This weeks episode of Ask Dr Jessica with Dr David Epstein, a practicing board-certified pediatrician and pediatric critical care physician. In this episode we will hear Dr Epstein's thoughts about common injuries in children that Dr Epstein sees while working in an urgent care--including how to treat and how to avoid common pediatric injuries. We discuss topics like basic wound care , avoiding ingestions, and best practices to avoid drownings. This part 1 of a 2 part interview.
Please follow Dr Epstein on instagram @davidepsteinmd. He also has a podcast called "Dr Dave's Pediatric Pearl's Podcast". Also, check out his website!
Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.
Do you have a future topic you'd like Dr Jessica Hochman to discuss? Email Dr Jessica Hochman askdrjessicamd@gmail.com.
Follow her on Instagram: @AskDrJessica
Subscribe to her YouTube channel! Ask Dr Jessica
Subscribe to this podcast: Ask Dr Jessica
Subscribe to her mailing list: www.askdrjessicamd.com
The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.
This weeks episode of Ask Dr Jessica with Dr David Epstein, a practicing board-certified pediatrician and pediatric critical care physician. In this episode we will hear Dr Epstein's thoughts about common injuries in children that Dr Epstein sees while working in an urgent care--including how to treat and how to avoid common pediatric injuries. We discuss topics like basic wound care , avoiding ingestions, and best practices to avoid drownings. This part 1 of a 2 part interview.
Please follow Dr Epstein on instagram @davidepsteinmd. He also has a podcast called "Dr Dave's Pediatric Pearl's Podcast". Also, check out his website!
Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.
Do you have a future topic you'd like Dr Jessica Hochman to discuss? Email Dr Jessica Hochman askdrjessicamd@gmail.com.
Follow her on Instagram: @AskDrJessica
Subscribe to her YouTube channel! Ask Dr Jessica
Subscribe to this podcast: Ask Dr Jessica
Subscribe to her mailing list: www.askdrjessicamd.com
The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.
Hi everybody I'm Dr. Jessica Hochman, paediatrician, and mom of three. On this podcast I like to talk about various paediatric health topics, sharing my knowledge not only as a doctor, but also as a parent. Ultimately, my hope is that when it comes to your children's health, you feel more confident, worry less, and enjoy your parenting experience as much as possible. I have a great guest for you today, Dr. David Epstein. He's a practising board certified paediatrician, a paediatric critical care physician and a podcast host. As an ICU doctor Dr. Epstein is skilled and treating childhood emergencies. So in this episode, I thought I would talk to him about common injuries and accidents he sees with children so that we can have a better understanding of not only how to treat injuries, but also how to lower our children's risk of getting into accidents in the first place. We talk about things like basic wound care, avoiding toxic ingestions and best practices to avoid drowning. So there's really a lot of great information in his podcast today. Thank you to Dr. Epstein for taking the time to come on. Ask Dr. Jessica. And lastly, if you're enjoying this podcast, I would be so grateful if you would take the time to leave a five star review. Reading kind reviews truly makes my day Dr. Epstein I'm so happy to have you here. Thank you so much for coming on the podcast. Oh, my pleasure. Thank you for inviting me. First, tell everybody what are your qualifications? Who are you? What kind of a doctor are you? I have no qualifications. No, I'm just I did my training. I went to Georgetown medical school. Graduated from there went into paediatric residency at Phoenix Children's Hospital slash Maricopa County Medical Centre. And I was there for three years in Arizona after which I did subspecialty training at Children's Hospital Los Angeles and paediatric Critical Care Medicine. After finishing my fellowship, I worked at UCLA for three years. And then I moved back to Children's Hospital Los Angeles where I worked 13 years, primarily in their cardiac ICU. And then, in 2015, we actually even more in 2014, my wife and I were my wife. She's kind of like the big picture planner said that let's, let's open up a paediatric urgent care. And so 2015 May of 2015 We opened up and it was MVP, paediatric urgent care. And we were there for six years before being acquired by pm paediatrics. And so from 2015 through now I've been doing urgent care. You know, when you opened up your urgent care in the area, the word on the street amongst us paediatricians was, we were so lucky because we had an ICU trained paediatrician, also working in an urgent care, which meant things like starting IVs, which typically, an urgent care doctor can't do, you are able to do and the and the level of care you were able to provide was really stellar. So thanks for all the work you've