Management of Infant Crying

This week, I'm highlighting some blog posts that I did for Erin MacPherson's Christian Mama's Guide last year. Some of you may not know but I am a real live pediatric ER RN. As always, these posts are meant to be educational and do not replace a doctor's visit if your child is ill.

Erin has a WICKED sense of humor and is releasing a series of books this spring so I hope you'll keep an eye out for them.

There is nothing that will bring a weary family into the ER faster than an infant who won’t stop crying. This is a leading cause of ER visits for the infant population.

Our approach starts with a good physical exam looking for a source of something that would cause the infant pain. Is there an ear infection? Is there a hair tourniquet?  Did they accidentally scratch their eye? Are they dry and fed?

A hair tourniquet happens when a piece of hair becomes wrapped around a baby’s fingers, toes or penis in the case of boys. They are usually easy to identify because the area distal to the constriction becomes purple from lack of blood flow. Imagine when you wrap a string too tightly around the tip of your finger.

If a hair tourniquet is found and we can see the piece of hair, first we’ll try to unwrap it. If it isn’t embedded into the skin, we may try a hair removal product to disintegrate it. If the hair is deeply embedded, the child may require surgical removal.

A corneal abrasion is a scratch to the eyeball and is quite painful. To look for these in a child, we’ll stain their eyeball with a dye and look at it with a Wood’s lamp in a darkened room. If one is present, generally the child is sent home with an antibiotic ointment for the eye for several days.

If a source of the infant’s pain cannot be found, we’ll generally try soothing measures like oral pain medication to see if that will calm the infant.

If the child continues to cry, a source of infection cannot be found and the baby is also resistant to soothing measures, then the physician may choose to proceed with a spinal tap and additional septic work-up. One reason for an inconsolable infant is meningitis.

If a septic work-up is negative, the infant may be said to have colic.

Were you aware of other sources for pain in the infant like a hair tourniquet or corneal abrasion?

Top Three Pet Peeves of Pediatric ER Nurses

At least my top three!

This week, I'm highlighting some blog posts that I did for Erin MacPherson's Christian Mama's Guide last year. Some of you may not know but I am a real live pediatric ER RN. As always, these posts are meant to be educational and do not replace a doctor's visit if your child is ill.

Erin has a WICKED sense of humor and is releasing a series of books this spring so I hope you'll keep an eye out for them.

Here’s a look into the mind of the pediatric ER nurse. Don’t we all have pet peeves when it comes to our jobs? Of course… the ER nurse is no different. Often times, these are not mentioned in “public” as we don’t want to offend families. But, in honesty, there are some things parents do that drive us crazy. Here are a few at the top of my list.

1. Calling medicine candy. This is a big no-no for us pediatric nurses. We really don’t want kids to associate taking medicine with the fun of having candy. Candy is good. Candy is fun. Candy is generally not lethal if you eat too much. Medicine is far different from that. So say something like, “This tastes sweet.” Or “This tastes like orange.”--- but don’t associate medicine with candy in the same sentence.
2.  Children not wearing helmets. I’m amazed at how many families come to the ER over concern for head injury after a fall off of (insert something with wheels here) and their child wasn’t wearing a helmet. First question: Do they have one? Often times the response is, “Yes, I just can’t get him to wear it.”

First off, as a parent, set the example. Are you wearing your helmet when you ride your bike? Second, from the moment your child is on anything with wheels, they need a helmet. Yes, even when they’re on their tricycle. This will institute a habit and an expectation—just like wearing a seatbelt.

Secondly, be firm. If they don’t wear their helmet, they lose their wheels. Parent, “I can’t keep him off his bike.” Well, then the wheels come off the bike. The skateboard is locked in the trunk of your car. Be firm.

It only takes one bad head injury for devastating effects. Don’t risk it.

3. Smoking. Secondary smoke is a big health risk for kids. If you smoke, you need to stop. Smoking outside, unfortunately, doesn’t help. Yes, even if you have a “smoking jacket”. If I can smell smoke, the particles are on you and can even be enough to trigger an asthma attack in kids. If you are a smoker, talk to your pediatrician about resources your state might have to help you quit. Smoking during pregnancy has been linked to the development of congenital heart defects in infants along with a host of other problems.

Now, you tell me, what are some other pet peeves you think a pediatric ER nurse may have? Are you offended by reading these?

