnic, especially now with COVID hopefully ending, we all need our picnics and family events. But just to be really careful during those times.
Dr. Mike Patrick: And balloons can be a particular problem like the latex balloons that pop and get little fragments. And I've seen kids who choke on those. And then, but the Mylar balloons, kind of the foil ones are going to be a little bit safer compared to the rubbery stretchy balloons.
Dr. Mary Ann Abrams: Alex, I think your point of whether it's a picnic or a family event or whatever, that's such an important point, to kind of think about even ahead of time because the issue with that is everybody thinks somebody is watching them. And nobody is watching them because everybody thinks somebody is.
And they're having fun, whether they're at a picnic or just playing at the backyard or whatever, if they're eating and running and playing. I remember a child with those little butterscotch hard candies or any hard candy, peppermint or whatever, perfect size. And this little one was just kind of walking along and suddenly, really it was very worrisome.
And this is kind of a good lead and I think to what you might want to talk about next, Mike, is what you do. Fortunately, this little one was okay. But boy, walking around and eating and running around and eating in those crowd situations are hazardous situations. We talked about situational awareness. That's kind of a good example of being aware of the circumstances or the situations that can lead to a hazard.
Dr. Mike Patrick: Absolutely. And I'm glad you brought up the hotdog thing, too. So not the coins, slice them in coins and then cut them the other way, right? So that they're a little, what do I want to say? Crisscross, cut the coin, so you'll have four little pie-shape pieces of hotdog, all right?
Dr. Mary Ann Abrams: Tiny.
Dr. Mike Patrick: Tiny. Very small. Okay, you mentioned what do we do if our child is choking?
Dr. Mary Ann Abrams: So it's pretty scary. And I think there's a lot of reflex action that people tend to take because, usually, if somebody starts to choke, most of the time, they're kind of coughing and gagging. And I think so many people wanted to start patting you or pounding on their back. And that's actually really kind of dangerous because you might be throwing off their ability to kind of cough it out on their own or maybe even pushing it, jostling them enough that it moves further down instead of coming up.
So first thing is if someone is coughing or kind of gasping or able to kind of, I'm choking. As long as they're moving air, those are all signs that they're still moving air, kind of keep a really close eye, but let then kind of manage it. Because a lot of times, even those little ones that I told you about, the butterscotch candy, they were able to cough it out. It took a couple of seconds but they coughed it out.
So really watching close and be prepared if they no longer can make any noise or they start to turn blue or really look like they're in distress. And then, depending on whether it's an infant, you manage it just a little differently than if it's a child or an older person. So an infant, we tend to hold them face them down in our arm, face down and give them four or five really hard, harder than a pat, really pound their back to kind of knock that loose.
Then you can put them over and do four or five chest thrusts, making sure their head is lower than your elbow. So that they're pointing down and getting gravity on your side. So you're basically trying to do that push from the back or from the front. You don't want to stick your fingers in their mouth trying to reach something unless you can see it. But you keep repeating that and call for help or have someone else call for help.
And if it's an older child, especially you can't really hold them in your forearm the way you can an infant, if they're awake, you can bring your arms around them, and pulling inward and upward in their upper abdomen. Or if they're on the ground, you can straddle them to push up on their upper abdomen, lower chest to try to push that out.
Dr. Mike Patrick: So this is one of those instances, and we hear about the Heimlich maneuver. And it's sort of hard to describe what that looks like in a podcast. I would recommend that folks, really, you want to be prepared and you want to know what to do if your child is choking before it ever happens. And a great way to do that is to take an American Red Cross training class.
And there are online options available where the entire class is online. And it talks about in the class, adult, child, baby, first aid, CPR, how to use an AED. And they're only like $35 for an online class. I'm going to put a link in the show notes for this Episode 484 over at pediacast.org to the American Red Cross training classes.
But I will recommend if you're a parent, a grandparent, teacher, coach, anybody who takes care of kids in capacity really ought to take an American Red Cross first aid, choking, CPR, how to use an AED class. And again, we'll put links to that in the show notes.
Dr. Mary Ann Abrams: And I would like to encourage parents to have their babysitters do that as well.
Dr. Alex Rakowsky: I was going to say the same thing, a plug for babysitting classes. Two of my daughters actually did a lot of babysitting and Nationwide had a great babysitting class. And so does the Lincoln County Fire Department, the county we live in, where I think it was like ten bucks and a whole day to kind of learn all the emergencies. But choking was like the big thing that they really spend time on. So they made it so much more comfortable.