done in our community. Thank you so much. Thank you. So I wanted to ask you about common paediatric injuries and sort of shed light to parents about what they can do for these common injuries. Because I think there's a lot of myths that go around and a lot of people aren't sure quite how to handle common situations. So first, I wanted to ask you about just basic cuts and scrapes. If a child falls and scrapes their knee, how are they supposed to clean it? How are they supposed to attend to it afterwards? What's the what's the best care? Yeah, I mean, for the most part, kids heal very well. The main thing is to get a lot of the debris out of there. And it really depends on the extent of the injury, minor scrapes, is like a little abrasion very shallow. You clean it off with a little water little, maybe a little so just gently. If it's more involved, you still want to clean it out and kind of irrigate it a little bit. But that's the main thing you want to control bleeding. And there over the years has been kind of like a shift away from antibiotic ointments and more to kind of like petroleum jelly. antibiotic ointments. I've seen it more in like surgical care post op surgical haircare wounds, where you're you have more of a high risk for getting infection. But the main thing that parents should do is just to keep the wound clean and dry. Sometimes with abrasions, you put band aids on them or gauze, and they tend to get stuck on the wounds. You know, because it gets all gooey, you know and everything. And so sometimes using nonadherent gauze is special guys, you can get it like any of your local drugstores to help reduce that sticking on the surface. But mostly it's when we when we have a wound Even a surgical wound that comes into the urgent care like the we need to suture clothes, we irrigate with just sterile saline or you know, like, basically water. So if you can clean it and irrigate it with like water put under the faucet, or just putting water on it and kind of gently scrubbing it to try to get out if it's like on a pavement, and there's like a lot of little rocks and dirt and things like that, just to clean it out and make it so it looks like there's no dirt net or WARM BODIES, then I think you're you're in good shape, and then you kind of want to cover it just to make sure that it doesn't get injured again, and that it kind of has time to kind of heal. But once it's kind of beginning to scab or drying out a little bit, you know, you probably don't need to cover it as much. And in fact, sometimes I'll tell the families when I have suturing a wound clothes, I'll say keep the band aid on for maybe a few days, if you see that it's starting to dry out a little bit, then you can take the band aid off or just put the band aid really loose on the skin. So it's not occlusive and it just blocking anything from from injuring the sight. Again, the thing that I've seen with band aids is sometimes you'll put it on and it'll be occlusive like a wrap it real tight. And then all the moisture stays in. And if it's moist, and it's kind of pruney it reduces the kind of the wound healing a little bit makes it a little bit less hospitable for wound healing and kind of delays. delays the healing so that's why I'm very cautious about the band aids and make making sure they're not too tight. Maybe a little loose. So air gets in there a little bit. No, I like these points. So it sounds like To summarise, if there's a scrape, you want to make sure you clean it. Well. If you put an ointment on, it does not have to be Neosporin or an antibiotic ointment, which I think always surprises a lot of parents. They always think they have to use Neosporin Yeah, I you know, it's funny because I advocate for kind of an Moylan, you know, that Boylan, you know, it's like a petroleum jelly or antibiotic ointment with Vaseline? I'll I'll say just put the antibiotic way, because everybody has that, you know, in their cupboard. And, and frankly, I do too, you know, so, you know, for minor wounds. It's I think the concern with the antibiotic ointments is that it can cause irritation. But if it's, if it's if it's a minor wound, probably not a big deal. I mean, I use it on myself, you know, if I get a little thing, I put a little antibiotic ointment, but really, if you don't, if you have, like, you know, like a petroleum jelly or Vaseline, and you got an antibiotic ointment, you know, six of one half dozen of another, you know, I think that's what I understood was that they're both similar. Yeah, it's not really a clear advantage over an antibiotic ointment like Neosporin versus no white men like Vaseline? Yeah, exactly. Yeah. And, but keeping in mind that if, if it starts spreading and get in the wound becomes more red and swollen, then you may actually need antibiotic ointment. And I'll tell families, that even though we did if we do a suture repair of a laceration, I'll say You know, we irrigated with saline, we use sterile technique. We