Pediatric ER Nurse Warning: Amber Beads for Teething Relief

Working in a pediatric ER, you see parents do lots of curious things. In the last three months or so, I began seeing a fair number of infants come in with these beaded amber necklaces around their necks.

One of the main goals in nursing is accident and death prevention. That's why we talk about using helmets and wearing your seatbelt. Honestly, some of us would like to see trampolines outlawed because they are responsible for so many childhood injuries.

We also don't like to see anything around a child's neck that would pose a risk for strangulation. Things like this would include wearing a sling at night. We generally don't recommend this for concern that the child may get caught up in it and get strangled to death. 

The first time I saw these beaded necklaces-- I was surprised at how heavy they were. I asked the mother why the child was wearing them.

She said, "Oh, they're for teething."

Hmmm.

I explained my concern to her that I thought they posed a significant strangulation hazard and whatever perceived benefit they had for teething pain would not outweigh this risk in my mind.

And she promptly removed them.

But now I see many infants coming in and wearing these so I thought it was time to blog about my concern for these infants' safety. 

 These amber beads seem to have originated in Europe where the claim is that when the beads are warmed up by the infants skin, they give off a pain relieving substance that is absorbed through the skin.  

This article provides an excellent overview of how these claims are categorically false. 

In fact, Health Canada issued a safety warning about the risk of these amber beaded necklaces use in children and France and Switzerland don't allow them to be sold in pharmacies. 

This article highlights a near miss of a toddler who became entangled in her necklace while she napped. 

Point being-- nothing should ever be placed around your child's neck regardless of any claims for perceived health benefits. 

Commentor Question: Lacerations and Plastic Surgeons

This blog is generated from a comment on this post: Medical Myth: Lacerations Need a Plastic Surgeon.

I do read each and every comment to the blog. Usually, I don't comment on real life medical scenarios but I thought this had several good teaching points that could serve the public good.

The comment:

I just brought my 5 y/o into an ED with a puncture wound to the center of his forehead through which you could see his skull. I thought the attending would close the wound, but the resident did under supervision. First year, and it was late July. What are the chances of a good outcome? The attending had to tell the resident that knots were backward, etc. Should I have insisted that the attending close, or that they call plastics? It was a large urban Children's ER.

Jordyn Says:

Thanks so much for leaving this comment and I hope you see this post.

As a mother and a nurse, I get the parental anxiety around closing lacerations. The truth is that anything that requires sutures is going to leave a scar. That's life. Now, how big or thick the scar is depends on many factors. How it was closed. There is a learning curve to closing the skin. Lacerations can actually be closed too tightly which can be as problematic as not bringing the edges close enough together.

That being said, there are many other factors that determine how the scar will look. Does it become infected? How does the patient normally scar? Some people genetically develop very heavy scarring (called keloid scarring) and there's nothing we can really do about that. Also, after healing, how much is it exposed to the sun?

Now, should you have allowed a resident to suture your child?

From the medical side-- students need to learn and must practice, at some point, on live patients. I'm glad this first year was being monitored during the procedure. That's what should have happened. Knots being tied backwards and needing to be redone doesn't mean you'll have a bad outcome. Experienced physicians redo sutures all the time. It's more the final closure that's important.

From my nursing/mother standpoint-- you have the right to refuse a resident practicing on your child. If you are uncomfortable then absolutely speak up and state your request plainly-- "I'm sorry, but I'd like an attending to close this laceration."

Some people are uncomfortable with a nurse practitioner or physician's assistant doing a laceration repair and request an attending. Keep in mind, that mid-level provider may have more experience than your attending physician. They may have been in practice four times as long! So maybe ask how many years they've been practicing as an attending before you pass over on a mid-level provider.

If you feel that you can't make this request to the doctor directly, then you need to tell your nurse who should advocate for you.

Should you have insisted on a plastic surgeon? The truth is that pediatric ER providers close lacerations every day on moving targets-- we don't commonly sedate kids for simple laceration repairs. Plastic surgeons are generally only utilized for complex laceration repairs and would honestly be annoyed to come to the ER for a simple repair.

If you don't like how the wound healed and the scar it left behind then you can consult a plastic surgeon to investigate a scar revision.

Hope this helps.

Author Question: Surgical Spleen Removal

Amanda Asks:

I have a character who was shot in the side, not life threatening, but he had to have surgery to remove his spleen as well as the bullet because some rib fragments damaged his spleen.

My question is how long would he be in the hospital after surgery? I'm sure when he first comes home he'll be getting around in a wheelchair or something while he heals and gets his strength back. When could I plausibly have him on his feet slowly walking around? I don't want any dramatic complications with his injury or anything. He's going to heal up great and be perfectly fine afterward.