Dr. Mary Ann Abrams: I was just going to say that, Alex. Just having that knowledge and practicing several times helps you feel more comfortable upfront and it helps you react better if you ever find yourself in that situation. I think sometimes, people are afraid of, "Oh, I don't remember it perfectly,' but you'll remember enough that you can take action and potentially save a child's life.
Dr. Mike Patrick: Yeah, absolutely. Now, a lot of times, kids will put something in their mouth of any age. And then, we know if it gets to the back of the mouth, that the natural thing to do is to try to swallow it. We just have a reflex of swallowing. And so a lot of kids will swallow things that are not food, that they should not have had in their mouth to begin with.
What happens, Alex, when a child swallow something that's not food?
Dr. Alex Rakowsky: This is a loaded question. So we can probably spend a whole episode on this. So I'm going to start off with the real basic thing where it is so important to know what they have in their mouth or what they swallowed. Because that really changes things around.
I'm going to break it into some categories here for parents to kind of think about or caregivers to think about. But the number one thing is what was put in their mouth or what is the most dangerous thing that could have been put in the mouth. And I have a funny story from urgent care. So just kind of break it down because it kind of makes a difference as far as what you're going to do.
So there are sharp objects. So there are sharp objects, so a toothpick, a piece of wood, staples. I've actually seen kids swallow staples, I don't know why. But essentially, sharp objects, you worry about something puncturing. So that's the first type.
Coins, I think is still the number one thing non-food related things swallowed by kids outside of medicines. And then, there's a sort of track to follow for coins. There is you small in between stuff like Barbie shoes which I stepped on in the middle of the night. They really hurt. Barbie high heels do hurt.
Lego pieces are one of the most commonly swallowed things. And I love Legos, and I really kind of promote it for kids to kind of learn. When you have an older child and getting little pieces, one of the little brothers and sisters cannot swallow it. And then, another path that you kind of follow there.
The fourth one, getting into some of the more scary ones here and harder to kind of figure out, oils like kerosene. We're in the middle of winter here. People aren't going to use as much kerosene as they used to but they may use it in the room because it kind of warms the room a little bit or kind of gives you that nice glow in the house.
But they come very nicely packaged and nice colors and flavors. And people use kerosene because it smells nice so kids want of course drink it. Tiki torch liquids, vaping solutions, liquid CBD or marijuana, again, CBD or liquid marijuana, can all be sort of liquid that get swallowed. And you really treat them a lot differently, let's say, compared to other things. So it's really important to know if they swallowed that.
Fifth category, some of the medicines, so if your grandma's missing medicines or there's some medicine the child has contact with, it's like imperative, really really important to know what it is. There are some medicine that can kill a child with one pill. Suboxone which is sort of like a long-term opioid that a lot of people take for opioid addiction or those who struggle with opioid addiction. One sublingual or underneath the tongue pill can actually kill a child.
The Hilltop clinic where I still work like one evening a month, and Mary Ann used to work has one of the highest opioid addiction rates in the country. There's a lot of grandparents that struggled with this. And the kids go through their houses and there may be some easy-to-take Suboxone there. So the meds are really really important.
Multivitamins of iron, like chewable multivitamins of iron. The iron can actually give you problems.
And then, the last thing we're going to bring up are magnets and button batteries where they have their own sort of ways you're going to treat them.
So before we get on to the next question, I do want to give a funny story because it makes a difference now what you're given. So I was in urgent care, I was about to leave and a mom comes running in, said, "My child's swallowed ten of these little yellow pills". And she showed a picture of these yellow pills. And she's like, "My mom, grandma, takes something similar for her blood pressure."
So now, we're suddenly looking at what she could have swallowed. And we looked it up and it could have been, it was a betablocker. So this could have been a two-year-old child could have gotten some major trouble.
Now, we're about to rush him down to the ER when dad comes running off with a plastic bag with the remnants of what he found on the floor. And there were no numbers on it, there was no name it. So we sent it to the pharmacy like, "What is it before we jump down the whole protocol for a kid who may have a beta blocker on board?" And we've got an IV and we got everything running just in case. And they called back and said it was generic Tic Tac.
Dr. Alex Rakowsky: Generic meaning they're not prescription. So they were essentially, not TikTok, which is the silly movies, but Tic Tacs like the little mints and they got it at the Dollar Store. And they looked just like grandma's blood pressure medicine.
So we saved the child an admission to the ICU. But again, it made such a difference just knowing what you had to work with.
Dr. Mike Patrick: Absolutely. And it's just again paying attention to what's going in inside the kid's mouth. By the way, I played that noise because you used the word beta blocker.
Dr. Mary Ann Abrams: Yeah.
Dr. Alex Rakowsky: Oh, it was because of generic.
Dr. Mike Patrick: Yeah, beta blockers, it's not plain language.