use, you know, a beta tine or a chlorhexidine to clean the wound. And even with that, there's also a chance that the skin could get infected. And if it becomes red, swollen, warm, tender, and pus draining, then those are signs that they need to be seen. And at some point, in fact, may need oral antibiotics because of topical antibiotics may not be doing the jobs. Yes, no, I appreciate you mentioning what to look out for. Yeah, thank you. And I liked the point, that it's not beneficial to let bandaids be too tight because I find with kids sometimes the worst part of the injury is getting the band aid off the thread that feeling when it comes off. So knowing that it's okay to be on a little loose. Yeah, I appreciate that point. Yeah, no, thank you. No, it's It's, it's it's interesting. I didn't I don't think I appreciate it till I was doing like urgent care stuff and, and seeing how things were and seeing a lot of wounds and I'm like, yeah, the band aids, they're good for a little while. I mean, even on the suture sites, you'll put a bandaid over there to cover it. But, you know, as the wound it becomes more mature and it's kind of healing you probably don't need it as much, you know, to be so tight, just loose enough to prevent something from hitting it. You know, like as kids run into stuff and do things like section protection. Now, as an urgent care doctor, you spend a lot of time there you see what parents commonly bring their kids in for when it comes to things like files Do you have any advice for parents on what they can avoid at home so that their kids don't get injured? That's, that's a really good question. I, I don't have any advice, because I think whatever you do, kids are going to find some way to fall and injure themselves. I mean, I've seen many times where kids trip and fall and, you know, they, they land with their chin on a Lego or something, you know, and they get a big laceration, or, you know, I've seen them like trip on a ball, like a toddler and get a femur fracture, you know, it's like, anything can happen anywhere. But I think, you know, supervising is important. Maybe not putting them in a position to have like, some significant fall like, you know, playing on the bed, because, you know, they're gonna fall off the bed and hit their head, you know, on the floor. You know, it's it's, I that's a very common theme. It's not that people aren't supervising their kids, but it's just that kids do things really, really quickly. They're very fast. And, you know, the unfortunate thing is, and just kind of going off on a tangent, you know, ICU is that we see a number of drownings. I think it's better now since, you know, the pools have been, you know, fenced in and things like that. And there's a bit more awareness. But when I did my training and in Arizona, in paediatrics they were we saw unfortunately, a lot of near drownings, and drownings were where the parents say, you know, I just turned my head for a second. And you know, they're at the bottom of the pool. Or even scary things, like if there's a bucket of water, that that toddlers, you know, they they look in the bucket when they fall in. And the thing is, is that they're, they're very top heavy, their head is relatively large compared to their body, and they don't have the strength to push themselves out. So you've seen kids drown in a bucket of water, you know, smaller kids or infants in in bathtubs. And so that's on the extreme side. But just to show you that, that it, it's very fast. Yeah, you turn your head and something happens. So with regards to injuries, I think just maybe not putting them in a significant, like environment that sets them up. Yeah, trampoline, parks are fun, and they're great, you know, and we, but we do see injuries from trampoline parks, you know, when they, they jump and they jump off the trampoline, and they fall onto the floor after or they collide with somebody. You know, those are, those are high risk activities. And if you go in with a, you know, you're transparent to yourself and say, hey, you know, this is not the safest, you know, it's a risk, but that's, they're having fun. Chaplin parks or, you know, the it's a kind of a setup, scooters, you know, the A, there were, there was a time where they used to have the hoverboards I guess they're not as popular now. But the hoverboards were a big thing. And, and we would see kids as they would be on the hoverboard. And then they they'd flip off and the typical injury, they just it flies out or they or it stops suddenly, and then they fall forward. And anytime they're gonna fall. Usually they put their hands out in front of them or behind them to brace their fall. And then that's where they get fret wrist fractures. Exactly. And so see a lot of a lot of those a lot of a lot of buckle fractures, you know, in the wrist where kids fall, and you can't, you can't prevent every injury, but there's certain like, certain things which are a little