Treating Your Child’s Scratches and Cuts: From the Medicine Cabinet to the Emergency Center

Children love exploring and playing... a set-up for fun, excitement, joy…and unintentional injuries! Skin wounds such as scrapes and cuts will occur in all children, and knowing how to care for these types of injuries is very important. Luckily, many skin injuries can be cared for at home and do not require immediate treatment in an emergency center. Today's blog takes a closer look at the different types of skin injuries and what kind of care you should seek:

Types Of Skin Injuries:

• Scrapes, scratches, and abrasions are surface wounds that do not cut through the skin.  Unless the wounds are persistently bleeding, dirty (with retained foreign body), or caused by an animal/human bite or electrical injury, most of these skin injuries can be cared for at home.
• Cuts, gashes, and lacerations are typically deep, jagged, and/or gaping and fatty tissue can be seen within the wound. Typically, these types of wounds need stitches and medical care should be sought (either at an urgent care or emergency center).

Home Care:  If the wound is bleeding, apply direct pressure to the wound for 10 minutes or until the bleeding has stopped. Then, gently wash the wound with soap and running water and remove as much dirt from the cut as possible. Once the skin is dried, apply an antibiotic ointment to help moisturize the skin and reduce the risk of infection. Most over-the-counter antibiotic ointments contain one or more antibiotics such as neomycin, polymyxin and bacitracin. The combination of these three antibiotics is often referred to as a triple-antibiotic ointment. Although the active ingredients are the exact same, many store-brand preparations are less expensive than the brand-named products. Medical Care:  If the wound requires stitches (also called sutures) or further medical evaluation, cover the open wound and continue to hold direct pressure for persistently bleeding injuries. Deciding where to take your child for stitches can be a tough decision.  Consider these factors when deciding where to go:

• Does your child remain relatively calm with cleansing and first aid? If your child does not appear overly anxious or scared, he/she may tolerate the laceration repair with topical and oral pain medications and distraction techniques.  Taking your child to an urgent care versus an emergency center would be an acceptable and safe choice.
• Will your child potentially need sedation for the procedure? If your child is very young and/or extremely anxious/scared or if the wound is extensive, he/she may need sedation medications to facilitate a successful repair. If you think your child may need sedation, you should take him/her to a pediatric emergency center.  Avoid letting your child eat or drink while heading to the emergency center, for most children need to have an empty stomach to safely undergo sedation.
• Will your child potentially need a pediatric sub-specialty surgeon, such as a pediatric plastic surgeon or pediatric orthopedic surgeon? If your child has an extensive laceration that is very large or deep, may involve underlying nerves/blood vessels/tendons/bones/joints, or was caused by an animal/human bite and is located on the face, hands, or feet, you should take him/her to a pediatric emergency center. If your child’s wound is significantly bleeding and is not stopping with direct pressure, has occurred to the face/neck/chest and is causing your child to have difficulty breathing, or is associated with a bone deformity or amputation, call 911 right away!

Expectations:  The goals of wound management, particularly suture repair, are to avoid wound infections, stop bleeding, and provide an aesthetically pleasing scar. All sutured wounds, regardless of whether an emergency medicine physician or plastic surgeon repairs the laceration, will leave a scar. The extent of the scar will depend on a variety of factors, such as the child’s genetic ability for skin healing (i.e., risk for keloid formation) and the size and severity of the laceration. Applying sunscreen to the area once the skin has healed and the sutures are removed may help aid in the cosmetic appearance of the scar. Additionally, unless the wound was caused by an animal/human bite, associated with an underlying broken bone or cartilage/tendon/joint injury, or exposed to excessive wound contamination, most healthy children do not require an oral antibiotic to “prevent” an infection. If your child needs pediatric emergency care, the Texas Children’s Hospital and Texas Children's Hospital - West Campus Emergency Center provides a complete range of pediatric services, treating children with both medical and surgical emergencies 24 hours a day, 7 days a week.  Additionally, the brand-new, Texas Children’s Urgent Care in Cinco Ranch is now open Monday through Friday, 4:30 to 11 p.m. and Saturday and Sunday, 12 to 8 p.m. A second Texas Children’s Urgent Care is scheduled to open this summer in the Town and Country area. Although Texas Children’s Urgent Care is equipped to handle a variety of pediatric illnesses and injuries, including simple laceration repairs, if your child potentially needs sedation or a pediatric sub-specialty surgeon, you should visit one of our Texas Children’s Hospital pediatric emergency centers.  

Author

Dr. Katherine Leaming-Van Zandt, Pediatric Emergency Medicine Specialist