Laceration care: What to do with a bleeding child

The Pediatric Insider

© 2011 Roy Benaroch, MD

Kids can be clumsy. Even I, myself, once fell off of a canister vacuum and needed a handful of sutures in my forehead. I’ve also cut my finger with an Exacto-Blade, requiring by friend Nani to sew me up (assisted by her dog.) It turns out that cheese can be sliced really thin with an Exacto-Blade… though in retrospect, I wouldn’t recommend it.

Anyway: cuts are inevitable, and some of them are going to need to be sewed up. Who needs a trip to the ER? What are the different ways of closure? What do I do afterwards to take care of the wound? And what kind of idiot falls off of a vacuum cleaner?

The best first aid for any sort of cut is pressure. Try that first. Use some gauze or a clean towel and push down. If the bleeding stops and the wound isn’t really in a cosmetically important place, you probably don’t need further evaluation. Clean the wound well with running water, and put on a Band-Aid if your child wants one or if it’s likely that wound is going to get dirty or pull apart again.

There are two main reasons for closing up a wound more formally: it won’t stop bleeding, or you’re not going to be happy with the scar. Any wound that gapes open is going to leave a bigger scar, and any wound that crosses over a joint is more likely to keep opening up and bleeding. Scars are more noticeable on the face (especially if they cross onto a lip or if they’re oriented vertically.) Whether a scar is going to be acceptable does involve some guesswork. If you’re in doubt, it’s probably better to go see someone experienced with wound care. Although you can, later, see a plastic surgeon to “clean up” a neglected wound, it’s usually better to close ‘em up earlier if an ugly scar is likely.

We’re reluctant to close some kinds of wounds because of risks of infection or poor healing. Animal bites are more likely to be loaded with bacteria, so sometimes it’s better to leave them open; wounds that have a lot of crush injury around them don’t tend to hold sutures well. Any wound that’s more that 12-24 hours old is more likely to get infected, too—so if closure is needed, don’t wait until the next day to go in for evaluation.

What kind of closures are available? Traditional sutures (aside: medical people don’t call them “stitches”) work great, but can be a little scary to put in a child. If the wound is under the chin or on the scalp, medical staples can be applied very quickly. They leave a bit more of a scar, but that’s OK on some locations. There is also a medical, overpriced version of Superglue that works pretty well on low-tension wounds that don’t gape open much.

No matter what kind of closure is recommended, any wound needs to be cleaned out well beforehand. The best way to do this is with a spray of water, either from a sink or some kind of syringe/tube gizmo. You’ll also want to ensure that for any kind of significant burn or laceration, your child is up-to-date on tetanus immunizations.

Whoever did the closure ought to have provided detailed after-care instructions about keeping the area clean, and when to return for suture or staple removal. You probably don’t have to go back to the ER or urgent care place that put in the sutures—your pediatrician can take care of removal afterwards (some pediatrician’s offices can also take care of wound closure. Call before you head to the ER!)

In general, keep the wound dry for the first 24 hours or so. Afterwards, if there are staples or sutures it’s best to gently wash the area once a day with soapy water. You don’t have to scrub, but you do want to keep the crusties cleaned off. A crusted, gunky wound makes suture removal a nightmare. Clean up the area and dry it off. You may have been instructed to then apply a dab of antibiotic ointment, and/or a Band-Aid or something to cover it.

The longer you leave staples/sutures in, the less likely the wound is to re-open—so wounds across joints need to stay in longer. However, leaving them in too long makes the scar worse, so for wounds on the face it’s better to get them out as soon as it’s safe. Get more specific instructions on when to return for removal from whomever did the closure.

Red flags: after closure, lookout for signs of infection like oozing or increasing pain or swelling. A little bit of redness at the edges isn’t a problem, but spreading redness or tender and warm red swelling is bad. When in doubt, go in for a re-exam. Prophylactic antibiotics are rarely necessary, but if they were prescribed take them as directed.

Cuts and scrapes and even an occasional broken bone are a part of childhood. You can’t keep your child 100% safe from sharp pokey things—or wayward, hateful vacuum cleaners.  Running water followed by pressure and a Band-Aid will probably take care of 99% of childhood lacerations, but if it’s still bleeding or looks bad, call your doctor or head to the ER.

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