Dr. Alex Rakowsky: It is an anti-hypertensive. No, kidding. It's a blood pressure medicine, yes.
Dr. Mike Patrick: Anti-hypertensive. See how easy it is for doctors to let this stuff just slip out. We don't even think about it. You know what I mean? Okay, so blood pressure medicine.
Dr. Mary Ann Abrams: I think that's good thinking about that. It's like, well, sometimes, adults take maybe two or three times a day with the same medicine. And it's safe, so why is it such a big deal with the little one took three or four them. But it's an adult medicine with powerful medicine in it that's put in there to address a health issue for somebody with the weight and the metabolism, the way the body runs for any grown-up. So that dose that's fine for an older person, a bigger person or someone who's been on a medicine for a long time can be very dangerous for a small child.
And also, the same dose can be hard for, we're getting a little bit as far off the field here, but someone who's been taking medicine for a long time can take a higher dose perhaps because they built up a tolerance. Whereas somebody, same body weight, same size might have a real problem taking much of a dose up front the first time.
Dr. Alex Rakowsky: We live in a town called Grandville and I was talking to one of the pharmacists there who I know pretty well. And he brought up something interesting because we were talking about the Suboxone which you all was going to bring up where he's like it's so easy to administer now because it's for people who do struggle with opioid addiction, that they want to make it as easy to administer as possible.
Then he's like, "Looking back to what I kind of handed out to people today, almost every single pill would not gag a child." In other words, they're all smaller now. It's like a lot of them have cool colors, a lot of them were shaped like candy." He said, "You don't even think about it," but he said, "And none of them will get stuck in the throat. They're not big hotdog size, not the little quarter piece hotdog size."
And he's like, "Yeah," 20 years ago, when he finished pharmacy schools, there were a lot of medicines that were larger and easier. It was harder to swallow them. It's like the vast, vast majority of some dangerous drugs for kids were so easy just to grab a handful and to swallow them. We tend not to think about it. And they've done it to make it easier for adults to swallow. But there may be one reason why I think we're seeing more of the toxicities now, just because the side effects from this is because the kids can get to them a lot easier.
Dr. Mike Patrick: For any chemicals, all these things that you've mentioned that aren't solid object but they are chemical related, drug related, it's going to be really important to know the phone number for the Poison Control Center, 1-800-222-1222. So wherever you are in the country, that's going to get you to your local poison control center.
And of course, if you're really concerned, or your child's having difficulty breathing or is not acting right, you just want to call 911 and get help right away. But the Poison Control Center line, here's a little ditty on the number you need to know. And put this in your smartphones.
[Start of Jingle]
Lyrics: 1-800-222-1222, 1-800-222-1222. If you think it might be poison, then the first thing you should do is call 1-800-222-1222.
[End of Jingle]
Dr. Mike Patrick: Okay, so you'll be singing that the rest of your day. But 1-800-222-1222, that's what you do if you child swallows pills, chemicals, whatever.
Let's focus in on like the Lego pieces, so solid objects. What should parents do if their child swallows one of these things.
Dr. Alex Rakowsky: So a lot of it depends on how they're acting. And if you have problems where the child's gagging, salivating, or has saliva coming out of the mouth. Looks like they're choking, or sometimes complaining of sharp pain in the middle or towards the belly. Four hours later, they're now saying, "My belly hurts." May have like a bloody stool. That needs to get seen.
Especially the first exams need to get seen urgently because that means that something might have been stuck in the food pipe or the esophagus. So you look for sort of signs that there's something blocking. Just because it gets in the stomach doesn't mean that you're sort of scot-free.
I've seen a child who's swallowed a bunch of staples and had no gagging problem. And then, mom noticed that this child have really bloody stools and we got an X-ray. And there's like a whole gutful of staples. She was the pulling the mail, the staples will fall in the ground, this kid will just eat them. And I don't know why, but he's a toddler, so they do that kind of stuff.
So a lot of it is like the urgent symptoms where you got to bring him in compared to something less urgent, but just to be aware that we need to kind of follow them along.
If they're having problems breathing, don't be a hero, call 911. I mean, I think that's the rule of thumb. It's like the same thing with calling Poison Control. If there's anything dangerous in the house, let them know. Because you really want to cover the worst-case scenario.
Same thing here, if you swallow something and that child is having problems breathing, gagging, things like that, call 911. Get them involved. They can handle things a lot better than trying to drive a child on the highway while you're looking back all the time to see what's going on.
Dr. Mike Patrick: And what about the kids who swallowed something and don't have any symptoms at all, which is what more often than not, that's the case? What do you do in that situation?