bit more risky, you know, hoverboards riding a bicycle without a helmet, trampoline parks, you know, those kinds of things? Yes, but yeah, even pandemic wise, I thought it was very interesting, because even when kids were at home, and they were like at their desk, I saw injuries from being on their computer. And I saw one kid who was like, you know, they're fidgeting in their chair, and they fall and they, they hit their chin on their computer, and they had a laceration on their chin. So even even in the best circumstances where there's they're not supposed to injure themselves, you know? So basically, you're saying, I should bubble wrap my kids put a helmet on them and just keep them. Exactly I'm saying exactly. Yeah, perfect. They won't get injured. Exactly. I mean, something that we hear as paediatricians a lot is, you know, you have to avoid things like walkers, because there's so many visits to the ER for walkers or you have to avoid Q tips for kids because there's so many accidents where kids put the Q tip in too far and they have to go to the urgent care. And there's a balance right where you don't want to be overly cautious with your kids. You want to let them play. You want to let them go on the trampoline. Sometimes parents are surprised when I tell them we have a trampoline in our house. But I've heard add that the way to avoid bad injuries is to make sure the trampolines not too crowded. And to make sure you have a net around the outside, yeah, so I've implemented those things. And I just hope for the best. Yeah. And in point of fact, in all full disclosure, I have three kids. And they all did gymnastics when they were younger. So yeah, so that kind of, you know, but you know, it's, it's a different environment, when you're like, like, you say, it depends on how you prepare, you know, like, the trampoline, in the backyard on concrete with no, with no netting, and protection, that's a setup for somebody to fall off and land and break something on the concrete. But with any activity you do in life, you know, there's going to be an injury associated, you could be just running down the sidewalk, a trip and fall and boom, you know, that's it. But, you know, I think if you have reasonable precautions, it's fine. I'm not saying that all trampolines are bad. I'm just always wear like the trampoline parks, because it always seems to be like a little bit of mayhem. Because there's a tonne of kids, and everybody's running around and jumping and everything. And it's like, but if you're at home, and it's kneaded and you have rules, I think that puts it, you know, a lot lower risk. If you're at a gymnastics gymnasium. Yes, there's, there are risks. But there are also a lot of mats. And there's also somebody supervising so it's, you know, it's it's, it's all relative, I guess I should say, it's all relative, it's true, I hear, you know, we're probably similar in the sense that I see a lot of visits here from those trampoline parks, and from things like riding bikes and riding horses. And I have to catch myself because I get nervous for my kids to participate in those activities. But I have to recognise that their children, they don't always happen, and you have to weigh the risk benefits. And there's there's value in kids trying new things and exercising and playing with their friends. Exactly. Yeah, I agree. Right. Just to bring it back to drowning, because that's something that I think is a really serious topic that I just want to make sure parents think about is that when you mentioned the supervising, something that we don't think about a lot is that drowning is quiet. It's not an event where kids make a lot of noise, when it happens, it's a quiet event. And so you really have to be vigilant, when kids are around water. Yeah, they can slip in and, and I use the term near drowning and drowning. And it's a little bit of a misnomer, because I think that's old terminology. And it's something that just kind of comes back to me, it's like, when I was referring to near drowning, that's somebody who drowns but survived. The, I guess, the terminology is basically just a drowning, and so you, you can survive a drowning, but you could be neurologically devastated from lack of oxygen to the brain, you know, those are the main the main things that that's the main, scary part of it, if somebody doesn't pass away, which obviously you don't want, either. There are periods where, you know, a child may be, you know, choking on water and not lose consciousness and, and gets out and is fine afterwards. And, you know, that's not necessarily a drowning per se. You know, it's it's just knocked on water, but it's still scary at that thing. It's but you know, your point is well taken is that it's very, very silent. You don't, you don't see the the person thrashing around, you know, like, in the movies, you know, when they have somebody, you know, I can't swim, I can't swim, and they're, like, thrash and make a lot