Wound Care

Some wounds are scrapes and minor cuts. If your child has had a traumatic injury, they may have skin wounds such as bruises, scrapes, or cuts. (Cuts may be called lacerations by your doctor.) Large wounds might require stitches or staples. Cuts are treated based on where they are, what caused them, how deep they are, and other factors. Sometimes cuts will heal on their own, without extra treatment. For a larger wound, healthcare providers might treat them with sutures (stitches), staples, plastic bandages, or a type of surgical super glue.

All wounds heal in the same way. First, new red tissue builds up in the bottom. Then, new skin grows in from the edges and covers the red tissue. Your child’s wound will heal fastest if you create the best conditions for new tissue to grow. This means keeping the wound clean, warm, and moist by doing things, such as:

• Washing your hands before touching the area.
• Keeping a clean dressing (bandage) on the wound.
• Being careful to not let anything touch or bump the wound.
• Helping your child eat right.

Wounds that don’t heal easily are called chronic wounds. They require special care to heal. Chronic wounds can result from:

• Surgical wounds that reopen.
• Skin that breaks down when there’s too much pressure over a bony area (pressure ulcer).
• Injury to the feet or legs from poor circulation (arterial or venous ulcers).
• Loss of circulation and feeling due to diabetes (diabetic ulcers).

Proper care of your child’s wound will help prevent infection and could reduce scarring. It will also allow your child’s wound to heal as quickly as possible.

Your child’s wound will heal fastest if you create the best conditions for new tissue to grow. This means keeping the wound clean, warm, and moist by:

• Washing your hands. The most important thing you and your child’s caregivers can do to prevent infection is to wash your hands. You can use soap and water, or an alcohol-based hand rub. Wash before and after touching your wound.
• Keeping a clean dressing on your child’s wound. Dressings keep out germs and protect the wound from injury. They also help absorb fluid that drains from the wound and could damage the skin around it.
• Being careful. Protect the wound from trauma or injury. Don’t let anything touch it or bump it.
• Helping your child eat right. Eating the right foods will give your child’s body the nutrients it needs to heal. Having a wound puts extra demands on your child’s body. To heal, they need more calories and more nutrients. Wounds will heal faster if your child gets enough of the right foods, and if they don’t, the wounds will heal more slowly. Follow the guidelines below to promote healing.
  • Protein provides the building material for muscle and skin repair. It also helps boost immunity. Good sources of protein include:
    • Lean animal meat, such as beef, pork, chicken, or fish.
    • Dried beans, peas, lentils, or tofu.
    • Nuts, peanut butter, or seeds.
    • Cheese, yogurt, or eggs.
  • Carbohydrates supply the energy your body needs to heal. Good choices include:
    • Whole grain breads and cereals.
    • Potatoes, rice, or pasta.
    • A variety of fruits and vegetables.
    • Foods with vitamin A, such as bright orange fruits and vegetables, and dark green leafy vegetables.
    • Foods with vitamin C, such as citrus fruits, peppers, tomatoes, strawberries, cantaloupe, and broccoli.
  • Milk and dairy products are good sources of both carbohydrates and protein. If your child’s doctor says your child should not eat dairy, soymilk can be substituted for regular milk.
  • Water replaces fluid lost with draining wounds. Make sure your child drinks liquids each day.
  • Be sure your child gets enough healthy foods too. Your child may have trouble eating enough at meals to promote wound healing. These ideas may help:
    • Eat smaller meals more often. It may be easier to eat 6 small meals per day rather than 3 larger meals.
    • Eat healthy snacks. Your child can get more of the nutrition they need by snacking between meals on healthy foods such as:
      • Cheese and crackers.
      • Cottage cheese and fruit.
      • Half a sandwich and a small piece of fruit.
      • Peanut butter or nuts and sliced apples.
      • Granola bars and fresh fruit.
      • Vitamins and minerals. Your child can get most of the vitamins and minerals they need from eating a well-balanced diet, as described above. Be sure they eat at least one serving per day of red meats, fortified cereals, or dark green leafy vegetables.

