Wednesday, July 18, 2007

Want a Painless injection? Cough!

If there is one thing that most people fear most about seeing the Doctor, it is the possibility of getting an injection. So great is the fear, especially in kids, that parents sometimes use it as a threat to get their kids to behave themselves in the clinic.

A lot of the pain is psychological and stems from the fear itself. I sometimes give myself an injection when I feel really sick. At first it was very difficult because we have a built in mechanism that makes it difficult to inflict pain on oneself. But after you get over the psychological barrier, it is actually quite painless.

So the first thing about having a painless injection is to overcome the psychological barrier itself. This is easier said than done. Thankfully, there are other techniques that can help.

1. Cough

Surprised? I certainly was when I watched this on "Brainiac" last night. This discovery may make the fear of needles a thing of the past! The latest study published in the British Medical Journal found that the pain of injection is significantly reduced when the patient coughs hard at the time of the injection. It is thought that coughing increases blood pressure which in turn reduces the perception of pain. Not convinced? Try getting a friend to pinch your arm. Then ask him to do it again, but this time cough hard. Can you feel the difference? Link to BMJ article

2. Local Anaesthetics

This works very well for kids. The only drawback is that the anaesthetic cream is applied and you have to wait for half an hour to an hour before the skin becomes numb. Works well especially if their eyes are also covered at the same time so that they can't see what is going on.

3. Distraction

This was the old method I used before I discovered the cough method. Essentially, I tell patients to relax and think of their favourite things or simply tell them something startling, for example, that there is a Gorilla standing behind them. Works pretty well, but the mother-in-law standing behind them may not be very happy being called a Gorilla. But you get the idea. The other way to distract is to pinch or tap the skin just prior to the injection. By the time the injection goes into the skin, the skin is still processing information about the tapping, so the pain information going to the brain from the needle has to contend with a narrow bandwidth, ie a traffic jam, so to speak.


The fear of injections is a thing of the past! Next time you need to get a jab, cough hard when the injection goes in. But please warn the Doctor first because he might miss the spot if you suddenly start jerking your body about!

Tuesday, July 03, 2007

Help Doc! My Baby's Belly Button Sticks out!

Umbilical Hernia in a 8 week old Baby

Many parents get very anxious when they see a protruding belly button in their newborn babies. I guess all parents want their babies to come out perfect and when there is something not quite right we get rather anxious, especially so for first time parents.

There is a funny little story told about the difference between the first time, second time and third time parents. The story goes like this....

With the first baby, when the pacifier drops onto the floor, the parent picks it up, washes it with baby safe dishwashing liquid, pops it in the sterilizer before giving it back to the baby. With the second child, the parent picks it up, rinses it under the tap and pops it back in the baby's mouth. By the time they have their third child, they simply pick it up, pop it into their own mouths and gives it to the baby.

This story brings home one very important point and that is that knowledge and experience empowers. So for the first child, parents are very careful about everything because they don't know enough. By the third child, parents have enough knowledge and experience to be able to discern what is important and what's not.

Another way to get knowledge and experience is to learn about it from other people which is why you are reading this blog.

Anyway this baby first came to the clinic at 8 weeks of age with a protruding Belly Button. This is a condition known as an Umbilical Hernia. What happens is that there is a small defect in the muscle wall that allows some of the intestines to pop out, thus forming the hernia.

Umbilical Hernias are very common. As the baby grows, the defect in the muscle wall gets smaller and by 12 months, most hernias would disappear. Larger hernias may take longer to disappear. If by the age of 4 the hernia is still present, then a minor operation may be required to fix the defect in the muscle wall.

There is a small chance that the bowels in the hernia gets stuck so that the contents of the hernia cannot be pushed back into the abdomen. When that happens, the baby needs to be seen by a doctor straightaway. Thankfully, such cases are not common.

Umbilical Hernia in same Baby now 3 months old

As you can see from these 2 pictures that were taken 1 month apart, the hernia is already noticeably smaller. The baby's parents are obviously relieved and happy.


Umbilical hernias are very common and most will resolve by themselves. There is no need to do anything unless they persist past 4 years of age.


Murtagh, Patient Education 4th Ed, McGraw Hill Companies, 2005

Latest Update:

I saw the baby again and now the belly button is normal!