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Author: Ashley Grigsby, DO PGY-1
Indiana University Emergency Medicine/Pediatrics
Originally published: Modern Resident April/May 2015
Every little boy knows the best place for anything is up your nose. That is, until they show up in your emergency department (ED).
The Case:
Three-year-old previously healthy male presents after he put his older sister’s jewelry bead up his right nostril two hours ago. Vitals are normal. As you walk in the room, he is breathing comfortably and appears well, but his big brown eyes see you coming and immediately start welling up with tears. He’s sitting in his mom’s lap; he’s anxious and wants no part of you coming near him.
Now you start thinking to yourself, “How am I going to remove this bead from his nose without a giant screaming fit?” This is when you decide to employ the mother to perform the Parent’s Kiss.
The Parent’s Kiss is a technique that was first described in 1965 and there have been multiple case studies since then. The technique requires a parent, or trusted caregiver of the child, and careful instructions from the physician. You first council the parent on how to perform this technique, then you ask them to perform it. The parent should tell his or her child, “I’m going to give you a big kiss.” The parent then places his or her mouth over the child’s open mouth forming a seal and subsequently blows into the mouth until resistance is felt, then sharply exhales while occluding the unaffected nostril of the child.[1] This puff of air should pass through the unoccluded nostril and expel the foreign body. It is important to explain the entire procedure to the adult prior to having them start the process with the child.
This process for removal is best for ages two to five years old or in children who cannot be coached to blow their own noses. It can serve as an invaluable tool in this age group, which is particularly useful as this age group can be the most difficult to gain trust from and to restrain. This technique also reduces the risk of tissue damage from instrumentation, especially in an uncooperative child.[1]
One study found this technique successful in 20 of 31 cases in children under age five years.[2] A systematic review also found a similar success rate of 59.9% over multiple case series with no reported adverse effects.[1] The systematic review did not find any difference in success based on the type of object that was lodged. There are some theoretical risks to this procedure, including barotrauma and ruptured tympanic membrane; however, none of these have ever been reported.[1] The studies also suggest that its use as first line option may increase success rates with instrumentation if the Parent’s Kiss fails.[2]
Overall, the Parent’s Kiss can serve as a non-traumatic first step in the management of pediatric nasal foreign bodies. Next time that little boy is staring at you wide-eyed and tearful, give this clinical pearl a try.
References:
1. Cook S, Burton M, Glasziou P. Efficacy and safety of the “mother’s kiss” technique: A systematic review of case reports and case series. CMAJ. 2012 Nov 20; 184(17): E904–E912.
2. Purohit N, Ray S, Wilson T, Chawla OP. The ‘parent’s kiss:’ An effective way to remove paediatric nasal foreign bodies. Ann R Coll Surg Engl. 2008 Jul; 90(5): 420–422.