22 February 2010

How to Tell It's Time to Suction Your Sick Child

This post is for all the parents who will potentially wonder when is the time to suction their special needs child who's down with a respiratory tract infection.

This is what I have learnt:

SIGNS THAT SUCTIONING NEEDS TO BE DONE ASAP

#1: Child awakens from long sleep and starts to cry/fuss continuously.
It's probably due cos the gunk has been accumulating over the long duration of sleep. And when gunk accumulates it tends to thicken, making it more difficult to remove. Nurses reported daily that the 1st secretions of the morning after Vera awakens is usually very thick and of copious amounts.

#2: Child coughs repeatedly and secretions come out but still cries/fusses.
Her body is trying to expel the gunk but it is building up too fast for her to clear through her own cough reflex. If left to "try to clear it by herself", child will become more and more fatigued by the effort and become weaker. This lowers her immunity and infection may worsen.

#3: Child's breathing sounds "wet".
I asked the physiotherapist what this means. He says to listen out for a throaty, gurgly sound like this:



#4: Using a manual bulb sucker does nothing to ease child's crying/fussing.
This is because the little contraption is no match for the amount of secretions that is filling up the child's airway. It's like drawing water from a flooding river with a bucket.

#5: At the onset of an infection, ie Day 1-2, secretions tend to peak.
This calls for frequent suctioning - which may be as often as 1-2 hourly, dropping in intensity to 3-4 hourly, then 5-6 hourly by Day 5-6.

#6: Good chest percussion technique (up to 15 mins) is required for suctioning effectiveness.
Just like all mothers would know, it's like massaging prioring to expressing breastmilk.

(Parents already expert at suctioning, do share more tips that you know!)

***

Being newbie suctioners, we're not very confident yet cos we didn't get much practice during the last admission. But just seeing Vera inconsolable for hours - no amount of carrying or cajoling worked - and my instincts told me that we were not suctioning frequently enough at the onset of the infection.

Vera is in hospital this time because Ian and I could not agree on when it was time to suction her.

I would press for immediate suctioning. Ian would rather delay it and let her try to get it out herself.

Why?

Because suctioning is extremely uncomfortable for a child. And extremely painful for a parent to watch.

Because she'll cry till she's red in the face, produce more mucus and become even more choked up.

Because she'll struggle, the catheter will rub against the fragile nose and mouth membranes and there will be bleeding. (what parent likes to see a child bleed?)

But I've learnt that, just like tube insertion, it's something that just has to be done. Harden your heart, get set, go.

The consequences of not draining the floodwaters in time?

A mild infection becoming a full-blown one.

With no consensus, I knew I couldn't risk managing her secretions at home alone. Moreover, none of us were well-practised at suctioning.

I knew I couldn't afford it worsening into pneumonia and spend the next 2 weeks in hospital.

Not with the birth so near. Not with my increasingly tired and aching body. Not with my inability to stand or bend over a hospital bed for long.

So mommy hit the "panic" button - even though it was just Day 1 of antibiotics treatment (you're supposed to give it a few days to work) - and rushed Vera to hospital.

I knew the consequences of the decision: The doctors would push to admit her "We don't want her to choke (i.e. aspirate) on her secretions at home". And Vera would have to spend her 2nd birthday in hospital.



As I sang her favourite Baby TV Birthday Song to her today with a surprise cake from NUH, tears welled up in my eyes.

Maybe it's the traumatic memory of her birth 2 years back. Perhaps it's the fact that she was in hospital on my birthday as well. Maybe it's the decorations for her celebration in school, sitting at home. Or just the emotional weight of being 35 weeks pregnant.

But Vera doesn't seem to mind.

She smiles at the song (I've been singing it to her for 2 months until she recognises it now), and I know it was the right decision to bring her in early and nip the bug in the bud.

She is much better now. To all the staff who sang Happy Birthday to Vera, thank you.

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