of noise. No, that doesn't happen. That's like it's very quiet, like you said, No, and to your point, you have to have proper supervision. When you when you think about drownings, or near drownings, you've seen, can you think about how they could have been prevented? In other words, I find it usually comes from as you point out, lack of supervision like there's a big party going on. People assume that all these adults are watching the kids in the pool, but they're not. Yeah, absolutely. It's all about supervision, especially the younger kids, because they don't know, it's, you know, when they when they get older, you know, it's easier if you have a lifeguard, you know, at a party or somebody who's designated a watch, if you don't have something like that the child is your responsibility. You have to really be there. And, you know, just don't say, Oh, I gotta run in and get something in the house. You know, I gotta, you know, if you do, you bring your child with you. Because nobody's nobody's going to take responsibility for your child, you know, unless you say, hey, you know, could you keep an eye on my child while I go into the house? You know, it's true. I tell people that you have to have a proper handoff. If you're going to leave and go in the house, you'd have to say to your spouse or to a friend. Hey, will you watch Jimmy while I go inside? Like you have to really clearly communicate who's watching your child at all times? Absolutely. Absolutely. My dad is a paediatrician. Cheyenne and when I was pregnant, and I told them the news for the first time, the very first thing he did I think I must have been 14 weeks pregnant. Was he got a fence around their pool? Yeah. Yeah, no, that's barely pregnant three months pregnant. And that was the most important thing for him to do. Yeah. Well, it's I think we have a little bit of PTSD and he probably saw a lot of drownings, you know, back in the day, because they didn't have pool fences around the pools. But, I mean, I had PTSD to the point where, like, I didn't want to pool like when the kids were little, like I, you know, no pool, no pool. It was only until they got bigger and they could swim, that we said, okay, you know, let's, let's do that. But before that, I didn't want to have anything to do with a pool. I didn't care. You know, if, if it was fun, it was as a No, I, I couldn't sleep at night. You know, this is what happens when you're in ICU doctor for kids? Yeah. Too much. Yeah. Now, one term, I just want to kind of clear the air on this, because I see this term pop up on social media platforms and thrown around the internet a lot. And I want to clear this term up for people listening. I hear a lot about secondary drownings, and I'll hear a lot of parents they come in and they're concerned because their kid choked on water, they're fine. But they worry low, something called a secondary drowning, where time passes, and they drown later have lung issues later. Is that something you've ever seen? Can you explain? Is that a real phenomenon? The short answer is no. That it's not a real phenomenon it the kids that come to, to you or me when I'm in the urgent care, if they look good, and their lungs are clear, they're not coughing, they're saturations are fine. They're not going to have a secondary drowning. And the idea is that the water sweeps out the surfactant, which is the chemical in the lung, that helps keep the alveoli open, and it disrupts the ability to breathe and transfer oxygen and causes lung collapse. Well, if that's going to happen, they're going to have a significant event, you know, a significant event to where they're looking sick, and they're probably going to be already in the ER. So if they're coming into an outpatient office, and, and they say, Oh, my child was coughing, and they got some water in their lungs, I think and they were coughing and coughed out water. And they're doing okay, now I just want you to listen to their lungs, everything. And if they they're making it to that, that arena, that venue, the chances are that they're not going to have any issues and, you know, you talk talking about secondary drowning or delayed drowning or dry drownings, you know, all these terms, you know, go back to the idea that, Oh, my child aspirated some water, and then they're going to have issues, you know, later on, if you have a significant event where they actually aspirated or, you know, brought water into their lungs, and they're having trouble breathing and coughing, you're not going to be at an outpatient office, you're going to be in the ER, and the times that I I've seen a delay or worsening in the lung function is when they're actually in the ICU already. And they they had had a little bit of a downtime, but not down enough to where they have neurologic injury or anything, but they aspirate a lot of fluid, and their lungs and you did an x ray, and they already had some sun, you know, signs of, you know, patchiness in their