Dr. Alex Rakowsky: A lot of it is I have a hunch that every child has swallowed something that we don't know until later on. I've seen kids in urgent care who had green stools and then mom's like, "We're missing our green Crayola crayons." Orange pieces, "And we didn't have any carrots, but yes, we have orange Legos in the house." And sure enough, you'll find a Lego on the stool.
So a lot of times, these will just pass through. So you're looking for damage to the gut. So damage and breathing to begin, stuck somewhere, cause of pain, other symptoms, and then you're looking at damage to the gut, where bloody stools, severe constipation for a child who doesn't have constipation, usually. Belly pain, where there's some sort of like sign or clue that there's some kind of blockage going on or some kind of damage to the gut lining. And those are things that you're really looking for. So in like two weeks later, you can have some damage still going on the gut.
Dr. Mike Patrick: So just kind of watch their stool and see if it will probably pass through whatever it is that they did eat. Coins can be an issue, especially the larger coins like quarters sometimes will have difficulty getting out of the stomach. But again, in that case, you're going to have upset stomach, vomiting, those sorts of things.
Some things will show up on X-rays so you can kind of get an idea of where it is. Not that you need an X-ray on a regular basis till it comes out. But if there are questions or concerns, some things will show up on X-ray. Other things won't.
Probably your best bet is just give your doctor a call. Let them know what your child swallowed and they can give you the right advice for your kid, dependent upon what exactly that is, whether you need to be seen or get an X-ray or just sort of watch for symptoms to develop.
Dr. Alex Rakowsky: And also, I want to bring up the embarrassment part, speaking as a parent here. And the three of us are all parents. Where you're thinking is, "I'm going to call the pediatrician something really stupid like my child just ate three Barbie shoes. And she'll never look at me the same way."
Every child has probably done this. Every family probably has a funny story. But I think the parents should not be embarrassed about or grandparents or babysitter that this could have happened. And the same thing goes in medication. You have something illegal at home, lead poison control knows. You got to get over the embarrassment.
Some of the worst disasters I've seen in urgent care were parents who were like, "I'm not sure what it was," and then later, child's in the ICU, says like "Oh, by the way, it was no, look at marijuana." And all of a sudden, you look, you're like "Okay, that makes sense about what happened to this child."
Dr. Mike Patrick: Absolutely. And then, you mentioned button batteries and magnets. Tell us why those are such a concern.
Dr. Alex Rakowsky: So button batteries are the ones that you find in a lot of toys, watches. A lot of the electronic devices will have this almost a two-millimeter round sort of button batteries. And those things are designed to produce a charge. And our body has charges, and we have electrical systems in our body.
Dr. Mary Ann Abrams: Charge?
Dr. Alex Rakowsky: Charge means you have like a battery.
Dr. Alex Rakowsky: I don't know about that. I think…
Dr. Mary Ann Abrams: Like a little electric…
Dr. Alex Rakowsky: I want you to do a better job describing charges then, yeah.
Dr. Mary Ann Abrams: I'm trying.
Dr. Alex Rakowsky: So it was like a…
Dr. Mary Ann Abrams: Electric charge to make energy, to make things run.
Dr. Alex Rakowsky: Yeah, so sounds like a little… So you can actually get something in your food pipe or the esophagus and has water in there. And water actually has a natural charge. And then, all of the sudden, the batteries like "Oh, I'm in my little socket," and as far as producing electricity. And that can actually burn through an esophagus.
So button batteries are really dangerous. So some of the recent recommendations is to give your child honey. So you give a teaspoon or two of honey every ten minutes while you're taking that child to the emergency room. And then, the GI docs, they can pull out button batteries out.
And then oh, I'm sorry, go ahead.
Dr. Mike Patrick: When we've talked about this on this program before, the honey thing just coats the inside of the esophagus and is protective, but it washes away pretty quickly. And so you do have to keep giving it. But then, you want to be getting them in right away if you suspect the button battery that they've swallowed. And then magnets?
Dr. Mary Ann Abrams: It doesn't take away the hazard.
Dr. Alex Rakowsky: Yeah, you're buying time, you're basically buying time.
And then, the little magnets actually, and there's some of those magnets that kids will use for various arts and crafts. So you'll see like little magnets that you can put on a bulletin board or on a steel refrigerated, magnetic refrigerator. Since a lot of refrigerator don't have metal on anymore.
But those things are powerful and they can actually move down at different rate. So now you have a magnet at one part of your gut attracting a magnet on the other part of the gut. And now that skin gets kind of pinched in and you could have damage. I saw a case of a child's severe abdominal pain. And the exam, he had what looked like a perforated or ruptured abdomen.
