Self mutilation

[richinma2005]

I saw one other paper by Al-Qattan years ago, but never saw this one from 2004. Pain. 2004 Jul ;110 (1-2):123-9 15275759 (P,S,G,E,B,D)
[Cited?]
Self-mutilation in young children following brachial plexus birth injury.
[My paper] Mary Ellen McCann, Peter Waters, Liliana C Goumnerova, Charles Berde
Department of Anesthesia and Perioperative Medicine, Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA. mary.mccann@tch.harvard.edu
Brachial plexus injury in adults commonly produces persistent pain. Pediatric textbooks and case series suggest that perinatal brachial plexus injury is very rarely associated with pain, though this is difficult to determine in preverbal infants. Some of these young children self-mutilate the affected extremity, which may or may not reflect pain. This study was designed to characterize the clinical presentation and course of self-mutilation following perinatal brachial plexus injury. In this retrospective chart review, 280 patients were identified as having a perinatal brachial plexus injury from 1990-2002. Self-mutilation behavior was defined as excessive mouthing of or biting of any part of the affected limb, and/or loss of any parts of the affected limb secondary to biting and infection. Case reports were generated which described the severity of the primary injury, the types of surgical interventions, the duration and temporal relationship of behavior with surgical interventions and the nature of the self-mutilation behavior. Eleven patients demonstrated self-mutilating behavior, yielding a cumulative incidence of 3.9%. The median age of onset of this behavior was 17 (IQR=11-21) months, the median onset of the behavior was 8 (IQR) months after surgery and the median duration of this behavior was 6 (IQR=4-7) months. The incidence of self-mutilation among children who had undergone surgery was 6.8%(9 of 133 children) compared to the 1.4%(2 of 147 children) for non-surgical patients (P< .05). Seven of 24 children (29.1%) who underwent brachial plexus dissection demonstrated self-mutilation, which was significantly different from the incidence of self-mutilation in children who did not have surgery (P < .001). Self-mutilation behavior in our population occurred more frequently in children following brachial plexus microsurgery. The reasons for this association are unclear, but may be related to either the surgery or the severity of the initial injury or both.

[Mare]

Yes that was Frankie complete BPI started biting right after nerve graft tried everything to protect his arm and hand. wrapping in gaze, pringles cans so he couldn't get it to his mouth,splints. you name it we did it. Mostly it was when he was watching TV or would wake from a nap I would go in his room all splints and wrappings were off and he would be in a pool of blood. he has had the backs of his hand stitched bit the top of his thumb off and also would hold his bpi hand with his right hand and bang it on his crib he broke his wrist several times. Dr Laurent said it was possible that he was getting some feeling and it was annoying or painful and he was to young to understand. It did stop after about a year but boy was it hell. I doubt it is self mutilation in the sense of intentionally trying to hurt themselves but more the feelings they get from a nerve not working in the right way or just starting to work. I have MS and I have to live with a numb tingling like your foot feel asleep feeling all through my body and it makes me crazy.
I think Frankie was part of the study Dr Laurent had ask me to fill out some papers and take pics of his injuries and ways we tried to stop it in hopes of helping doctors to better understand what was going on this was in 1994
Mare

[tlangley03]

I posted a topic earlier today about this very thing.

Joshua..my 11 month old son, had Nerve Grafting surgery in May and has started biting his thumb...Badly! I have wrapped his hand in gauze then a baby sock then I put my husbands hunting sock on over that up to the shoulder. He does ok with that but of course that can not stay on 24-7.. the hand has to breath and we have to do pt. If I take my eyes off of him for a second I look back and he has bitten in. Last night I was getting ready to bathe him and sat him on the floor in the living room to get a towel....I came back and he had blood everywhere. He had bitten it again and it looks rough.

I dont know what to do! I am terrified that this is going to end up with him loosing his thumb. I am doing everthing I can think to do......

If anyone has any thougths...........PLEASE HELP!!!!

[jmar]

5 people in my family have actually got a self-mutilating disease called lesch-nyhan syndrome. this disease is horrible. i know how you feel when you see your son hurting himself all the time. there is a mitt you can buy that it is too thick to put in the mouth but soft enough that it wont hurt him. check with a medical supply store. you may have to order it because it is not a common item. it has mesh on one side so the skin can breathe and really thick padding on the other. you can see the hand through the mesh. without this mitt my nephew would have no eyes because he would poke them out. he cant bite his hands because his teeth had to be removed at a very early age. we cannot even look away while his mitt is off and cannot even let go of his hand. i hope this helps. i will try to find out the exact name for them and let you know. good luck and sorry you have to deal with this. i know how horrifying it is. another thing you could do is put a brace on his elbow so he cant bend his arm enough to reach his mouth and he would still have the freedom to use his hand. you could alternate between the two.