lungs significant signifying some water or some maybe some, a little bit of consolidation of tissue, you know, then you watch them over a period of hours. In point of fact, when I would do, I would do bronc Casca peas, we would actually flush in saline into the lungs to wash out for samples. And so we do five CC's at a time, but you could end up putting like, you know, 1020 30 cc's of fluid actually into the lung and you're suctioning out but you're not getting it all out. And so there is fluid you're putting in the lungs, are they having problems from that? No, what happens is the fluid gets reabsorbed. So really, you have to have a significant amount of fluid going into the lungs to cause any problems. And if it is a significant amount of fluid, you're gonna see it right away and you're gonna have problems coming in to where if you come into an outpatient office, like an urgent care or paediatricians office, that paediatrician or urgent care doc is going to tell you to go to the ER, you know, if you're having that significant, so if you're coming in and your child aspirate a little bit of water, and had a little bit of coughing afterwards, but he's been playing normally and, and having fun and eating and doing these things and you want to get checked out of your paediatrician. That's totally fine. And if they say that, you know, the lungs are clear, he looks good saturations are good. The chances of having any sequelae or repercussions later on are exceedingly small. I mean, nothing's ever 100%. But I can't think of an instance and where there was any problems. After a scenario like that, that helps a lot just to hear that you as an ICU doctor who's worked in urgent care for many years, that you've never seen a kid where, yeah, he was in the pool, and then no symptoms, and then all of a sudden had an episode of a secondary drowning. Exactly. I find a lot of parents will ask me this. This question comes up quite a bit when I read something online, and they get nervous. So I appreciate you. Clarifying. No, absolutely. I mean, we, you know, we see it all the time, especially in during the summer months. Everybody's in the pool, and everybody, you know. Yeah. It's it's a very common question. But thank you for bringing it bringing that up, too. Because it's, it's, I think, it's it's one of those things that circulates and I don't know how to stop it. But this is good. This is a start. Yeah. Okay, now question about ingestions. Because I've seen a lot of parents accidentally leave out things or substances they don't want kids to have. Do you have any advice for parents or anything that you've seen as a cautionary tale for parents to be careful? Yeah, I mean, especially with with you know, THC containing edibles and things like that. The unfortunate thing is, they make them very appetising, looking, you know, like gummy bears, or little things like that, or, you know, they're cute, like little candies, and things like that, and kids love candy. So, if you're going to have any substance like that, that you really don't want your child to be exposed to or accidentally adjust, you have to put it high out of the reach or in a locked cabinet, things like that. Kids just assume that if it's at their at their height, and it's not a lot cabinet, they're going to get into it. I mean, that goes that goes for cleaning supplies, anything that you may have in the garage, that's you know, like antifreeze, any, any chemicals, you know, they're, they're going to get into it. So just assume that. And as a paranoid, you know, ICU doc, we have the child locks and everything like that on the cabinets and everything. And even with that, you're gonna get children, your there's going to be a little small object that they're going to put in their mouth, and they're going to swallow the, you know, from like a little button battery, you know, to, you know, marble, you know, to a coin, you know, so there are all these things that are choking hazards, ingestion hazards. And again, it goes back to supervision, anticipatory protection, and putting those places where they can't get to them. Because just just assume that they will, you know, it's just like getting injured at home, they assume that they're gonna get injured on something, you know, but do everything you can to prevent it. But with ingestions, especially with, with pills, if you have certain kind of medications that you take, or a grandparent takes, you make sure to keep those out of reach of the kids. And the most important resource that I can't emphasise enough is the Poison Control Centre, that if you do have an instance where they ingest a pill, it could be something, you know, over the counter, you know, like a Benadryl or, you know, a Tylenol or whatnot. call poison control right away. They're open 24/7. And here I do, I should find 1-800-222-1222 Two, yeah. 2221222. Perfect. Perfect. Yeah, great. Yeah. Yeah, you go, or go? Yeah, so it's very important. I