And ended up having ten magnets. And five magnets were from the day before and five magnets were like a week before. And they were trying to attract themselves and they basically ruptured his gut in the surgery.
So it's something to really be aware of. And those magnets are in a lot of things that you don't even think have them. They are dangerous and if you suspect your child have them, that's something you just go to the hospital. It's not 911, but go to the hospital.
Dr. Mike Patrick: Yeah, not a great toy, especially those rare earth magnets that are really strong. They're small, just the right size to swallow, definitely keep those away from young kids.
Dr. Mary Ann Abrams: And they're sometimes designed to look really cool on a desktop. So again, they look really cool and attractive. So that can draw a child to it. And then, there's also some kids who have behavioral problems that they do eat things that aren't food or just do that for a variety of reasons. So it's not even just came across something.
So again, maybe a parent would know that, if their child has that kind of a health condition. That make sure that other family members or someone's watching your child, just watch for that also.
Dr. Mike Patrick: Absolutely. And teenagers, too, you think "Oh, my teenager is fine with these magnets," and they may be. And they are kind of fun to play with. But they really need to know, hey, this can be life threatening if you swallow this so don't put them in your mouth.
Dr. Alex Rakowsky: Speaking of teenagers, one last thing, before we jump to the next topic, so I'm not saying that we should keep up with every TikTok challenge or every YouTube challenge. But there had been some silly ones through the years. Like drinking high concentration peroxide and see what happens. Or drinking something that can burn your esophagus.
So teenagers can do these things as well. And again, it's an embarrassment. I'll say, "Why are you frothing at the mouth? I know you don't have rabies." And then like, "I don't know." And then you have to like, "What did you look at? What did you drink?" And again, a fair number of disasters I've seen were a teenager were involved with some kind of either prank or some kind of challenge. And just again get data, get data and figure out what they drank.
Dr. Mary Ann Abrams: And sometimes, people put things in their mouth just because they like to kind of toss it around their mouth. And they are surprised or startled or gasped or whatever and swallow it by accident. And it was never intentional, and it was something that seems no big deal, so they don't even mention it to somebody. And then, depending on what it was, it could be very dangerous, especially if they're like, "What could these little cute magnets do?" So not mentioning it, not realizing it.
Back in the day when people sewed their own clothes more or other sewed thing, you tend to put a bunch of straight pins in your mouth while you're pinning things. And it's a lot of times people would inhale those straight pins. So it could be perfectly normal behavior that can lead to those things.
Dr. Mike Patrick: Yeah, and of course, as parents, if you're doing that sort of thing, you're modeling that for your kids. And so a young child sees that you have the needle in your mouth and they find a needle, and that's where it goes. So you have to be careful about that for sure.
So talking about teenagers here, let's move to the far other end of the spectrum and talk about little babies and teething. That's another in the mouth that comes up often. What do parents need to know about baby teething, Mary Ann?
Dr. Mary Ann Abrams: They basically need to know that it's normal and healthy and it means your little baby's growing up just fine. I don’t know, teething's just kind of a bad name maybe. Babies start to get their first tooth around six months. And sometimes, I think it probably is irritating and sometimes no one ever realizes they're having teething.
If your baby seems a little fuzzy and maybe they're drooling a little more, but otherwise they're fine. If you take a look in their mouth, then you should look in their mouth off and on anyway. Just so you kind of know what their little mouth looks like. And then, one day, when they're a little fuzzy, and they're drooling a bunch, and you're like, "Oh, my goodness, he's getting his first tooth. There's a little tiny little sliver of white there. A little bump."
And so, it that's annoying, there used to be lots of remedies and medicines and I think less is more. So sometimes, if you think they're bothered, you can wash your hands and kind of just gently massage that are or rub a little something on it. Take just a plain wash cloth and put really cold water on it and kind of gently dab that area and maybe let your baby kind of gum it a little.
There are teething rings. As long as they're kind of solid and putting those in the freezer, keeping them cold can kind of make them feel a little bit more comfortable. And if they're really uncomfortable and there's nothing else that appears to be bothering them, they're not sick with some other symptoms, a little dose of Tylenol, acetaminophen could maybe help them sleep through the night if they have a little trouble with that.
Does teething cause a fever? I think the general consensus is it doesn't cause a fever, at least not to the extent that it's the kind of the fever that makes you worry about the child. So if your baby has a high fever, I wouldn't write it off to teething. And if they are teething, I wouldn't just assume they're going to have a fever.
Dr. Mike Patrick: Absolutely. Because babies get fevers for a lot of reasons and they're all teething at the same time that they get those. So just because something is related to something else in time doesn't mean that the one thing caused the other for sure. Very important concept there that association does not equal causation.
