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 is needed, it sometimes takes a little more know-how to help wounds heal properly.
The following FAQs will help you prevent serious bleeding and 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 with clean gauze or cloth over the site for five or ten minutes. The most common mistake is interrupting the pressure too early in order to peek at the wound.
Once bleeding stops: Gently wash the wound with soap and water for five minutes. If your child persistently objects, try soaking the wound in the bathtub. Cleaning the wound will decrease 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 cover it with a dry gauze or bandage until healed.
How do I know whether or not my child needs stitches?
Here are some guidelines to help you determine whether or not stitches are needed:
Cuts that go all of the way through the skin may benefit from stitches.
Any cut that is gaping open with visible dark red muscle or yellowish fat should probably be closed, even if it is small.
Any cut that is gaping and is more than ½ inch long should probably be closed. 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.
If your child has a cut that is deep, gaping, or in a cosmetically sensitive area, call your pediatrician to determine if stitches are needed.
What are the options available nowadays for closing a small cut?
Skin glue was approved for use in 1998 and has become very popular. It is applied by rubbing it over the cut while the cut is being held closed. It is a good choice for straight cuts and is quick and painless. If done well, the cosmetic outcome is the same as stitches. However, it cannot be used to close a wound that has any tension on it from muscle usage. This is because skin glue is not as strong as stitches and, when used in areas of tension, the risk of the cut reopening is high.
Steri-strips (or "butterfly" bandage closures) are narrow adhesive strips placed over a cut, with a bit of tension to keep it closed. They are used for small cuts that are not very deep or over a joint or areas of tension. If they stay in place for at least three days, the outcome can be just as good as stitches. However, they are not as strong as stitches and do not stay in place well.
Stitches provide more strength and little to no risk of being pulled off too soon. However, they can be traumatic due to the time and pain involved in putting them in. Absorbable sutures are stitches that do NOT need to be removed. Non-absorbable sutures are stitches that need to be removed, usually 5-12 days later, depending on the location.
Staples are most often used for cuts in the scalp (within the hair). They are very fast and close the cut almost as well as stitches.
How soon after an injury does my child need to see a doctor for stitches?
Most cuts can generally be closed as long as 24 hours after the injury. Some cuts should be closed sooner, but it is very safe to wait at least 8 hours to have a cut closed.
If you do decide to wait: Wash your child's cut under the faucet to get out any dirt. Do not let the cut dry out. Wet some gauze pads and tape them over the cut. Change the gauze every two hours to keep it moist.
My child's cut is on his face. Should I be concerned about scarring from the stitches?
Facial cuts in children usually heal remarkably well and with very little scarring. Pediatric plastic surgeons recommend that most facial cuts be repaired using simple interrupted sutures. The suture size and needle type are specifically designed for the delicate skin of the face.
How can I make my child's scar less visible?
There are some simple things you can do to help minimize your child's scar appearance 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. Damaged skin is very susceptible to becoming permanently discolored by the sun for up to 6 months after an injury. It is very important to minimize sun exposure to the healing cut. Keep it covered with a hat or clothing as much as possible or use a broad sunscreen to minimize darkening of the scar (called "hyperpigmentation"). Do not apply sunscreen until two weeks after the cut.
Scar massage. Scars may soften and flatten more quickly when they are massaged. To do this, use your fingers to apply moderate pressure and massage the scar in circles.
Silicone sheets or gels. Silicone products may help soften, flatten, and improve the coloration of a scar if used for at least 12 hours a day.
My child has a 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 and may be pink, red, or purple. These 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. You may be referred to a pediatric plastic surgeon to see if treatment is needed.