It is the dreaded FBIN. Foreign body in nose. Your otherwise adorable, brilliant toddler decided TEOTWAWKI would be a great time to see if shoving peas up her nose would keep her from having to eat them.
This is not good. And because you are not a physician with the cool tools of the emergency department, the options for removing the FBIN are limited. However, if you start to panic, your child is going to stress out as well, and that will make everything worse. Just to add more pressure, statistics show that your child is only going to allow one or two attempts at most for clearing her nose. This has to be done right the first time.
The very first thing to do, as soon as you know you've got a problem, is to get the child to breathe through her mouth. Sniffling may move the object farther up the nasal passage. Depending on exactly what is up her nose and how painful it is, pain medication may be required to help calm her down. In a situation like this, many doctors turn to an anti-inflammatory like ibuprofen and in some cases would consider a sedative as well.
Most of the time, you are going to know what is up her nose. She was playing with beads, or Legos, candy, batteries, magnets, or pencil erasers. Beans, seeds, bugs. Maybe pebbles. How you approach removing the FBIN is going to depend largely on what exactly it is. Is it hard? Soft? Round? Square? Smaller? Larger? Smooth? Rough? Metallic?
A physician has several options in a grid-down situation where there is no ER:
- Positive pressure (child). The child pinches the clear side of the nose closed, takes a deep breath, and exhales forcibly through the side with the foreign body. This method is good for solid objects like beans and beads. It is difficult for small children to perform.
- Positive pressure (parent, kissing technique, mouth-to-mouth). While pinching the clear side of the nose closed, a parent performs mouth-to-mouth, forcefully blowing air through the child's mouth in an effort to dislodge the object.
- Positive pressure (straw). It's the same as the positive pressure parent technique above, but using a straw between the two mouths instead. Quick puffs are delivered through the straw.
- Bulb syringe. This is also primarily for removing round, smooth objects. Make sure you have a good seal with the nostril and suck the foreign body out. The syringe may need to be trimmed to work. Do not risk pushing the object farther up the nasal passageway with a bulb syringe that is too long.
- Derma-Bond, Vet-Bond (do not use super glue!). Put a little of this glue on a small stick, like a Q-tip with the cotton removed. Make contact with the foreign body and hold in place for at least 60 seconds before attempting to remove.
- Saline washout. Fill a bulb syringe with 7 ml of sterile saline. Insert the bulb syringe in the opposite nostril and advance it until you form a tight seal between the nostril and the bulb syringe. Squeeze the bulb forcibly to eject the saline to the other side. The saline will hopefully carry the object out the other nostril. This method is good for friable objects like crackers.
- Tweezers. May work for some objects. Don't risk pushing the object further up the nasal passage.
- A bent paper clip or a wire loop held by a hemostat. Either of these can be used to rotate around the inside of the nostril between the object and the mucous membrane to dislodge and remove the foreign object.
Sometimes children do things that escape our notice, and some of the foreign bodies children choose to shove up their noses don't cause immediate discomfort, or even any discomfort. Peas and raisins are nice and soft and squishy. Something like that is going to eventually start giving off a very foul odor. And there will be a runny nose, but only on one side. (Unless, of course, the objects were shoved up both nostrils. A parent's natural reaction is to panic, thinking there's some type of infection. However, there will be no fever. Careful questioning may reveal that the child did indeed shove something up her nose.
Other items you are going to want for this situation include a very good headlamp with a strong light to it and a small pair of pliers to hold the nostril open (unless, of course, you have a nasal speculum on hand).
Links to related posts:
Glues
Saline solution
For further reading:
https://www.oatext.com/20-ways-of-removing-a-nasal-foreign-body-in-the-emergency-department.php
https://www.webmd.com/first-aid/foreign-body-nose-treatment
https://www.drugs.com/cg/nasal-foreign-body-in-children.html
https://www.healthline.com/health/foreign-body-in-the-nose#treatment
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4.16.23