mean, even as clinicians there, there's so many substances out there that we get referrals for that we can't know everything. And so we often call the poison control centre ourselves, to get advice from them on certain things in certain major things that cause life threatening injuries, or to intoxications. We are familiar with, but there's, there's so many different chemicals, that it's hard to keep track of them all. So you even use them as a resource. No, I think and I think it's such a great point that you bring up that assume that if kids can get into it, they will because that is so true. Yeah. One scenario I've experienced a lot is that when kids go to their grandparents house, and the grandparents might not be as baby proofed, and pills are left out, and you'll find a kid has accidentally ingested grandma's, you know, antihypertensive medications. That's something that comes up a lot. So just a reminder for people if there's a house that you visit frequently, to ask them to to lock up any cleaning supplies I put away pills and things like that. Yeah, and a lot of the pills, I mean, obviously, they come from the pharmacist in the Child Protective bottles, you know, so that, you know, they're hard to open, true. But what happens is, if somebody's on a number of pills, what they do is they put them in a pill box to so they can remember to take them every day. And so those, you know, are locked, you know, so, you know, leaving those around is time for investigation of like toddlers, you know, they love looking at those kinds of things. So, oh, I have a question for you about just gonna pivot to foreign bodies really quickly. Sure, sure. There's a myth going around. And I just want to know from you, if this is true, that boys tend to put more things in their nose and girls tend to put more things in their ears. Is this true? I don't know. I don't I haven't looked at the literature on that. You know, it seems like boys just get into more trouble anyway, that but yeah, I've seen a lot of anything, any place that a child can put something they're going to put in whether it's there in their mouth, their ears, their nose, their bottom, they're going to for whatever reason, so I we had a cute story where a little boy he was, he put a rock in his nose. And he said, Well, he just wanted to save it because he wanted to give it to his mom because it was shaped like a heart. And we're like, oh, okay, you know, and we and we got out the rock. And sure enough, it was shaped like a heart. It was an but he didn't have anywhere to put it, you want to put it in a safe place. So he put it in his nose. So that's a great story. Very sweet. Very sweet. It's cute and, and we had another boy as like, years ago, he was doing a magic trick. And he wanted to make a marble disappear. And so he did make it disappear into his into his bottom. And the parents are like, is it going to be okay? Yeah, he's gonna it's gonna poop out. It's gonna be fine. Don't have to worry about it. So Oh, my goodness, you must you could write a book I'm sure on all the stories you've seen? Oh my goodness. Yeah, there's a lot of interesting stuff. Oh, is there anything else that you'd like parents to know, or anything that we didn't cover about paediatric emergencies or any cautionary tales you think they should be aware of? Yeah, you know, going back to foreign body ingestions I think that those are, are very interesting. You know, obviously, we spoke about pills and medications and chemicals and things like that, and those can cause some significant injury. Chemicals under the counter, your child swallows it, it may not necessarily be classically poisonous, but it can cause a lot of it could be very caustic to the mucosal lining in the oesophagus. And so they can get burns in so they may not be injured from a poisoning but they they're their oesophagus gets gets burned. And it can cause a lot of problems or if they aspirate some of the chemicals into the lungs, it can cause a lot of problems. So I think being aware of those things is very important. You know, like liquid Drano, things like that things that are alkaline, acidic, and things that are acid, you know, can cause a lot of problems with tissues on the skin on especially on the inside. So making sure that they don't drink anything is important. The other thing is, with foreign bodies, like coins, and batteries and magnets, and sharp objects, those are all kind of things that I'm always concerned about. A magnet by itself is okay. Like if it's a single magnet, fine, but if there are two magnets, you know, that's an instant, you know, sending to the emergency room because what can happen is the magnets. Once they go down to the intestines, they attract each other and they can trap tissue between the two pieces. And that can cause injury to the tissue in the intestines and can create a perforation or a hole. Sharp Objects can do that too. Yeah, batteries. You're always concerned because