Care of Abrasions and Minor Lacerations in Pediatric Age

Topic Name Introduction Initial Assessment Wound Classification Management Principles Procedural Techniques Aftercare & Follow-up Complications Special Considerations

Introduction to Pediatric Wound Care

Proper management of abrasions and minor lacerations in children requires understanding of wound healing principles, age-specific considerations, and techniques to minimize trauma and anxiety.

Key Principles

• Child-centered approach to minimize psychological trauma
• Appropriate pain management before procedures
• Aseptic technique to prevent infection
• Age-appropriate wound care instructions
• Parent education and involvement

Initial Priorities

• Establish rapport with child and family
• Quick assessment of wound severity
• Pain evaluation and management
• Determination of tetanus status
• Assessment of need for antimicrobial prophylaxis

Initial Assessment

History Taking

• Mechanism of Injury:
  • Time and circumstances of injury
  • Potential contamination
  • Force involved
  • Associated injuries
• Past Medical History:
  • Tetanus immunization status
  • Allergies (especially to antiseptics/anesthetics)
  • Bleeding disorders
  • Keloid formation history

Physical Examination

• Wound Characteristics:
  • Size and depth
  • Location and orientation
  • Edge appearance
  • Presence of foreign bodies
  • Degree of contamination
• Functional Assessment:
  • Neurovascular status
  • Range of motion
  • Tendon involvement
  • Joint involvement

Pain Assessment

Age Group	Recommended Scale	Key Considerations
0-3 years	FLACC Scale	Observe behavior and physical signs
3-7 years	Faces Pain Scale	Use simple visual aids
7+ years	Numeric Scale (0-10)	Can usually self-report accurately

Wound Classification

Abrasions

• Superficial:
  • Epidermis only
  • Minimal bleeding
  • Good healing potential
• Partial Thickness:
  • Through epidermis into dermis
  • More painful
  • Risk of scarring
• Deep:
  • Into subcutaneous tissue
  • Higher infection risk
  • May need specialized care

Lacerations

• Simple:
  • Linear wounds
  • Clean edges
  • Minimal tissue damage
• Complex:
  • Irregular edges
  • Tissue loss
  • Multiple layers involved

Risk Stratification

Risk Level	Characteristics	Management
Low	Clean, superficial, <6 hours old	Standard wound care
Moderate	Moderately contaminated, 6-12 hours old	Thorough irrigation, consider antibiotics
High	Heavily contaminated, >12 hours old	Extensive debridement, antibiotics

Management Principles

Pain Management

• Topical Anesthesia:
  • LET (Lidocaine-Epinephrine-Tetracaine)
  • EMLA cream
  • Application time: 20-30 minutes
• Local Infiltration:
  • 1% lidocaine with epinephrine
  • Maximum dose: 4.5mg/kg
  • Buffering reduces pain

Wound Preparation

• Cleaning:
  • Normal saline irrigation
  • Pressure: 7-8 psi
  • Volume based on contamination
• Debridement:
  • Remove devitalized tissue
  • Preserve viable tissue
  • Consider conservative approach in children

Closure Methods

Method	Indications	Advantages	Disadvantages
Adhesive Strips	Superficial, low-tension	No anesthesia needed	Limited strength
Tissue Adhesive	Small, clean wounds	Quick, painless	Cost, technique sensitive
Sutures	Deep or high-tension	Strongest closure	Requires anesthesia

Procedural Techniques

Suturing Guidelines

• Material Selection:

  Location	Suture Type	Size	Removal Time
  Face	6-0 fast absorbing	Plain gut	5-7 days
  Scalp	4-0 or 5-0	Nylon	7-10 days
  Trunk/Extremities	4-0 or 5-0	Nylon	10-14 days

Tissue Adhesive Application

• Technique:
  • Ensure complete hemostasis
  • Approximate edges precisely
  • Apply thin layers
  • Allow 30-60 seconds between layers

Aftercare & Follow-up

Wound Care Instructions

• First 24-48 Hours:
  • Keep wound clean and dry
  • Minimize movement
  • Ice for comfort
  • Elevate if possible
• Ongoing Care:
  • Daily cleaning with soap and water
  • Antibiotic ointment application
  • Dressing changes as needed
  • Sun protection

Return Precautions

• Increasing pain or redness
• Fever or systemic symptoms
• Wound dehiscence
• Purulent drainage

Complications

Early Complications

• Infection:
  • Signs and symptoms
  • Risk factors
  • Management approach
• Bleeding:
  • Assessment
  • Hemostasis techniques
  • When to be concerned

Late Complications

• Scarring:
  • Prevention strategies
  • Treatment options
  • When to refer
• Functional Impairment:
  • Assessment
  • Rehabilitation needs
  • Follow-up care

Special Considerations

Age-Specific Approaches

• Infants:
  • Careful restraint techniques
  • Parent involvement
  • Quick procedures
• Toddlers:
  • Distraction methods
  • Child life specialist involvement
  • Reward systems
• School-Age:
  • Explanation of procedures
  • Involvement in care
  • Positive reinforcement

Documentation Requirements

• Detailed wound description
• Procedure notes
• Materials used
• Follow-up plans
• Parent instructions provided