John E. Monaco, MD
Just the other day we took care of a little girl that I won't soon forget. The story went like this:
Jamie is a healthy toddler who, as always, was put down to bed with her favorite teddy bear. This particular bear had a pink ribbon around its neck tied in the form of a bow tie. Jamie's mother said that she loved to drag the bear around by its ribbon collar and often went to sleep with it gripped tightly in her hands. So, at about 11:30 that night, Jamie's father changed her diaper, noticed her clutching the bear, and noted that all seemed well with his little girl.
At about 6:30 the following morning, Jamie's mother heard her becoming restless in bed and figured it was time for her to wake up. As she rolled Jamie over, she appeared to be perfectly content, wiping the sleepiness from her eyes. Once again, Jamie needed a diaper change, so her mother thought she would attend to this before proceeding with the other tasks of the morning. As she rolled her over, she attempted to remove the bear from Jamie's clutches. The problem was the bear would not move. She seemingly could not pull it from Jamie's grip. But she noticed Jamie's hand was open, she was no longer actually gripping the bear. Still she couldn't move it. Then she noticed, with horror, that the first finger on Jamie's right hand was completely black from the first knuckle to the tip. The ribbon of the bear's collar was wrapped around it twice, and very tightly. She had the presence of mind to grab some nearby scissors and cut the ribbon away. Unfortunately, even after removing the ribbon from Jamie's finger, the color did not return. She touched it and it felt cold. She noticed Jamie was not moving her finger voluntarily, and cried whenever her mother tried to move or manipulate the finger. Jamie's mother, at that point, wasted no time in taking Jamie immediately to our Emergency Department.
Luckily, by the time she arrived at the ED, the staff there was able to elicit a faint pulse in the finger tip using a pulse oximeter. By the time the orthopedic doctor arrived, much of the color had returned, but the outermost layer of skin appeared as if it had been burned. It was determined that there was nothing to be done surgically at that time, so Jamie was admitted to the hospital for observation.
Within hours after admission, Jamie developed a blister that started at the tip of the finger and ended at a line clearly demarcated by the offending ribbon. For a couple of hours, there was concern that the blister was causing additional damage by creating secondary pressure on the finger. If the blister did not resolve on its own, the surgeon contemplated the possibility of taking Jamie to the operating room for a procedure that would involve cutting the skin of the finger to relieve the pressure. Thankfully, this was not necessary, the blister resolved on its own and eventually the outer layer of skin sloughed off.
By the time Jamie was discharged from the hospital the next morning, her finger remained somewhat swollen, but she was moving it and it seemed to have normal sensation. We were all reassured when the finger found its way to Jamie's mouth where, we were told by her parents, it normally gives her many hours of comfort and pleasure!
Not surprisingly, Jamie's parents removed the ribbon collar from the bear forever and planned to tell all their friends with small children about the risks of getting fingers tangled in such objects. They also planned to write the toy company to let them know of the potential risk. As for all of us, this case reminded us of the endlessly imaginative ways kids have to injure themselves!
John E. Monaco, M.D., is board certified in both Pediatrics and Pediatric Critical Care. He lives and works in Tampa, Florida. He welcomes your comments, suggestions, and thoughts on his observations.
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