As pediatric surgeons, my partners and I deal with all sorts of seemingly strange conditions in the office and the emergency department. One such condition is what we call a “hair tourniquet.”
Anyone who has had blood drawn is familiar with a tourniquet: usually a thick rubber band that is tied tightly around your arm to block the blood flow so your veins swell and they’re easier to see. It turns out a strand of hair or thread can act like a tourniquet as well. With infants and toddlers, the hair or thread can become wound around a toe or other extremity, severely reducing the circulation of blood. Such instances increase in the winter when children are regularly wearing socks, especially if the socks are not changed daily. We also see this condition when babies first come home from the hospital, when moms begin to lose some of the extra hair they grew during pregnancy.
The longer the tourniquet stays in place, the more severe the condition becomes. Early signs are mild swelling and sometimes increased fussiness, and are easy to miss. But as the blood flow continues to be inhibited, the toe becomes increasingly swollen, painful and discolored, often like a bruise. If the tourniquet is not relieved, it could result in permanent damage. It is usually when the swelling gets worse that most parents first become aware of the problem, because their child becomes very uncomfortable and upset. Even if you can’t see the hair itself, it doesn’t mean it’s not there. The swelling can often obscure the very fine thread or hair causing the problem. Occasionally, by the time the toe gets to this stage, it may be numb, and the fussiness will have passed.
If your child demonstrates signs and symptoms of a hair tourniquet, even if you can’t see it, it’s important to bring her to the pediatrician’s office, urgent care or emergency department immediately to avoid permanent complications from decreased blood flow. Parents often feel terrible about not having noticed the tourniquet sooner, but the truth of the matter is that once the swelling begins, the condition can progress rapidly because the tourniquet gets progressively tighter from the swelling, resulting in further inhibition of blood flow and even more swelling.
Fortunately the treatment is simple: cutting and removing the tourniquet to improve blood flow. However, it can sometimes take several hours or days for the color and swelling to improve. Infection, characterized by persistent redness and swelling, is another complication.
Remember, if you have any questions at all, you can call the office of Pediatric Surgical Associates. We are always available to discuss and address parents’ concerns.