Baby won’t settle? Check for this potential emergency.

baby-feet

This quick check only takes a couple of seconds and may prevent a medical emergency in your child.

Let’s say your baby has become increasingly irritable and unsettled over the last hour. They are now crying constantly. You try all the things that usually get them to settle without success. It’s strange, they were perfectly fine just a short time ago.  What now?

Of course there are many things that can cause this sort of behaviour, and if it continues medical assessment is absolutely warranted.
But there is one quick check you can do to make sure that the problem is not hair tourniquet syndrome.

What is it?

Hair Tourniquet syndrome probably occurs a lot more frequently than we think.
It is potentially an emergency as it can quickly lead to ischaemia (loss of circulation) and loss of the digit or toe.

Often the tourniquet results from a single hair that becomes wrapped around the appendage.
Fingers and toes are the most commonly effected areas but there are reports of tourniquets occurring on the penis and even the clitoris.

hairt
Hair tourniquet in baby I helped to care for. Successfully treated without lasting problems (see below).

Following pregnancy a mother may experience increased hair shedding known as ‘telogen effluvium‘ due to hormonal changes.
Loose strands of hair may become wrapped around the babies fingers or toes or other appendages.
As it dries out it shrinks, slicing into the skin and quickly becoming undetectable in the resulting inflammation.

The tourniquet syndrome can also result from a single thread of cotton from an item of clothing or stuffed toy.

Another potential cause to be aware of if your baby is in hospital (and I have seen this on two occasions now ), is cotton strands from dressings around IV sites or other areas.
Many cotton bandages have easily fraying edges, and some of the ‘netting’ type dressings can easily trap-and-wrap around a finger or toe.
If you cannot easily examine the fingers/toes suggest the nurse removes any dressings to check.

Hair-Tourniquet syndrome should always be considered in an irritable baby with no obvious cause of distress.

Treatment:

Do NOT try to cut the hair. Usually by the time the child is distressed the hair will be tight and attempts to cut it will only result in further injury.

If the finger/toe appears purple or dark red due to impaired circulation you will need urgent medical assessment.

Apply hair removal cream if you have it at hand. In the emergency department where I worked we had success managing this situation with a liberal application of hair removal cream which usually successfully dissolved the hair after 2 applications (over about 30 minutes).
Make sure the baby does not accidentally ingest the cream (you can apply a loose bandage over the foot). One applied you should seek medical assessment.
If the tourniquet is from cotton or other threads this may not work.

 


REFERENCES:

Toe-Tourniquet Syndrome: A Diagnostic Dilemma!   
(Ann R Coll Surg Engl. 2006 July; 88(4)

Toe Tourniquet Syndrome in Association With Maternal Hair Loss
( Journal of the American Academy of Paediatrics)

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