Dr. Mike Patrick: I'm just going to move on from that one.
Dr. Mary Ann Abrams: Well, two things being related to each other doesn't mean one made the other happen.
Dr. Mike Patrick: Yeah, which oftentimes, we talk about with vaccines.
Dr. Mary Ann Abrams: Yes, there you go.
Dr. Mike Patrick: So kids get a vaccine and something will happen. And it doesn't mean that the vaccine caused that thing to happen. It probably would have happened anyway.
I also wanted to mention with teething, you definitely want to avoid topical pain killers that have benzocaine in them, so things like Orajel, Anbesol, other brand names. That those are not safe for kids and they can result in a condition called methemoglobinemia which I'm going to explain. That's just a blood condition that also causes some oxygen problems.
And so, it's really not a safe thing to use in children. And then, even the herbal remedies, there are some of those like highlands teething tablets that the FDA has had warnings about in the past that can contain belladonna, which is a chemical that is in the plant deadly nightshade, which just right there, it sounds pretty bad, right, deadly nightshade?
So not something that's good for kids. And so you really want to avoid any topical remedies to put on their gums, really, the cold is the best. But not ice itself directly on the gums, but cold water, cold wash cloth like you've mentioned. And of course, some Tylenol, acetaminophen if they are seeming pretty uncomfortable.
But you know, babies are fussy for a lot of reasons. And older kids also have teeth that come in. And those older kids, you don't really hear about them complaining of their adult teeth coming in. I mean, maybe a little bit of a discomfort but we can sort of use them as an example of what the babies are probably going through. And it's really not as bad as it may seem for sure.
Our next topic was going to be routine toothcare. And because we're running a little short on time, I'm going to breeze by that. But I do want folks to know we have a fantastic trio of podcast that we did with our Chief of Dentistry here at Nationwide Children's Hospital, Dr. Janice Townsend. One on infant teething and toddler care, that was PediaCast Episode 423. Toothcare for Kids and Teens, that was Episode 439. And we also did one on dental trauma and emergency toothcare, that was Episode 429.
So if you're really interested in learning more about baby child and teenager teeth, please do check out those podcasts. And I'll put links to them in the show notes. So folks can find them easily over at pediacast.org for this episode, 484.
So let's move on to we're talking about the mouth and the throat today. Sore throats are pretty common. Alex, what do we need to know about sore throats?
Dr. Alex Rakowsky: So just like the swallowing issues, a lot of it depends on other factors. So sore throat can be a sign of an infection, so if it's a sudden sore throat with fever or you have a lot of congestion or runny nose and a low-grade fever and a sore throat, then think more of an actual issue with an infection, I'll get to that in a second.
If you have seasonal allergies, you're outside in the spring and you have a runny nose, sore throat and not just some post-nasal drip from your allergies. So if you don't feel sick, except for the allergies, again it just can be from that. Or it can just be from dryness where especially now, it's been a cold week here in Columbus. And it's supposed to get even colder where the force here, at least here in the office at Children's, is just pounding away.
And it's dry in the office. So you almost have to like keep your mouth moist just because you're trying to get some of the dryness away. And just having like the winter dryness can give you a bit of a sore throat, you don't feel sick, but you feel there's a little bit of a tickle back there. And then, thrush which Mary Ann's going to get to later on here.
So if you think it's something infectious, majority of them are still going to be viruses, but if there's a severe sore throat, high fever, belly pain, child is not eating, you're worried about strep throat, you're worried about an exposure to strep throat, get seen by your doctor or urgent care.
And if it's less of a cold presentation, more of a just sort of throat and fever, then it could easily be strep throat. So definitely get seen for that. But again, the vast majority of sore throat are not going to be strep throat, but that's the one you can actually do something about.
Dr. Mike Patrick: Yeah, very important. And any severe throat pain or difficulty swallowing, drooling, maybe it's really painful to open the mouth wide enough to be able to eat. And those are things that you definitely want to be seen for. Because it may not just be the back of the throat. I mean, you can have a pus collection around the tonsil called a peritonsillar abscess. You can also get infection that goes back even deeper called the retropharyngeal abscess. So deep infections in the throat.
So when you have pain that's sort of out of character for your child, they're not eating, drinking, they're drooling, make sure you get them seen right away for those kinds of severe sore throats.
So how do we differentiate a viral sore throat from strep throat? Because we treat those differently, right?
Dr. Alex Rakowsky: Yeah, so if you think it's going to be an infection causing the sore throat. It's not allergy, it's not irritation, you think it's just an infection. There's going to be a good chunk of them. The most common viruses tend to have runny nose, some cough, not all. Potential fevers, but they tend to be more what we call your typical cold symptoms. More like ask any parent they can describe, "When my child has a cold, this is what I usually see."
