Almost Invisible Hair Strands Could Wrap Around Baby's Toe
Parents try everything they can to protect their children from injury, but sometimes injuries occur when and where we least expect them. A medical problem called toe tourniquet syndrome is one such situation. Sometimes, babies are brought to the emergency room or urgent care clinics with a thin thread that has somehow wrapped itself around the baby's toe or finger, cutting into the skin and blocking blood circulation to the toe. If the threads are visible, the emergency room personnel remove them and then work to save the digit from further damage. However, there have been cases of babies with the appearance of a thread cutting off the circulation to the toe, but no thread could be seen. The authors of this article describe two such cases.
The first case involves an 18-month-old girl whose parents found that her third toe of her right foot looked like it was being strangulated. It was red and swollen and there was a thin groove along the base of the toe. This groove, however, wasn't new and they had brought it to their pediatrician's attention almost three weeks earlier. At that time, the parents were told that it was due to a skin infection for which he then prescribed antibiotics. Despite the antibiotics, the toe worsened. She was then diagnosed with mycosis, a fungal infection. Not long after, the parents brought their daughter to emergency for more investigation.
In the emergency department, the doctors couldn't find any threads but they did suspect that a hair strand may have been the cause. The girl was taken to surgery where two hair strands were removed from around the toe, a light-colored hair, looking like it was from the child and one dark one, which could have come from either parent. Later on, while the wound was being cleaned, a third, light hair strand was removed as well.
After three days of treatment, the toe regained its usual color, good blood circulation and normal appearance.
The second case involved a five-month-old boy who also had a problem with his third toe of his right foot. Over five weeks, his toe became red and swollen. Originally, the doctor had examined the toe for strangulation but was unable to find anything, even with a magnifying glass. The child's pediatrician then prescribed a corticoid ointment, which seemed to help reduce the swelling and redness. The strangulation line on the toe did not go away, however, and when the child was put under anesthetic, the doctors did find two fine strands of hair in the groove on the toe. The mother had been losing a lot of hair since the child's birth, she said but the doctors reported that the hair was more likely that of the baby because of it's blond color and fineness. After one month, the toe had returned to normal.
The authors wrote that this type of problem can happen to infants and babies and go undetected because of their inability to explain what is hurting them. Therefore, if symptoms like this appear, it is important to take into consideration that hair may be the cause, which would then be difficult to see. Interestingly, the problem happens more often in the warmer summer months, when hair may be in wading or swimming pools.
Toe strangulation from hair seems to occur most often in babies around four months of age, but may be as young as three months or as old as 11 months. This problem may also happen to a finger and the average age is about three months and is often associated with using mittens in the colder months.
It may be a good idea to warn new parents of this type of injury, particularly if either parent has long hair or the father has a lot of body hair. In warm weather months, children's toes should be checked after spending time in a pool or tub. In the colder months, mittens and gloves should be inspected by turning them inside out to check for loose threads.
Serafin Garcia-Mata, MD and Angel Hidalgo-Ovejero, MD. Hair Tourniquet Syndrome of the Toe: Report of 2 New Cases. In Journal of Pediatric Orthopedics. December 2009. Vol. 29. No. 8. Pp. 860 to 864.