What is the recommended treatment for a wound in a child?

Wound Treatment in Children

The recommended treatment for wounds in children includes thorough wound cleansing with sterile saline or clean potable tap water, keeping the wound moist with an appropriate dressing, and monitoring for signs of infection. 1

Initial Wound Assessment and Cleansing

• Cleansing technique:

  • Use sterile saline solution or clean potable tap water to thoroughly irrigate the wound until all visible debris is removed 2, 1
  • Use warm water rather than cold for patient comfort 2, 1
  • Use sufficient volume (100-1000 mL) with adequate pressure for effective irrigation 1
  • Avoid additives such as soap or antiseptics in irrigation solutions as they may impair healing 1

• Pain management during wound care:

  • Apply ice for pain relief (no more than 20 minutes at a time with breaks between applications) 2, 1
  • Consider topical anesthetics for painful wounds (e.g., LET - lidocaine, epinephrine, tetracaine) 1
  • For extensive or deep wounds, consider procedural sedation or analgesia 2

Wound Dressing Selection

• For superficial wounds:

  • Apply a clean occlusive dressing to keep the wound moist and prevent drying 2, 1
  • For minor skin infections or secondarily infected lesions, mupirocin 2% topical ointment can be used 2
  • For children 2 years and older, a small amount of bacitracin may be applied 1-3 times daily 3

• For deeper or more complex wounds:

  • Apply a thin non-adherent contact layer directly to the wound surface 1
  • Secure dressings with tubular bandage rather than adhesive tape to prevent further skin damage 1
  • Choose appropriate dressing based on wound characteristics:
    • Dry wounds: saline-moistened gauze or hydrogels
    • Exudative wounds: alginates or foams to absorb exudate 1

Infection Prevention and Management

• Monitor for signs of infection:

  • Redness, swelling, warmth around the wound
  • Increasing pain or tenderness
  • Foul-smelling drainage or purulence
  • Fever or systemic symptoms 1

• For infected wounds:

  • Obtain cultures from abscesses and purulent skin infections if the child:

    • Requires antibiotic therapy
    • Has severe local infection or signs of systemic illness
    • Has not responded to initial treatment
    • Is part of a potential outbreak 2

  • Antibiotic selection for infected wounds:

    • For mild infections: Topical mupirocin 2, 4
    • For moderate infections requiring oral antibiotics: Amoxicillin-clavulanate or cephalosporins 1, 4
    • For severe infections requiring IV therapy: Vancomycin for hospitalized children with complicated skin infections 2
    • If the patient is stable without ongoing bacteremia, clindamycin is an option if local resistance rates are low 2

Special Considerations

• For bite wounds:

  • Thoroughly irrigate with tap water, saline, or soap and water solutions 2
  • Consider antibiotic prophylaxis (amoxicillin-clavulanate) 1
  • Ensure tetanus immunization status is current 2, 1

• For burn wounds:

  • Cool burns with TBSA <10% in children in the absence of shock 2
  • Use appropriate dressings based on burn depth and extent 2, 5
  • Standard antibiotic ointment-based dressings have shown better healing rates than silver-based dressings for pediatric extremity burns 6

Follow-up Care

• Wound monitoring:

  • Follow up within 24 hours for high-risk wounds 2
  • Arrange for wound check within 10-14 days for sutured wounds 1
  • Seek immediate medical attention if signs of infection develop 1

• Prevention of recurrent skin infections:

  • Keep draining wounds covered with clean, dry bandages 2
  • Maintain good personal hygiene with regular bathing 2
  • Clean hands with soap and water or alcohol-based hand sanitizer 2
  • Avoid reusing or sharing personal items that have contacted infected skin 2

Pitfalls to Avoid

• Don't use tetracyclines in children under 8 years of age 2
• Don't routinely administer antibiotic prophylaxis for uncomplicated wounds 2
• Don't use high-pressure irrigation for contaminated soft tissue injuries 7
• Don't delay wound care for children with extensive or deep wounds requiring specialist care 5
• Don't forget to evaluate tetanus immunization status and provide prophylaxis if needed 2, 1