Compared to sore throat that will not have the congestion, it will have belly pain pretty commonly, will have a headache pretty commonly. So that's one way to kind of tell the difference between the two.
Also exposure, so everybody at home has a head cold, and all of a sudden, your youngest gets a sore throat and a head cold, just probably going to be a head cold. But if somebody in school for example had strep throat or someone in the basketball team has strep throat, now your child has less of a virus appearance but having a sore throat and fever, then think more strep throat.
The only way to really tell is to actually do what we call a rapid strep test. And it's like good 95% of the time. Well, now, we have one that can test both. But call urgent care or your clinic just to get tested for that.
Dr. Mike Patrick: So before you diagnose strep throat, you really want to test to show that it is strep throat because there are viruses that can also make throats look like someone has strep throat. And those, we don't want to treat with antibiotics. Really, only strep throat is the one that we want to treat.
Dr. Alex Rakowsky: Yeah, I like researches. I just teach the residents a lot about just looking at research, and there has been sore throat studies done since the 50s. And we've gone through several strep throat epidemics where they actually just went and just everybody got a rapid strep test during a "strep throat epidemic". And it's still usually, it's around 80% virus, 20% strep, and even during epidemic, it will still be the majority and there's still going to be viruses.
So you don't want to overtreat, so just calling your doctor and saying "My child has a sore throat, I need an antibiotic." You're probably not needing antibiotic eight out of ten times. Or in the middle of a strep throat outbreak in your community, probably half of the time, you don't need it.
And we think of antibiotics as being safe, but they can give you side effects and then it can give you some resistance. Now, we really try to avoid that. And now, with urgent cares, the thing's open really late. It's pretty easy to get seen and tested.
Dr. Mike Patrick: Yeah, great points.
Dr. Mary Ann Abrams: Other little things sometimes was the lymph nodes in your neck, the glands, they can tend to be swelling with the virus or with strep or bacteria that I often find that with strep, they're a little tender. And if you're used to kind of checking your own neck, you can sort of feel when those lymph nodes are bigger. But if they sort of hurt when you push on them, that's another reason that you might want to have your child checked and tested for strep.
Dr. Mike Patrick: And the reason that we get concerned about strep versus a virus is that strep that's not treated can lead to something called rheumatic fever which we don't really see as much these days as we did in the past. And there's some various reasons that people think why that one could be a different strain of strep that's around now, that maybe doesn't cause rheumatic fever as much other strains did. But it's still a possibility, we do still see it from time to time.
And rheumatic fever is caused when your body's immune system that's supposed to be fighting the strep then starts to attack other parts of your body including your heart down the road. And so, by treating strep, that can avoid that from happening.
And then, another term that gets kind of confused with all of this is scarlet fever. And scarlet fever is really just strep throat with a rash associated with it. Because the particular strain of strep is making a chemical that causes this rash to happen.
And that's another one of those, long time ago, scarlet fever was considered very dangerous. And again, we think maybe it was because the strains that caused it back them were more invasive and led to meningitis and that sort of thing more often than it does today. So this is just the sort of the evolution of diseases over time. But we still do worry about the possibility of rheumatic fever with strep. And that's why we're so careful when we suspect it, to see if it's there and then to treat it with an antibiotic if it is indeed strep throat.
We've been mentioning thrush. So Mary Ann, what is thrush?
Dr. Mike Patrick: So thrush is the name that we give to like a yeast infection. It's usually caused by a yeast that's called a candida. And in babies, it's pretty common. It's a yeast infection and we call it oral thrush, meaning in the mouth and a lot of babies get this.
And usually, they have little kind of a white, almost little white dots all over the linings of their cheek and sometimes on other parts of their mouth, their tongue, and even the inner part of their lips. But often, you'll see it on their cheeks.
And it's not a horrible serious illness. It's irritating and annoying, but usually and sometimes it's associated with like a diaper rash. They'll have a rash around their bottoms as well, with little red dots that are little pockets of the yeast infection.
So when people see this, you really do, you need a medication to treat it. And probably, the easiest medicine for infants is look for oral medicine that you can kind of squirt in their mouth and point at sort of towards those cheeks several times a day for a week or two, depending on how well they respond to it and how long it lasts.
And then, it's important too, the yeast is probably everywhere in our environment but kind of want to take some steps to reduce their exposure to the yeast. So if they are drinking out of bottles that have reusable nipples, et cetera, you want to sterilize those or boil them or use new ones. Boil or sterilize or get new pacifiers, things like that. And don't share things from one's person's mouth to the baby.
