Understanding referred pain in children

Kids-Referred-PainHave you ever watched a TV show where someone who’s having a heart attack grabs his left arm or shoulder? Have you ever had a stabbing pain in your forehead or the bridge of your nose after eating ice cream too quickly? With a heart attack, the source of the pain is in the person’s chest. With a brain freeze, the source of the pain is in the roof of your mouth.

Referred pain occurs because the body’s sensory nerves occasionally send signals in the wrong direction. The following examples commonly occur in children:

  • When children complain of mouth, cheek or tooth pain, they sometimes have an ear infection.
  • When children complain of ear pain, they sometimes have a throat or lymph node infection in their neck.
  • When children complain of knee pain, they sometimes have a problem in their hip or testicle.
  • When children complain of low back pain, they sometimes have constipation.
  • When children complain of stomach pain in the middle of the night, they sometimes have a pinworm infection.
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How to prevent nosebleeds

Nosebleeds are common in children for the following reasons:

  • frequent colds
  • nose picking (and other injuries to the nose)
  • dry air (especially in the wintertime)
  • allergies

The reason these situations lead to nosebleeds is because they all irritate the lining of the nasal septum (this is the name of the cartilage that separates your nostrils).

The best way to prevent nosebleeds is to deal with the underlying condition. In addition, it helps to moisturize the lining of the nasal septum by rubbing a thin coating of petroleum jelly along the septum. (Some of my ear, nose, and throat colleagues prefer saline gel products that can be purchased without a prescription.) Most kids prefer to do this themselves because they do not want anyone “messing with” their nose. If your child falls into this category, show her how to do this by demonstrating the technique on yourself: the product can be applied with a cotton swab or with an index finger after your child washes his hands. Apply the lubricant once or twice a day as needed to keep the problem under control. If your child continues to get nosebleeds, discuss the situation with your doctor.

How to stop nosebleeds

Most people do not know the proper way to stop nosebleeds. The methods I hear about most often include putting a cold compress on the bridge of the nose, leaning forward, or having the child tilt his head back so his nose is pointing up in the air. The reason such remedies abound is because people do not realize that 95% of the time, the bleeding is coming from the nasal septum (this is the name of the cartilage that separates your nostrils). 

The best way to stop bleeding is to put direct pressure on the area that is injured. Therefore, the way to stop a nosebleed is to pinch someone’s nostrils with medium pressure for five minutes without peeking. Once the bleeding stops, ask your child to refrain from picking or blowing his nose because that would dislodge the clot and the bleeding could start again. 

If your child’s nose continues to bleed after five minutes of constant pressure, repeat the pinching procedure for ten minutes. If that does not work, call your doctor.

Stuffy babies usually do not have colds

In the first few months of life, babies are obligate nose breathers. This means that they have to breathe through their noses. By the time babies are three to six months of age, they are able to breath through their mouths, but most still prefer nasal breathing. Because babies breath through their noses, they make all sorts of noise—snurgles, snorts, and other sounds that mimic a cold. If a baby truly has a cold, he will have a runny nose and a cough.

The reason this distinction is important is because many parents feel the need to clean their baby’s noses if they are stuffy. As long as your baby can feed easily, you do not need to (a) put saline drops in his nose or (b) clean his nose with a nasal aspirator. If your baby is so stuffy that she cannot feed properly, you should discuss this with your doctor.

The blue rubber item you get after birth is not a nasal aspirator

After a baby is born, the nurses usually put a blue rubber aspirator in his bassinet. Parents commonly take this item home and use it to clean mucus from their baby’s nose. You should be aware that this device is not a nasal aspirator. Instead, the hospital nurses use it to suck saliva or mucus out of a baby’s mouth after he spits up. The reason it should not be used in the nose is because the tip is pointy and can injure a newborn’s sensitive nasal passages. A true nasal aspirator has a blunt tip that cannot be pushed too far into a baby’s nose. The tip can also be removed so the inside can be cleaned out from time to time.