If they are not eating at least 5 servings a day of fruits and vegetables, your doctor or dietitian may recommend a daily multi-vitamin. Your child should only take other vitamins or minerals as recommended by a healthcare provider.

Check with your child’s doctor or a dietician for the number of servings they should have of each thing based on your child’s age and weight.

Some people like to follow special diets for specific medical conditions. Your doctor can tell you if you need to do this. For example, if your child has diabetes, carefully follow the diet and medicine recommendations for their diabetes. If your child is a diabetic and their wounds are not healing, follow up with your dietitian or other healthcare provider.

If you need further help getting enough calories and protein in your diet, contact a dietitian. Your healthcare providers can help you find one.

Wounds can range in size from scrapes and minor cuts to large wounds.

Caring for Scrapes and Minor Cuts
Caring for scrapes and minor cuts includes:

• Cleaning them daily with mild soap and water. If your doctor prescribed an antibiotic ointment, apply a thin layer of ointment once or twice a day. Or, you can use over-the-counter antibiotic ointment.
• Checking daily for signs of infection (pus, red streaks, or tenderness).

Caring for Large Wounds or Wounds with Stitches or Staples
Caring for large wounds or wounds with stitches or staples includes:

• Taking prescribed medicine as directed. If your child was prescribed antibiotic pills, make sure they take them as directed until they are gone.
• Changing your child’s dressings as directed. You may not need to change the dressings or you’ll have a follow-up appointment before you need to start changing them.
• Keeping the wound dry for 48 hours after it was treated.
• Washing the wound as needed with mild soap and water after the first 48 hours). Put a very thin layer of antibiotic ointment over the stitches or staples, if directed by your child’s healthcare provider.
• Avoiding soaking the wound until it’s fully healed. This includes baths, long showers, saunas, and hot tubs.

Preparing to Change the Dressing
Keeping a clean dressing on your wound will help it heal. Your child’s nurse or doctor can show you how to change the wound dressing. They will let you know how long to keep the dressing on and what wound care products to use. Before you change the dressing, you must clean your work area and gather your supplies.

The supplies you might need include:

• Non-sterile gloves
• Adhesive remover
• Gauze sponges or pads
• Sterile normal saline
• Plastic trash bag
• Gauze wrap or dressing
• Scissors
• No-sting skin barrier film
• Skin prep
• Tape
• Other dressings (ask your child’s doctor about what these might be)
• Medicine

Saline, also called saline solution, is sterile salt water. It can have different amounts of salt in it. Normal saline has about 0.9 percent salt. You can make it or buy it.

To make a saline solution, follow these steps:

• Get a clean storage container and mixing utensil. Either wash them in the dishwasher or boil them for 5 minutes.
• Use 1 quart (4 cups) of distilled water, or boil 1 quart of tap water for 5 minutes. Do not use well water or sea water.
• Add 2 tablespoons of table salt.
• Mix the water and salt well until the salt is completely dissolved.
• Cool to room temperature before using.

Saline solution can be stored at room temperature in a tightly covered glass or plastic bottle. You can keep it for up to one week. Always label it and include the date.

Removing the Old Dressing
Remove an old dressing by:

• Washing your hands with soap and warm water or an alcohol-based hand rub.
• Putting on gloves if they are recommended.
• Slowly lifting the corners or edges of the wound dressing or tape. If it sticks to the skin, dab the edges with an adhesive remover, a moistened gauze pad, or a moistened paper towel.
• Holding down the skin surrounding the bandaged area. Gently and slowly remove the tape or dressing. Lift the tape across the skin rather than pulling it away from the skin.
• Lifting the edges of the dressing toward the center of the wound, then gently lifting it from the wound.
• Soaking the dressing with saline solution if it’s sticking to the wound, to help loosen it.
• Carefully discarding the old dressing into a plastic trash bag and tying it closed. Put that bag into a second plastic bag and throw it away.
• Removing the gloves and washing your hands again.

