What are the discharge instructions for a 5-year-old female patient with a 2.5 cm laceration on the bottom of her left foot near the fifth digit flexor crease that was treated with gelfoam (absorbable gelatin sponge) and wrapping, but not repaired?

Discharge Instructions for a 5-Year-Old with Foot Laceration

For a 5-year-old with a 2.5 cm laceration on the bottom of the left foot near the fifth digit flexor crease treated with gelfoam and wrapping, proper wound care and monitoring for signs of infection are essential for optimal healing.

Wound Care Instructions

Dressing Management

• Keep the current dressing clean and dry for the first 24-48 hours
• After this initial period, change the dressing daily or when it becomes wet or soiled
• When changing the dressing:
  • Wash hands thoroughly before handling the wound
  • Gently remove the old dressing
  • Clean the wound with clean, room temperature potable water 1
  • Pat the area dry with a clean towel
  • Apply a new clean dressing and secure it in place

Cleaning the Wound

• Clean the wound with clean, room temperature water 1
• Mild soap may be used if available
• Avoid using hydrogen peroxide, alcohol, or other harsh chemicals on the wound

Activity Restrictions

Weight-Bearing

• Minimize weight-bearing on the affected foot for 3-5 days
• Have the child use crutches if available and appropriate for age
• Otherwise, encourage the child to hop on the unaffected foot with adult assistance
• Resume normal weight-bearing gradually as comfort allows

Other Activities

• Avoid swimming or soaking the foot in water until the wound is fully healed (approximately 7-10 days)
• Avoid running or jumping activities for 7 days

Medication Instructions

Pain Management

• Give acetaminophen (Tylenol) as needed for pain according to package instructions based on child's weight
• Avoid NSAIDs like ibuprofen if possible due to increased bleeding risk 2

Signs of Infection to Watch For

Monitor for signs of infection, which include:

• Increased redness extending more than 0.5 cm around the wound 1
• Increased swelling
• Increased pain
• Warmth around the wound area
• Pus or foul-smelling discharge
• Fever (temperature above 38°C/100.4°F)
• Red streaking from the wound

Follow-up Instructions

• Return for follow-up in 7-10 days to check healing progress 2
• If the wound shows any signs of infection as described above, seek medical attention immediately

When to Seek Immediate Medical Attention

Return to the emergency department or seek immediate medical care if:

• The wound begins to bleed and doesn't stop after 15 minutes of direct pressure
• Signs of infection develop as listed above
• The child develops a fever (temperature above 38°C/100.4°F)
• The wound opens up or appears to be separating
• The child is unable to walk or bear weight after 3-5 days

Footwear Recommendations

• Have the child wear open-toed sandals or loose-fitting shoes that don't put pressure on the wound site
• Consider using a protective covering (like a clean sock) over the dressing when the child needs to walk

Additional Care Tips

• Keep the foot elevated when the child is sitting or lying down to reduce swelling
• Ensure the child drinks plenty of fluids and maintains good nutrition to support healing
• After complete healing (2-4 weeks), gently massage the scar with moisturizer to help with scar remodeling 2
• Protect the healed area from sun exposure with sunscreen (SPF 30+) for at least 6 months to prevent darkening of the scar 2

By following these instructions carefully, the laceration should heal well with minimal complications. The most important aspects are keeping the wound clean, monitoring for signs of infection, and seeking prompt medical attention if any concerning symptoms develop.