Dr. Alex Rakowsky: I also want to add that I have seen probably a handful of teenagers on steroids that they're taking for asthma, so inhaled steroids. And there's always the risk of having, if you don't rinse your mouth, to get thrush. And actually, I've seen it a couple of times. And the thing with this is it's very painful.
And then they open up their mouth and they see the white. They're petrified that they have it at their age. But you can get it from just being on, a lot of them will need their steroids for various reasons. But if you let them sit in your mouth for too long, you can get thrush as well.
Dr. Mary Ann Abrams: Especially inhaled steroids.
Dr. Alex Rakowsky: Inhaled steroids, yeah.
Dr. Mary Ann Abrams: Through your mouth, and people who are on high doses of oral steroids, and some other medications can have that. And antibiotics can predispose to that as well.
Dr. Mike Patrick: Yeah, especially little babies who may be an antibiotic for an ear infection. And you're not only killing the bacteria that's causing the ear infection, you're also killing the normal good bacteria, good, in quotes, bacteria, inherently good or bad. But you have bacteria in the mouth that the antibiotic kills and then that leaves rooms, space available for the yeast to start growing because yeast, that's everywhere.
And then, another thing, babies sometimes would get milk or breast milk or formula, coating on their tongue as the milk sort of lies down in the grooves between taste buds and in the tongue.
And so, some babies, you'll think it's thrush but it's really just milk on the tongue. And so, that's something else to keep in mind. If the baby is not fussy and the white is only on their tongue and you're not seeing it on the inside of the cheeks or elsewhere on the mouth, it's just on the tongue, then that might just be formula or milk. When in doubt, call your doctor and have them take a look and see exactly what's going on and what's causing the whiteness inside the mouth.
All right, well, once again, Drs. Alex Rakowsky and Mary Ann Abrams, we just love when you guys stop by and visit. Alex, remind us of once again about Primary Care Pediatrics at Nationwide Children's.
Dr. Alex Rakowsky: We're big. So I actually, so I'll leave it at that. So no, actually, we have I think 16, we just got two new clinics. So we have either 15 or 16, depending on what month people are going to listen to this, clinics that cover about 110,000 children in the Central Ohio area, which is a lot. And we also have school-based clinics. We have a mobile van. And we do some outreach clinic as well.
So Primary Care is a big system. Actually, the biggest primary care system that's hospital-based in the country. And half the clinics have residents, we teach residents at these clinics. And half don't, we have some medical students there as well.
So it's a great place to kind of get a lot of cutting-edge sort of up-to-date information because the residents are really kind of pushing us in clinic to keep up of what we know and what we don't know. So it's a nice system, but we are busy, we're big. Our department does a nice job of keeping it all together because it's a lot.
Dr. Mary Ann Abrams: And it's open and safe with COVID, everything is really in place to help people be safe. So don't be afraid to come in if you need to or want to. And telehealth has also created a lot of opportunities to be seen as well.
Dr. Mike Patrick: Mary Ann, really excellent points. We really just learned a lot about how to protect ourselves, how to protect each other from COVID. And so, we certainly want kids to get their immunizations.
And when you have concerns, health concerns for your child, we really do want you to be in contact with your doctor. And then they'll let you know, is this something we can do by telemedicine? Or is this something that's really better suited to come in the office? And when you do come in the office, it's going to be definitely safe and we're ready to see you.
I'm going to put a link to Primary Care Pediatrics at Nationwide Children's in the show notes so folks can find you easily. And if you are in Central Ohio and you need a primary care physician, you can call 614-722-KIDS. That's our Primary Care referral line and they'll be able to set you up with the pediatrician in your neighborhood here in Central Ohio.
Lots of links in the show notes for you this week. We do have that book again, What to Do When Your Child Gets Sick along with the discount code that I had mentioned before. Also, our Pediatrics in Plain Language survey and the play list of all of these episodes that's on SoundCloud, a link to American Red Cross training classes, all of those toothcare episodes that I had mentioned, we'll have links to all of those things again in the show notes over at pediacast.org.
So once again, Dr. Mary Ann Abrams and Dr. Alex Rakowsky, both with Primary Care Pediatrics at Nationwide Children's. Thank you both so much for being here today.
Dr. Alex Rakowsky: Thanks, Mike.
Dr. Mary Ann Abrams: It's great to talk with you both. Take care.
Dr. Alex Rakowsky: Take care.
Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. I really do appreciate that.
Also, thanks to our guests this week, Dr. Mary Ann Abrams and Dr. Alex Rakowsky, both with Primary Care Pediatrics at Nationwide Children's Hospital.
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Thanks again for stopping by. And until next time, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So, long, everybody.
Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.