Jordyn Says:

I ran this question by some of my nursing cohorts who focus in adult surgery.

Having your spleen removed would require a couple days stay in an intensive care unit. This would be due to risk of post-surgical bleeding and concern for infection.

The surgical nurse I spoke to said these patients are up and walking by the time they come to the floor so there would be no need for the character to use a wheelchair.

Once research point that is helpful with this question is that you can Google search for discharge instructions regarding many kinds of operations. For this one, I searched for Home Care Instructions after Spleen Removal. This document gives excellent information that can be translated into your novel.

For instance-- how long the patient should expect to have pain. Driving and lifting restrictions which can help determine what they would physically be capable of in your novel.

FYI-- patients who have had their spleens removed are at more risk of serious infection. Your spleen is part of your immune system. So some infections that would normally not be a big deal for the general population can be life threatening to those who have had their spleen removed.

Author Question: Management of Unusual Patients

Amy Asks:

I hope you can address this. Or, if not, point me at a resource that can. I am writing a short horror story in which a patient complains about not being able to get clean. She washes and then within an hour, she's dirty again. And if she doesn't wash, the dirt just accumulates. She's a magnet for dirt. The patient is not complaining of Morgellons and has no history of drug abuse. Neither does she have a history of (or current problems with) OCD behavior.

My assumption is that the doctor would review proper hygiene with her and then find a tactful way to make a referral to a psychiatrist or psychologist. Is that correct?

What questions would the doctor ask? What language would she use when documenting this meeting? And what would she do when more patients start presenting with the same complaint?

In my story, the complaint becomes a pandemic. With this illness, it's always possible to wash away the dirt, you just can't keep it away. What are the long-term health consequences of not being able to remain clean? I know that it will increase the possibility of local infections but can you become ill from simply being dirty? (This hypothetical illness would only attract dirt, not pests. But would being dirty make it easier to attract and harbor fleas, ticks and lice?)

Thank you for any help you may be able to provide me!

Jordyn Says:

Wow, Amy. This is a very intriguing question.

I’ll have to take it from an ER nurse's standpoint. A patient who presents with a complaint of dirt accumulation despite showering definitely raises some eyebrows. If the patient is not expressing wanting to kill themselves or others—then there’s no immediate need to involve psychiatric services. The doctor may say something akin to, “I don’t think this has a medical cause. I think it might be best to follow-up with your regular physician for a referral to a mental health professional.”

Mental health evaluations are rarely done in the ED by an ER physician. These services are likely contracted out or handled by someone else other than the ER physician. You may have heard this phrase about ER docs, “Knowledge of all. Master of none.”—Meaning they have a significant knowledge base but are not specialists. Their job entails identifying a true medical emergency and managing that—so in absence of that, they’ll refer on.

I would say localized infection from open wounds is the biggest risk. As far as attracting other pests—what kind of environment do they live in? Just because you have extra dirt on you doesn’t mean you’ll have lice, etc.

I also ran you question by friend, author and ER physician Braxton DeGarmo.

Braxton says:

I cannot think of a single scientific way that someone could become a dirt "magnet." As such, the idea of a pandemic in which people can't keep clean would very much require some sort of fringe science explanation and to pull the plot off you’d have to build that idea in bits and pieces to make it believable—much like Crichton did for re-building ancient DNA from amber to clone dinosaurs.

Now, as a psychiatric condition, this is very plausible. I've taken care of people who thought they were shrinking and that snakes were under their skin. All of these were manifestations of a psychotic break. So, yes, a tactful referral to psych would be warranted. It would be easier to come up with something that causes such a psych pandemic than one where people keep attracting dirt and grime.

The problem, though, is that everyone's psychotic break would be different. So, again, you’d have to build some case where they all share OCD or the opposite, an attraction to dirt to where they purposefully seek to get dirty. Both scenarios will require some work to build scientifically plausible causes.

Perhaps, there could be an illness that leads to a specific deficiency and the dirt they instinctively "collect" somehow fills this need and is absorbed through the skin. To the casual observer, they just look dirty, but a closer look finds common mineral “X” or whatever, within everyone's grime. And it's the only common factor, thus leading the protagonist or someone to figure it out.

Most folks have heard of people with certain deficiencies sharing a common trait, such as pica to fill an iron deficiency. So, this might be an easier way to build plausibility.
 

As for the specific questions, yes, local skin infections might become more of a problem, but not necessarily any systemic issues. Likewise, with fleas and such. Degree of skin cleanliness has nothing really to do with such infestations. 

Best of luck with this novel! Very intriguing idea.