What to do (or not to do) if Your Child has a Neck Abscess

Wait, what? Yes, you read that right.

When Kai was two months old, we flew across continents and oceans to be with family in Nairobi, Kenya. Kai was not a passive baby. I could not put him down for a second. I couldn’t cook, I couldn’t clean. I literally had to take him with me when I went to the toilet. I look at wonder at those babies who are content just lie there, staring at the ceiling or sucking on their toes. Never Kai. Even when you carried him, he wanted you to talk to him, play with him, take him for a walk… He never napped for longer than 20 minutes at a time! It wasn’t enough time to even take a shower so I would only take a shower when my mother came home from school. She’s a teacher. The good thing was, he never cried much, and only when you put him down.

Kai at 4 months, before the incident

When he was around 4 months old, he cried for 2 days straight. At night he hardly slept. My father remarked on how intensely he was crying. I wondered if this was ‘the colic’, which we had not experienced before. On the third day, while I was giving him a bath, I noticed a huge bulge on his neck that had not been there the previous day. I give him a bath daily (of course!) and would have noticed had anything been there. The appearance was shocking. It looked like a boil. It was red and hard, and painful to touch. It was clearly the source of his pain and subsequent tears.

Neck abscess on my poor baby

It must have been a Monday afternoon. I googled and the results said he probably had a neck abscess. I called my younger brother, who is a doctor. He told me it is caused by bacteria getting under the skin, and as white blood cells gather to kill that bacteria, pus is formed which would normally drain internally but remains at the site, causing the swelling. It would need incision and drainage (I&D), a procedure carried out in a surgical theater. He advised me to go the pediatrician immediately. To get his shots, I had been taking him to Gertrude’s Children Hospital in Donholm. When I called them, they were closed for the day and told me to go the following day, which was a Tuesday.

My mother came home from school and suggested we go to a herbalist. I was extremely against it. My mother is conservative in many ways. It is not that she doesn’t trust modern medicine, but she sees no need if herbal medicines work just fine. Before you go dismissing them, some herbal medicines have been proven to be effective for certain conditions. There was a time J (my older son) had a bad case of oral thrush and he was having difficulty chewing and swallowing. My mum got him some black powder from that herbalist and that very morning he was able to eat and he was completely healed a couple of days later. I just didn’t think this was one of those situations. But my mum had Kai’s best interests at heart, and my appointment at the clinic was for the following day. So she got us all into her small car and drove us to the herbalist. The herbalist said it needed cutting and draining (I&D), but she wasn’t going to do it. I wouldn’t have allowed it anyway. A procedure like that requires a sterilized theater. Instead, she gave us an ointment to cover and soothe the abscess.

The following day, I took him to Gertrude’s Children Hospital in Donholm. The pediatrician said he needed I&D and referred me to a pediatric surgeon who was going to be at their other clinic in BuruBuru. She gave me a painkiller and that helped Kai a bit. I went there in the afternoon and after a long wait, he finally showed up. He had been held up at his other gig, he came in still wearing his badge from The Agha Khan Hospital. He advised immediate admission for the I&D at the main hospital, Gertrude’s in Muthaiga. He asked me about insurance, I did not have insurance in Kenya. Just the regular NHIF. He gave me an approximate quote for the surgery at Getrude’s. I consulted my brother and my mother and they all agreed that since I was to be paying out of pocket, it would be cheaper to go to Kenyatta National Hospital (KNH). The best doctors in the country work and teach there anyway. The surgeon wrote me a referral. I asked him why we couldn’t just prick the abscess with a pin and drain it. Listen, there are no stupid questions.

What Not to Do When Your Child Has an Abscess

Do not, under any circumstances, cut and squeeze it yourself. The surgeon told me an abscess is not a boil. A boil is small and on the surface. It has a head as well so you can easily squeeze it.

An abscess goes deeper into the tissue. If it a neck abscess, there are veins involved. The abscess is not one big sac. It is several tiny sacs, like an orange. You cannot squeeze it out. Instead, you risk worsening the infection. The only way to get rid of an abscess is through I&D.

Go see your doctor if you suspect your child has an abscess.

Early Wednesday morning, my mum took the day off and drove Kai and I to KNH. We went through triage and what not, and were told to go to section number 54 (I don’t remember the exact number). When went to 54, the pediatric surgeon’s domain, we were told that he only does consultations on Thursdays. That is the sad state of public healthcare in Kenya. The sadder part is, if we were willing and able to, we could go to the private wing of the hospital, where we would be seen immediately.

So the pediatric surgeon was on site, but he was only seeing private patients, and only dealing with the public cases once a week!

I will admit I am privileged. I could afford to go to the private wing. After about an hour’s wait, we met with the surgeon who admitted us immediately. After paying the deposit, I think it was Kshs 30,000, we were led to the ward to wait for the surgery that was to take place at 5pm in the evening when he had a free slot. It was going to be a 15 minute procedure. The surgeon said we were not to feed the baby at least 4 (or was it 6) hours before the surgery.

Now, Kai loves eating. He breastfed constantly. To this day, his appetite can only be described as voracious. It took a lot of will to bear through his cries for milk. He had stopped crying from the abscess pain because of the painkillers, but he cried continuously for like 5 hours until it got to 5pm. At 5pm, we were told the surgeon was held up at another surgery and would be out by 6pm. Another hour of hunger and painful cries. My sis-in-law came by and helped to walk him around. It was finally approaching 6pm and it was clear we were likely to spend the night at the hospital (if everything had gone well, we would have been discharged on the same day). 6pm came and went and when we went to inquire what the hold up was, we were told a covid patient had been operated on in the theater we were to use so they were disinfecting it. By this time, it had been over 6 hours of fasting for Kai. I couldn’t bear it anymore and breastfed him.

Finally, the surgeon showed his face at 8pm and said he was ready, but by this time, Kai was full of milk and sleeping deeply. He told us he would schedule his surgery first thing in the morning at 9AM and advised us to stop feeding him at 5am. Luckily, he woke up after 7 so it was just a two hour ‘fast’ to get through.

On Thursday morning, the nurse came for him and together, we walked to the theater. He cried briefly as they disappeared behind the theater door. My mum and I waited outside. While the procedure lasted less than 15 minutes, they kept observing him until he woke up from the general anesthesia. He was brought out half an hour later, smiling! He was smiling! He hadn’t smiled for like a week.

He hasn’t stopped smiling since!

They didn’t stitch him up, they said the cut would close on its own in a week or two and it did.

Neck abscess I&D cut healing

The total bill came to just over Kshs. 100,000. As Kai is insured in Japan, when I cam back I was able to claim that amount from my insurance company.

What a thing to go through. It has taken me almost two years to write about it.

Enjoy these happy pictures of J and Kai a couple of months after the surgery.

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Kai is almost 6 months here, and J is almost 8 years and 6 months