Being a mom means always being on call. Whether it’s splinters, stings, or scrapes, if blood or pain is involved kids blow right past dads to us. Then they freak out and give accusing glances when it hurts while we fix it. Totally unfair.
OK, since I am an emergency doctor, perhaps in our family the mommy preference is reasonable. However, it only recently occurred to me to use the same techniques at home that Children’s Hospitals use to cut pain by half! Duh.
Here are a few specfic tips for some common summer maladies, then general pain management ideas which can cut boo-boo pain in half.
SPLINTERS: Splinter removal is easiest immediately, or a day after it gets in. The redness that develops in the first few hours around the splinter can make it hurt more, so if it doesn't come out easily consider putting antibiotic ointment on for a while and trying later. The body will have a chance to make fluid and infection-fighting white blood cells that can make next day removal easier.
Positioning is everything! Make sure your child is in a comfortable spot with good lighting, letting your child choose where if possible. For a toe or foot splinter, have your child lay on their tummy unless they’re one of the 20% of kids who want to watch. If another adult is available, have kids sit facing them on their lap to get a hug while the affected finger or toe sticks out behind the other adult’s back for you to work on.
For pain control, 10mg/kg of ibuprofen ½ hour beforehand will help. Pressing an ice pack and vibrating toy near the splinter will also help block the sharp pain, just like rubbing a bumped elbow or putting on an ice pack. Leave the vibration/ice on while you’re taking the splinter out. Give the child as many choices here as well: popsicle or treat? TV or game? If they can “hold still for 10 seconds!”, letting them eat something during rather than after the procedure can enhance distraction and buy you time.
Sterilize a needle or tweezers with rubbing alcohol, and pull out in the same direction the splinter went in. For a HUGE splinter, gently splitting the skin on top of the wood or material can make it easier to lift straight out. After you're done, put antibiotic ointment on with or without a band-aid. If some parts of the splinter are left, soaking in soapy water or just waiting should do the trick, but if the area gets more red or has drainage, go see your doctor. Weird as it sounds, though, sometimes surgeons will just leave a foreign body in place and let the body dissolve it over time. If there’s some small splinter you can’t get out, if it’s not bothering your child, you can choose your battle and let time heal that wound.
Bee Stings: honey bees leave stingers, but wasps, hornets and yellow jackets don’t. If you don’t see a stinger, skip straight to the next paragraph: they aren’t subtle if they’re there. If you DO see the stinger, the current recommendation is just to get it out ASAP. The little venom sac will be releasing venom as long as the stinger is in, so to reduce the reaction it’s better to be fast than finicky. Sure, you could scrape or use tweezers, but fingers work fine and are close at hand, so to speak.
Systemic reactions (wheezing, lip swelling, vomiting, hives) are beyond this tip guide: give 0.5mg/pound of benadryl and call or go to the doctor. Even non-allergic kids, however, get a reaction about 4-10x the what they would get from a mosquito: red, swelling, pain then after an hour or so itching.
Use ibuprofen and ice for pain relief. While the acute pain is going on, ice directly on the site may be too intense. Ice with or without vibration upstream “between the brain and the pain” may be more helpful then. Once it starts itching, scratching will spread and worsen the reaction. A vibrating toy over an ice pack will relieve the itch without spreading the reaction.
To get them past those first painful few minutes, having an I spy book or distraction cards can help. “Hold on this ice pack, and when you find five things I’ll go get you a popsicle!”
Scrapes:
Sure, you want to clean it, but of course it’s at its most painful when fresh. There really isn’t a huge rush if your child is freaking out; even open wounds like lacerations can be safely cleaned and closed in kids 12-24 hours after they occur. One option is to buy a topical lidocaine formulation, apply it, wait, THEN clean and bandage. LMX (
If you can’t or don’t want to wait, again, pressing ice and/or vibration upstream of the injury confuses the nerves and blocks some of the pain. In the emergency department, research found placing a wound under running tap water for 2 minutes is just as good as irrigating with sterile saline (assuming you have safe city water). With enough water, you don’t need stinging soap. In the hospital, betadine and peroxide are only used to prep skin for surgery: we DON’T want it inside wounds! Get the water room temperature and run it as strongly as your child will tolerate. The solution to pollution is dilution!
I invented a vibrating bee Buzzy and Flippits Bee-Straction cards that we use at our house and hospital, but any vibration/ice source will do. If you don’t have a Buzzy or vibrating toy, gently randomly scratch the skin above the injury to distract the nerves when the water first hits the wound. Even better, do that while pressing a frozen pop upstream an inch or so to further confuse the pain nerves. After rinsing, apply antibiotic ointment. We prefer those that only have two antibiotics (e.g. Bacitracin) rather than those that contain three (e.g. Neosporin) because some children react to the third ingredient, but really, any should be fine.
Jellyfish: Oooh, I hate those guys. Step one is to get rid of any tentacles, but use a stick or shell, don’t touch them. Once the offending stingers are off, address the ouch.
Sure, everyone knows that meat tenderizer sprinkled on a sting makes it better (nematocysts are neutralized and don’t fire In the presence of nitrogen products). So does vinegar; however, on the beach, who routinely has either? Now, one idea is to get a packet of vinegar from a fish restaurant and put it in the beach first aid kit. Alternately, you can use salt water from the ocean to rinse off and hopefully help neutralize remaining nematocysts.
If you want to earn major cred, peeing in your own cupped hand and wiping it on a leg may be effective, but… uh, ew. If they won’t be scarred for life, go ahead and let a sibling pee on the leg. Now, this brings up an interesting point: some studies DON’T find urine helps, possibly because if you’re well hydrated your pee has a lot of fresh water and not so much nitrogen in it. Here’s another theory: everyone gets so excited about the idea of intentionally putting pee on skin, this distracts the patient from the pain. After such Herculean efforts, cognitive dissonance may make the kid figure “Gosh – if I’ve subjected my leg to pee, I MUST be better.”
General Principles:
When it comes right down to it, why don’t we include distraction in our first aid kits? Hospitals use distraction for all sorts of painful procedures, why not use some of those same techniques at home?
Counting and finding tasks can reduce pain by 50%. While you can buy cute commercial distraction cards to make sure the questions you’re asking are pitched at the right level, (e.g. Flippits/Bee-Stractors), Where’s Waldo books and detailed picture books are great too. It does help if you have another person hold up the distractor and ask the questions, or make sure you have several tasks or finding games queued up if Plan A or B fails to take the attention away. “There are 8 ladybugs. Can you find them all? Where are four green things?” Math or recall are too difficult to be good for distraction, so don’t ask about “remember what we saw last night.”
Finally, never promise that it won’t hurt: boo-boos usually do. Instead, whip out your treats, your distraction tricks, and assure your child that you have some neat ideas that will make this MUCH more comfortable! Go, Dr. Mom!
By Advisory Board Member, Amy Baxter, MD
Dr. Amy Baxter is CEO of MMJ Labs and inventor of Buzzy® and Flippitstm. After graduating from Yale University and Emory Medical School, she completd Pediatrics Residency and a Child Abuse Fellowship at Cincinnati Children's, and Pediatric Emergency Medicine training at Children's Hospital of The King's Daughters in Virginia. Dr. Baxter is director of Emergency Research for Pediatric Emergency Medicine Associates at Children's Healthcare of Atlanta, Scottish Rite, and a Clinical Associate Professor at Medical College of Georgia.buzzy4shots.com
