Hair Tourniquet Syndrome

As a new parent, like all new parents, I find myself continually rifling through a repetitive mental checklist every time I hear the new addition to the family start to cry. Is she too hot? Is she too cold? When did she last eat? (She can’t possibly be hungry already). Does she need to be changed? Does her head feel warm? (Here honey, feel her forehead…now feel my head…now feel yours…do they feel the same?) This scenario seems to play out 20 times a day in newborn baby households around the world for certainly every parent at one time or another. Given my unique line of work as a foot and ankle surgeon, I do have one other checkbox that I constantly review and that is could this particular screaming fit be the result of hair tourniquet syndrome. Many new, and even experienced, parents have never even heard of hair tourniquet syndrome. While rare, hair tourniquet syndrome can have devastating results and should be something added to new parents checklist when their little one starts to fuss.

The name of the condition explains it all. With hair tourniquet syndrome, hair, thread, or similar thin pliable material becomes so tightly wrapped around an appendage that pain, laceration of tissue, and in extreme cases loss of affected appendage can occur.  Forty percent of reported hair tourniquet syndrome cases involve the toes.  Babies under 4 months old represent the highest risk age group because 90% of new moms experience some degree of post-partum hair loss immediately following childbirth. New moms spend so much time in close contact with baby during feedings, diaper changes, and washing, as well as folding a seemingly endless amount new, tiny person laundry that loose strands of hair can become easily lost inside baby’s socks and footed sleeper-style clothing. The constant wiggling and kicking motion that new babies are prone to do causes the loose hair or thread to become spontaneously tied around the toe and continue to constrict the area if not immediately addressed.

Once the hair or thread has wrapped itself around the toe, the material then acts as a tourniquet and begins to block adequate blood supply to the toe via the arteries and blocks appropriate blood return out of the toe via the veins. This reaction causes the toe to become significantly larger and more swollen and turn color to bright red, blue, and purple. As the swelling increases, the hair remains tightly constricted and can lacerate the tissue similar to cutting cheese with a cheese-wire. Extended periods of time with inadequate oxygen flow to the affected toe can lead to ischemia and gangrene, ultimately leading to amputation of the toe due to significant tissue death. Fortunately, amputation of the digit is extremely rare.

Early signs of hair tourniquet syndrome can often be missed like most of the time the child will be in socks or closed toed clothing at the onset of symptoms and thus may not be as obvious. Early signs include a sudden onset of an inconsolable baby. Once socks or clothing are removed and the toes are inspected, parents should look for red, swollen toes, where hair stands may be evident, making the cause of distress much more obvious.

Initial treatment includes unwinding hair under magnification with fine surgical instruments. If laceration of soft tissue has already occurred, or should hair not become untwined, then surgical removal may be necessary. Surgery includes making a small incision through hair and baby’s toe to release foreign material. Surgery is done under anesthesia in the operating room and while the incision causes injury to the baby, it usually prevents loss of the toe. Regardless of the effective treatment method, this condition is an emergent situation and early action is imperative to prevent tissue death.

Prevention includes checking baby’s socks and clothes for loose hair or thread prior to dawning and washing baby’s clothes inside out. Hair tourniquet syndrome is, fortunately, a rare phenomenon but should be added to every parent’s “crying baby” checklist. The good news is, while a very distressing situation to endure as a parent, outcomes remain consistently excellent.