By: David Markenson, MD, FAAP
It is almost impossible for a curious and active child to avoid some scrapes and cuts. And while a kiss from mom or dad and some TLC is often all that's needed, it sometimes takes a little more know-how to help wounds heal properly.
Here are some ways to help stop serious bleeding and prevent other problems such as scarring when your child gets a cut.
What's the best way to treat a small cut or scrape?
Almost all active bleeding can be stopped by applying
direct pressure. Press a clean gauze pad or cloth firmly over the area for 5 to 10 minutes. Importantly, avoid lifting the cloth to peek at the wound too soon—this is the most common reason bleeding continues.
Once bleeding stops: Gently wash the wound with soap and water for 5 minutes. If your child protests or the area is too sensitive, try soaking the wound in a bathtub. Proper cleaning will lower the chance of infection and prevent dark spots caused by dirt trapped in the skin.
After cleaning: Apply a small amount of antibacterial ointment to keep the wound moist and help prevent infection. Small cuts and scrapes can be left uncovered, but if the area is likely to get dirty—or appearance bothers your child—cover it with dry gauze or a bandage until it is healed.
How do I know whether or not my child needs stitches?
Here are some simple guidelines to help you determine whether a cut needs stitches or another type of wound closure:
Cuts that go all of the way through the skin may benefit from stitches.
Any cut that is open with visible dark red muscle or yellowish fat should probably be closed, even if the wound is small.
Any cut that is open and is more than ½ inch long probably needs stitches. Get a ruler and measure it if you are not sure. Cuts smaller than this may not require closure, but if they are gaping, then it is best to have them checked out.
Small cuts that are not gaping may not require actual stitches but may still benefit from steri-strips.
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If your child has a cut that is deep, gaping, bleeding heavily or located on the face or another cosmetically sensitive area, call your pediatrician. They can help you determine if stitches—or another type of wound closure—are needed to promote proper healing and reduce scarring.
What to do if serious bleeding won't stop
Injuries can happen anywhere. Knowing how to stop bleeding on the spot can save a life―whether it is from a kitchen mishap, a bicycle fall, a car crash or even a shooting or suicide attempt.
For a teen or adult, losing about half a can of soda’s worth of blood is serious. For a young child or infant, even a few tablespoons can be dangerous. Bleeding is considered "flowing" when you can see the blood pulsing out.
If you saw someone losing a lot of blood, would you know how to help?
Act quickly.
A person who is bleeding heavily can die from blood loss within minutes.
Call 911 immediately.
While you wait for emergency responders, take these important steps below. Always check that the area is safe before you approach. If it becomes unsafe, move yourself—and the injured person, if possible—to a safer place.
3 lifesaving steps to take while waiting for emergency responders to arrive
1.
Apply direct pressure to the bleeding site. Expose the wound to find where the bleeding is coming from. Place clean gauze on the wound. If you have a hemostatic dressing (a special type of gauze that helps blood clot more quickly) use it. If you do not have gauze, use a clean piece of clothing.
Press down firmly with both hands, one on top of the other, applying as much pressure as you can. Lock your elbows and use your body weight to help provide strong, steady pressure. Use no more than one gauze pad or one thin piece of clothing for a single layer.
If blood soaks through the gauze, you do not need to do anything but can place one more gauze pad on top. Do not remove the first pad. If the top layer also becomes soaked, you may replace only that layer. Remember not to stack multiple pads or remove the original pad.
2.
IF bleeding doesn't stop on an arm or leg, apply a tourniquet. If direct pressure isn't enough and you have a commercial tourniquet, place it 2-3 inches above the wound. Tighten it until the bleeding stops. The tourniquet may be applied and secured over light clothing if needed, but it works best over bare skin. Avoid placing a tourniquet over a joint.
If the bleeding still doesn't stop, you can place a second tourniquet about 2 inches from the first one between the tourniquet and the heart. Homemade tourniquets aren't ideal, but if they are your only option, make sure they are at least 2 inches wide.
3.
If bleeding stops, watch closely for re-bleeding. If the wound starts bleeding again, remove any newer pads but keep the original pad in place on the wound. Reapply firm, direct pressure just as before.
To learn more, visit
StopTheBleed.org.
What are the options available for closing a small cut?
Skin glue
Skin glue was approved for use in 1998 and is now one of the most common ways to close small, straight cuts. It is applied by gently holding the cut closed and brushing the glue over the surface of the skin.