Ways to Induce Labor According to the Old Wives

Have a pregnant character in your novel? What lengths might they go to to put themselves into labor? Would those methods actually work?

I'm pleased to host guest blogger Erin MacPherson today at Redwood's Medical Edge to discuss those ever popular myths (and some truths) about how to get a woman to go into labor. Erin has a wicked sense of humor so this should not only be informational but give you a chuckle as well. She hosts the equally funny Christian Mama's Guide.

If you're interested, I've started doing a twice monthly guest post over at Erin's blog giving "real life" girlfriend to girlfriend advice about pediatric issues. Ever wonder what a pediatric ER nurse thinks about things? This is the place to look. You can find my first post there that discusses if it's truly a risk taking a less than two-month old out in public. http://www.christianmamasguide.com/2011/08/31/newborns-and-the-er/

Welcome, Erin! I think her non-fiction book would be a great gift for anyone expecting a little one.

Somewhere between 36 and 41 weeks of pregnancy, you might decide to take matters into your own hands and try to induce labor at home. I fully support this. Not because I think it will work—it probably won't—but because the diversion of trying to induce labor at home will probably keep you from destroying the still-dirty baseboards in your nursery or wasting more gas on another trip to the hospital. Here are the old wives' best labor-inducing tricks:

1.        Eating spicy food. The story goes that eating a spicy burrito will get your whole digestive track moving and doing the Macarena, and your cervix will want to join the fun. The only effect I ever felt from eating spicy food was heartburn, but it's worth a try. A little Thai curry never hurt anybody.

2.        Walking. I tried this—a lot—at the end of my first pregnancy. I'd get home from work, grab a snack, lace up my tennies and start roaming the neighborhood. I didn't want to roam too far from home in case I actually went into labor, so I spent most of the time pacing in front of my house and looking psycho in front of my neighbors. It never did jump-start contractions, but it did soothe my nerves to be outside and get some fresh air.

3.        Sex. The gist of this method—which I'm sure was "discovered" by a man—is that sperm on the cervix can help spur it into dilating. Sounds a bit fishy to me, but my husband thought this sounded like a great idea, so I agreed to give it a try. It did not work out as well as my hubby or I had hoped. Not only did I not go into labor, but it was a bit tricky navigating around a really, really huge pregnant belly. But, you can rest assured, the same "professionals" who suggest this method, also assure you that it will in no way hurt your baby, so if you're wanting to give it a try, feel free.

4.        Castor oil. Castor oil makes your bowels move. The theory here is that —aside from giving you a really bad case of diarrhea— your moving bowels will somehow trigger a chain-reaction and the rest of your body will start moving as well. I have yet to know anyone that got anything other than diarrhea and some abdominal cramping from taking castor oil, but if you're a glutton for punishment—and ready to spend the day in the bathroom—then drink up.

5.        Nipple stimulation. I want to go on record as telling you not to try this one at home. I have a girlfriend whose doctor assisted her with nipple stimulation using a breast pump in the doctor's office with access to medical help, but most doctors don't recommend this method at all. Why? Because it actually works. Something about how nipple stimulation mimics a baby's suckling and causes your body to start contracting. The problem is that the contractions are often super-close together and super-unproductive, so it can pose a danger to you and your baby. So, if you absolutely must try this, I suggest that you talk to your doctor or midwife very candidly about it first and stay close to the hospital (say, in the parking lot) when you actually do it.

6.        Acupressure. Tell your hubby you want a foot rub—he groans and moans. Tell your hubby you need him to perform some acupressure to induce labor and suddenly he puts on his superhero glasses and gets focused on the task at hand. The general idea here is that by putting pressure on certain pressure points around your body, you can stimulate your uterus into contracting. Look up the pressure points online and ask your doctor if you're at all nervous. At the very least, you'll get a nice foot rub.

7.      Raspberry leaf tea. Raspberry leaf is on the pregnancy no-no list because it has a tendency to produce contractions. But if producing contractions is your aim, raspberry leaf tea can move off of the ix-nay list and onto the A-OK list. My doctor said it was safe after thirty-eight weeks, but before you go making yourself a big pitcher of raspberry iced tea, you might want to call your doctor just to be uber-certain that it's okay. It's always better safe than sorry.

8.      Begging and pleading with God for mercy. I guarantee that God will eventually hear your pleas and put you out of your misery.

QUESTION: What did you (or WOULD you) do to induce labor? Have you written a scene with a pregnant woman in labor?

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