Toe Tourniquet Syndrome
When we announced our pregnancy with Parker tons of advice and tips came pouring in from family, friends, and even strangers. One of the most unusual pieces of advice I remember getting was to always check your infants toes and fingers (and for boys their penis) during every diaper change. If they ever become inconsolable even after you attempt the usual remedies to thoroughly check then as well. This advice came from a few 2+ moms in a Facebook group I had joined so I took it very seriously. After some quick research online I discovered that it was called toe tourniquet syndrome which is more common then you would think and can be very severe. It occurs when loose hairs or strings from sleepers wrap themselves around cutting off circulation.
Having learned this, I am always careful to check during diaper changes and baths. My postpartum (PP) hair loss has been significant this time around with such long hair and I thought I was so careful to check Caity regularly. As some point in the previous day or so Rob and I had both missed it.
On Tuesday I had made an appointment for Caity to see the pediatrician to be treated for Thrush and receive the last 2 vaccines for her 2 month batch. She was in such a good mood, had been all day, so I was tickling and playing with her while I took her sleeper off. I looked down to tickle her feet and immediately recognized what I saw. I quickly yelled for the pediatrician as I examined her toe. The color still looked decent, not blue, but the hair(s) was wrapped around so tightly I could barely see it. The pediatrician started poking at it but it was clear he had no idea what he was doing. I didn’t handle the situation very well and was hysterical at that point. I texted Rob to come up (he was in the car with P). The next thing I knew the pediatrician had taken a pair of unsterilized scissors and she was bleeding. Rob came in at that point and we quickly decided to take her to the ER. Looking back I am so angry for how he handled the situation and we have since changed to another office.
We dropped Parker off at a friends house and made our way to the ER. She had been so upset in the pediatricians office she quickly fell asleep in the car. The ER was busy but we were seen pretty quickly. The staff very sweet and although he had never seen a case like this before, he had heard of it. He was surprised to see her in such good spirits since infants are usually inconsolable. I was relieved she wasn’t in a lot of pain that still didn’t help with my guilt. With the help of 2 nurses the doctor tried for 45 minutes to get under the hair to cut it but not even a suture needle was small enough. He ended up injecting her with Lidocane to help with the pain so he could make a tiny incision on the side of her toe. He removed several small strands that were wrapped around. The damage was so deep it was extremely hard to see the base to guarantee it had all been removed. We took her home with instructions to wash it regularly and come back in if the color worsened.
I didn’t sleep much that night and checked over her toe and every feeding. By morning there was no change and I asked Rob to take off of class that day so we could take her to the Pediatric ER. I knew it would take awhile to heal but I was expecting a little improvement and since the ER doctor had never seen this, I was hoping for a more reassuring assessment from someone who had. Luckily we were able to drop P off again and headed to the Pediatric ER that was a little farther away. I was immediately impressed. It’s neat to see all of the little difference between the two facilities. The staff was exceptional and we were seen quickly. The doctor that saw us had seen several cases before. She looked Caity over and was pretty confident that it had all been removed. We left with the same instructions to keep it clean and a close eye out for a change in color.
On the way home I asked Rob to stop by my hair salon so I could get my hair chopped off. I knew it wouldn’t ensure this didn’t happen again but I thought it would be better than nothing. I do miss my long hair but this is so much easier to take care of, quicker to wash, and the PP hair loss isn’t as noticeable.
I took a few pictures over the last week to show the difference as her toe has healed. The swelling didn’t start going down until day 4 and by day 6 we were able to start seeing the base where the hair was wrapped. The night it happened I put up a PSA on my Facebook and a few mom groups I belong to. I received a lot of feedback from parents who were unaware so I decided to write our story down and share some information the doctors and nurses gave me.
How It Happens:
During the first few months postpartum women lose a lot of hair. Infants also spend most of their time dressed in footed sleepers. In both cases it is common for lose hairs and strings to make contact with infants during diaper changes and bath time. Hair is very thin and strong and had the ability to stretch when wet and tighten was it dries. The wrapping occurs by repetitive movement when the appendage is in a confined area such as an infant wearing a sleeper who loves to kick their feet. As the hair tightens the limb can become swollen and circulation cut off.
What To Look Out For:
If your infant is irritable or inconsolable it’s a good idea to inspect especially if the usual remedies such as a diaper change or feeding doesn’t work. If you notice an appendage swollen it may also been an indication something is wrong. Often time the hair/string wiggles into the natural bends of the finger or toe hiding it early on making it easier to miss.
How To Avoid It:
Check your infants fingers, toes, and penis at every diaper change. After bath look over your infant for any stray hairs. All footed sleepers and socks should be washed inside out and checked regularly for loose hairs or strings.
What To Do:
In mild cases or when the hair/string is wrapped around multiple toes you maybe able to simply cut the hair. In more severe cases you may need thin scissors or tweezers to get under the hair. If you are having a difficult time, the toe is losing color, or the child in inconsolable you may want to call your pediatrician. If it is after hours it is worth a trip to Urgent Care or the ER. If there is an option to see or go to a facility with a pediatrician I highly recommend that. They are more likely to have seen it before and be able to treat it quicker.
In some cases the pediatrician or doctor may use ointment to dissolve the hair/thread. For more serious cases they may need to numb the area or immobilize the child in order to use scissors, scalpel or other tools to attempt to remove the hair/string. Antibiotics maybe prescribed to prevent infection and in serious cases the recommendation to consult a specialist maybe given to assess loss of function.
This whole situation has been a quite emotional for me. Although Caity is fine and it wasn’t really a big deal, I still felt incredibly guilty and responsible. As a parent I want to protect my child from everything. Although that is impossible to do, I am grateful for blogs, online moms groups, medical professionals, and Google to help keep me informed of as much as possible. I am curious to hear if you have experienced a situation like this or know someone who has.