Cleaning the Wound
After you remove the dressing, you may see a thick, yellow, gummy film over your wound. This is good. It means the dressing is keeping the wound moist, which helps it to heal. Gently wash the wound when you change the dressing by:

• Putting on new gloves.
• Placing a towel under the wound.
• Wetting a gauze sponge or pad with saline or water. Gently clean the wound.
  • Start at the center of the wound. Dab in circles out to 1 inch past the edge of the wound. Do not go from the outer edges of the wound back toward the center. This could spread germs into the wound.
  • Be sure to clean away any liquid draining from the wound.
  • Throw out your cloth or gauze and get a new one as often as needed.
• Rinsing the wound again with a new gauze pad to remove any loose debris not removed by the first cleaning.
• Throwing the cleaning materials into the plastic trash bag.
• Drying the skin surrounding the wound by patting it with a soft, clean towel.
• Checking the wound for redness, drainage, swelling, or odor. New tissue at the bottom of the wound should be light red or pink and look lumpy or glossy. Do not disturb this tissue. It is very fragile and will bleed easily.

Applying a new dressing
Once the wound is clean:

• Open the new dressing and remove it from the package. Touch only the corners of the dressing. Cut it to size if necessary.
• Apply a skin barrier to the skin around the wound.
• Carefully center the dressing over the wound.
• Secure the dressing in place with tape.
• Remove the gloves and wash your hands.

Removal of Stitches or Staples
See your child’s discharge instructions for details on when to have your child’s stitches or staples removed. If stitches or staples are left in too long, they can cause scars and infections.

Stitches may be removed by your child’s regular doctor, or at the clinic or hospital where they were originally placed. Generally, stitches are removed in 5 days if they’re on the face, in 10 days if they’re on the chest or belly, and in 10 to 14 days if they’re on an arm or leg.

Reducing Scars
Almost all cuts result in some type of scar. How much your child scars often depends on their genetics. Factors such as sun, infection, and the type of cut can also affect scarring. To help reduce scars:

• Keep the wound out of the sun while it heals (this can take 3 months to a year). After it heals, use high SPF sunblock on the wound for a full year.
• Keep the wound free of infection by applying a thin layer of antibiotic ointment daily for 3 to 6 months.
• Keep the wound from getting too hot or too cold.

As your child’s wound heals, you will see the results of the wound care they have received. Your child’s doctor can help you understand any other results. Be sure to keep any follow-up appointments your child has so that you can talk to the doctor about the wound care and its results.

Your child’s discharge instructions should include when to schedule any needed follow-up appointments.

If your child had stitches, the stitches can be removed by your child’s doctor or at a wound care center. Generally, stitches are removed in 5 days if they’re on the face, in 10 days if they’re on the chest or belly, and in 10 to 14 days if they’re on an arm or leg.

Wounds that don’t heal easily are called chronic wounds. They require special care to heal. Sometimes bacteria (germs) are the problem. When your child has an open wound, it’s easy for common bacteria to get inside. Bacteria in your wound is called contamination. Not all contamination is bad though.

If bacteria are in your child’s wound, but they are not reproducing and not causing a problem, it’s called colonization.

Infection means the bacteria are spreading, so there are a lot more of them. They can invade the soft tissue and prevent healing.

Other factors that slow wound healing include:

• Poor nutrition
• Certain diseases, such as diabetes or diseases of the liver, kidney, or lungs
• Certain treatments, such as chemotherapy or radiation
• Smoking
• Obesity

During wound care, your child might get an infection, especially if the instructions from your child’s doctor are not followed.

The following symptoms could mean that your child’s wound is infected and you need to contact your healthcare provider:

• Increased pain at the wound site
• Redness or swelling around or spreading out from the wound site
• The wound site or surrounding area feels warm to the touch
• Fever or chills, nausea, or vomiting
• Foul odor coming from the wound after the wound has been cleaned
• Any change in color or amount of drainage from the wound

A small amount of clear drainage is normal. Pus that drains from the wound might be white, green, or yellow, and it is often smelly.

Scarring can also occur, even after proper wound care. Almost all cuts result in some type of scar.