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Benefits: Quick, painless, and offers a cosmetic result similar to stitches when used correctly.
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Limitations: Skin glue is not strong enough for areas where the skin is under tension from movement, such as joints or muscles. It also cannot be used near the eyes or where glue might spread to sensitive areas.
Steri-strips ("butterfly" bandages)
Steri‑strips are narrow adhesive strips that are placed over a cut to pull the skin edges together and keep the wound closed. These are best for small, shallow cuts that are not under tension and not located over a joint.
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Benefits: When they stay in place for at least 3 days, the healing result can be as good as with stitches.
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Limitations: They are not very strong and may peel off early, especially if the skin is moist or the area moves a lot.
Stitches
Stitches are a strong and reliable method for closing deeper or more complex cuts.
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Benefits: Stitches provide more strength and little to no risk of being pulled off too soon. Absorbable sutures are stiches that do NOT need to be removed. Non‑absorbable sutures are stiches that need to be removed, usually 5-12 days later, depending on the location.
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Limitations: Stitches require a medical procedure to place and sometimes to remove. They may cause more discomfort during placement than glue or steri‑strips and usually take longer to apply than staples or skin glue.
Staples
Surgical staples are another option for closing certain types of cuts, especially those on the scalp (within the hair).
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Benefits: Staples are very fast to apply and close the cut almost as well as stiches.
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Limitations: They are usually not used on the face or other visible areas because the cosmetic results may not be as good. Staples must be removed later during a follow‑up visit. Some children may feel discomfort when the staples are placed or removed.
How soon after an injury does my child need to see a doctor for stitches?
Most cuts can be safely closed for up to 24 hours after the injury, unless the wound is dirty or poses higher risk of infection, like an animal bite. However, it’s always best to contact your pediatrician or another medical professional as soon as possible to get their advice.
My child's cut is on their face. Should I be concerned about scarring from the stitches?
Facial cuts in children usually heal remarkably well with minimal scarring, unless there is an infection or the wound is jagged or gaping. For the best cosmetic outcome, it is best to have your child evaluated promptly by your pediatrician or another qualified medical provider. They can recommend the safest way to close the wound and discuss how to lower the risk of visible scarring.
How can I make my child's scar less visible?
There are some simple things you can do to help minimize the appearance of a scar once the skin has fully healed.
Note: Scars cannot be completely erased, and no treatment can return your child's skin to exactly the way it looked before the injury.
Sun protection. Protecting the healing skin from the sun is one of the best ways to prevent a scar from becoming darker or more noticeable. Damaged skin can become permanently discolored by sunlight for up to 6 months after an injury. Keep it covered with clothing or a hat whenever possible ot use a broad‑spectrum sunscreen to help prevent darkening of the scar (called hyperpigmentation).
Do not apply sunscreen until your pediatrician or other medical provider says it is safe. If a provider did not evaluate the wound, wait until the skin is fully healed before applying sunscreen.
My child's scar seems to be getting bigger. Should I be concerned?
Sometimes, no matter what you do, a scar might not look as good as you want it to. Most of the time, this is a cosmetic issue. Occasionally, there are medical problems that can arise.
Hypertrophic scar. These are prominent scars that form as a wound heals. They may be pink, red or purple. Hypertrophic scars are often thick and raised, but they do not extend beyond the initial injury.
Keloid. These scars have spontaneously enlarged to form a firm, smooth growth. They are typically raised above the surface of the skin, look shiny, rough and irregular in shape. They can be pink, red or purple. Some keloids can become quite large, much larger than the original injury, and often extend beyond its original borders.
If you suspect a hypertrophic scar or keloid, talk to your child's pediatrician. They may provide a referral to a pediatric plastic surgeon, who can advise if treatment is needed.
About Dr. Markenson
David Markenson, MD, FAAP, is the former Chief Medical Officer and Chair of the Scientific Advisory Committee for the American Red Cross. He has authored many articles on the care of children and has led the creation and update of countless national programs on CPR and first aid. Dr. Markenson was the founding Co-Chair of the First Aid Science Advisory board, has led national and international evidence-based guideline groups on first aid and CPR, and has been a chair and member of ILCOR's first aid task force. He is a pediatrician who has also trained in Pediatric Emergency Medicine and Pediatric Critical Care. Dr. Markenson currently is a Professor of Public Health and Emergency Medicine at New York Medical College, Senior Associate Dean for Research and Director of the Center for Disaster Medicine.
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