Children’s Lacerations: What You Need to Know

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by Dr. Christopher Haines

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03.23.2022

Children’s Lacerations: What You Need to Know

Kids Health Secrets | Blue Emerald Wellness

deep laceration on forehead

Find out how to deal with lacerations in kids. Get answers for all your questions about treatment, prevention and more.

Lacerations are a common injury in children. If you have children and they have not sustained a laceration, the likelihood is that they will and hopefully this information will help you. They can occur from a variety of accidents, such as falls, cuts with a sharp object, or bites. In this blog post, we will discuss the types of lacerations that occur in children, how to treat them, and when to seek medical help. We will also provide some tips for preventing lacerations in your little ones!

What is a laceration?

A laceration is a cut or tear in the skin. They can occur anywhere on the body, but are most common on the head, face, and hands. Lacerations can vary in size from a tiny nick to a large tear requiring repair.

Types of Lacerations:

There are three types of lacerations that can occur in children: incised, punctured, and avulsed. Incised lacerations are the most common type, and they occur when a sharp object cuts the skin. Punctured lacerations involve a piercing injury, such as a nail or needle. Avulsed lacerations are the most serious type, and they occur when a chunk of skin is pulled from the affected area.

Treatment

Most lacerations can be treated at home with basic first aid measures. Clean the wound with soap and water, then apply pressure to the wound to stop the bleeding. After the bleeding has stopped, apply antibiotics ointment as well as a dressing of gauze or a band-aid.

Reasons to Seek Medical Help:

•Bleeding heavily and unable to stop

•Deep/longer ½ inch

•Close to the eye

•Cuts on face/ears/nose/lips

•Puncture dirty rusty object

•Embedded debris

•Ragged edges/non-linear

•Animal/human bite

•Excess pain

•Signs of infection

•Vaccines (not having tetanus, animal bites)

If you need to bring your child to the emergency department, emergency physicians may need to repair your child’s wound/laceration with steri-strips, stitches, or tissue glue.

Steri-strips

putting steri-strips on skin

Steri-strips are special adhesive bandages (can be purchased over the counter) that are used for shallow wounds/lacerations that do not require stitches (sutures). Steri-strips function like stitches. In general, they are left on until they fall off and do not require removal.

Tissue Glue

dermabond label

Tissue Glue (dermabond) is a special adhesive that is used to close lacerations. Similar to steri-strips it is generally used for small, shallow wounds, functions like stitches and does not need to be removed.

Stitches

stitches in skin

Stitches or sutures are a special type of thread with a curved needle on the end that allows closure of deeper laceration. They come in different sizes (used for different parts of the body based upon need for cosmetic outcome or the amount of tension on a wound) and are used to hold the wound together. Additionally, stitches may be absorbable or non-absorbable ,which means if they are absorbable they will come out on their own and not need removal. In many pediatric emergency departments based upon research, physicians are primarily using absorbable sutures as it makes it less traumatic for a child since they will not need removal.

Animal bites

pitbull dog

Animal bites can cause significant lacerations in children and should be evaluated by a medical professional, possibly an emergency physician depending on the type and extent of injury.

The most common bite that is seen in the emergency department is caused by dogs. There are 4.7 million dog bites yearly according to the CDC, with greater than half in children. The most common victims of dog bites are boys aged 5-9 years with injuries to the face neck and head. Parents should take additional care with young babies and toddlers. Research has shown that certain breeds have a higher risk of bites.These include the following breeds; Pitbull, Tottweiler, German Shepard, and mixed breeds.

In general, bite wounds/lacerations will not be repaired and may be treated with antibiotics as they are higher risk for infection. However, depending on location (if there is a risk of cosmetic deformity, most commonly on the face), emergency physicians will repair and treat with antibiotics if a parent understands that there is risk of infection and that the repair is being done to improve the cosmetic outcome of their child.

It is also important when you come with your child to the emergency department to have the information about the animal that caused the bite as this will impact the need for rabies treatment/vaccination. Parents should also keep in mind that bites from bats, raccoons, skunks, and foxes can be serious while having an increased risk of rabies.

Common Questions asked by parents

Will my child have a scar?

long scar on skin

If you talk to any emergency physician or plastic surgeon, we are asked this question frequently. The answer is yes. Once your child has sustained a laceration, the likelihood is there will be a scar however, the purpose of repairing a wound is to minimize the scar. The good new is that children’s lacerations heal well.

Does my child need a plastic surgeon?

This is a common question we hear from parents. The answer is that emergency physician and pediatric emergency physician are trained to close most lacerations and are very comfortable closing wounds in children of all ages. We also know when a plastic surgeon is needed, our limitations, and will have a discussion with you when we think a plastic surgeon is needed.

Common reasons we have a discussion with you regarding the need for a plastic surgeon is the following: large, potentially disfiguring lacerations, large facial lacerations involving the lips, ears, eyelids and nose. Also, keep in mind you can always request a plastic surgeon, but you may have to wait as they are generally not in the emergency department and in some case you may be asked to pay depending on whether it is considered an elective, cosmetic repair.

Can it be glued?

This is also a common question we hear in the emergency department. As would be expected, parents are hoping that their child can have a laceration repaired with tissue adhesive (glue) as it can be less traumatic and invasive. At times we can use tissue adhesive depending on the type of laceration, but we will take into account the location (tissue adhesive is not great for around the eyes, animal bites, and extremities), age (younger children may pick at the tissue adhesive, pull it off and it may result in more scarring), and depth/length of the wound (longer and deeper lacerations do not do well with tissue adhesive).

Do they need something to be sedated?

This is a question that is child specific while also relating to the type and location of the laceration. We do not sedate or provide anxiolysis (medication to relax the child) for every laceration repair. We will assess every child individually as sedation has risks. While assessing we evaluate risk versus getting the best laceration repair that we can get. So the real answer is, it depends. It depends on the age of the child, how long the repair may takes as well as many other factors. When we don’t use sedation or anxiolysis, we may use child life techniques (techniques that will distract or calm your child) and use gentle techniques to restrain. But the good thing is that although every child (and parent is different), the majority of children can have a laceration repaired without secondary trauma.

Did I bring my child to the emergency department soon enough?

distracting a toddler boy with a smartphone

In general, if you think your child may need stitches, your child should be evaluated in an emergency department within 6-12 hours. If you are unsure, use the guide above or call your child’s pediatrician. After this time frame and the longer you wait, the risk of infection increases with closure. So if you delay, a wound/laceration may not be able to be repaired which can lead to increased scarring.

Prevention

Finally, lets go over some tips to prevent lacerations in your little ones:

-Teach your children about basic safety rules, such as not running with scissors

-Supervise them when they are playing with sharp objects or around animals

-Make sure they wear appropriate gear when participating in sports or activities that may involve contact

We hope you found this blog post helpful. If you have any additional questions don’t hesitate to ask us at BlueEmerald Wellness/Kids Health Secrets!

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For more information and resources on your baby’s or child’s health, parent tips and tricks, pediatric emergencies, please visit our website or blog. Follow us on Instagram, Facebook and Twitter. You can also visit our website to download free PDF guides and hear our podcasts.

The information in this blog is not intended to substitute for professional medical advice, diagnosis or treatment. All content is for general information purposes and is the opinion of staff at Blue Emerald Wellness. Please do not delay seeking medical advice or treatment because of something you read in this blog.

Disclosure: We only recommend products we would use ourselves and all opinions expressed here are our own. This post may contain affiliate links. If you use these links to buy something we may earn a small commission. Read our full privacy policy here.

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