Care of Abrasions and Minor Lacerations in Pediatric Age

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

Disclaimer

The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.