Saturday, October 20, 2012

'Mother's Kiss' May Dislodge Objects Stuck in Child's Nose

October 15, 2012 — The "mother's kiss" technique helped dislodge foreign objects from children's noses in 60% of reported cases, according to a literature analysis published online October 15 in theCanadian Medical Association Journal.
"The mother's kiss appears to be a safe and effective technique for first-line treatment in the removal of a foreign body from the nasal cavity," Stephanie Cook, BM BCh, from Buxted Medical Centre in the United Kingdom, and colleagues write. "In addition, it may prevent the need for general anesthesia in some cases."
The positive pressure technique involves a trusted caregiver sealing his or her mouth over the child's mouth and rapidly exhaling while occluding the unaffected nostril. Closure of the glottis limits the risk for barotrauma, and the low pressure generated is comparable to that of a sneeze (60 mm Hg).
To determine whether "mother's kiss" was effective, researchers from the United Kingdom and Australia performed a systematic search of current literature, identifying 6 relevant case series and 2 case reports involving children aged 1 to 8 years. Fourteen articles were excluded, including 4 review articles, 7 articles not written as case series, and 3 articles that consisted of a technique description only.
Data analysis revealed that mother's kiss was effective 59.9% of the time (95% confidence interval [CI], 52% - 67%), a success rate found to be independent of object type (smooth, 73% [95% CI, 56% - 86%] vs irregular, 77% [95% CI, 62% - 87%]).
Most foreign objects (87%, 27/31) documented in the studies were visible before removal attempts. Two studies concluded that fully obstructing objects were much more likely to be propelled out of the nose than those allowing air to pass, and that irregularly shaped objects tended to be easier to grasp.
The authors also found that implementation of the technique may prevent the need for general anesthesia in some cases. Of the 2 studies that included relevant information, one reported a 90% decrease in anesthesia use during 6-month periods before and after implementation of the technique (from 32.5% to 3.2%), and the other reported a lower rate of general anesthesia when the technique was attempted first (11.9% vs 18.8%; P = .34).
No adverse events were reported despite theoretical risks for epistaxis, ruptured tympanic membrane, or pneumothorax.
Insufficient data were provided in the studies with respect to determining technique success relative to the length of obstruction time, object visibility, or prior attempts at removal.
"Further studies are needed to compare different positive-pressure techniques, and to test their efficacy in specific situations addressing how long the foreign body has been lodged and its location in the nasal cavity," the authors write. They also note that future research should involve preregistered, large, consecutive, prospective case series to reduce the effect of selective reporting.
CMAJ. Published online October 15, 2012. Abstract
Commentary: A fascinating study regarding a unique way in which parents can actually treat their child effectively while potentially avoiding need for traumatic medical intervention.

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