if they get stuck in the oesophagus, or if they get any in the mucosal area, they tend to burn the tissue because the charge that's associated with them, and coins are particularly tricky because they can be ingested where they get swallowed and they can get stuck in the oesophagus. And the reason why I'm saying that is with coins or any other object, if they're ingested, if they have drooling, trouble swallowing that those are signs usually that they're they're lodged in the oesophagus and they probably need to be removed. And you can get an x ray and see if there's a coin that's stuck where it shouldn't be. If they aspirate or breathe you know foreign object into their airway. Usually it's associated with coughing, and difficulty breathing. And obviously, if there's any that you go to the emergency room, certain things are more visible than others. Like if you get an x ray, anything that's metallic is going to show up really well. But things like like plastic, and sometimes the parents will come in and like, oh, they swallowed something like a Lego or something like that, it's going to be really hard to see that on an x ray. Usually, they don't show up very well. Or, you know, things that aren't very dense. So just to kind of give them an idea that but anything that that causes, you know, choking like coughing, difficulty breathing, just think that it's in the airway, anything that causes drooling, or they're not swallowing as well or not eating could be obstructing the oesophagus. Oh, and it can be so benign, you don't even Yeah, it's so easy for a parent to miss it. I've had kids that choked on like a little, little piece of a peanut. Yeah, it gets lodged and they'll be drooling. And we can't figure it out. And we do an x ray. And lo and behold, there's a piece of a peanut there. Yeah, yeah. And, and into into with those little peanuts, sometimes they can be aspirated and go into the lower airway. So they may be coughing initially, and have some wheezing. But we've seen some times where it's a small, little something, and it gets lodged in an airway and it stays there. And so over time, be like, Oh, they keep getting pneumonia, or they have wheezing, and so that can cause issues down the line. So if there's any concern for choking or foreign bodies, it's always good to get checked out. For sure. I'm curious, your thoughts on this? I've been I've hear paediatricians give different advice about swallowing coins, some will tell parents to look in their poop till they find the coin. And I find that it's really hard to find the coin, like I'm sure it does get passed through, but it's easy to miss. Yeah, so if a child's acting normal and they don't find the coin in the poop, is that okay for parents to move on? Yes. Yeah, yeah, usually, the issue with coins is either it gets stuck in stuck in the oesophagus, in which case, you're going to have those symptoms, like I talked about drooling, trouble feeding, things like that. Or if it gets, if it goes down to the stomach, and gets stuck in the outlet of the stomach, you're gonna have vomiting. So you're going to know you're going to have symptoms. So if you don't have any of those symptoms, and it's a small coin, let's say if it's a nickel, or a dime, or a penny or something, you know, it's probably going to pass out and, you know, who knows how long it takes, there's a good chance, like you said, you're gonna miss the coin, and I don't think you need to get a repeat X ray. Sometimes we'll do an initial x ray to see where it is. And if it's in the stomach, and it's fine, you'd be like, Okay, it's gonna it's gonna poop out, that's fine. If you have any vomiting that may be concerned that it's obstructing, you know, the pylorus you know, the outlet. And then you need some intervention. But for the most part, you can time you know, you don't have to you don't have to search through poop. Dr. Epstein, I'm so impressed with all the things you've seen, that you've raised kids that you let do things get out of the house, go to school, be tricky. It is tricky. And I you know, every day is a new adventure. And as as you have teenagers, then you worry about other things. So, as my parents said, you know, you never stop worrying. And my dad says the same thing to me. Yeah, never stop worrying. Yeah, I still remember my, my grandma, who was telling my parents, make sure they put a jacket on before you go outside. My parents at the time were like in their 60s, you know, like, so you never you never ceased being a parent, you ever cease being a child. So, this is true. Thank you so much for listening to part one of my interview with Dr. David Epstein. Please stay tuned for next week's episode where we talk about how to think about bites. And we talk about it all from insect bites and bee stings to human dog and cat bites. And if you're on Instagram, you can follow me at ask Dr. Jessica and you can also follow Dr. Epstein at David Epstein, MD. See you next Monday.