What is the recommended treatment for a 28.6kg child with a lacerated upper and lower lip, including wound care, antibiotics (e.g. amoxicillin), and pain management (e.g. acetaminophen)?

Management of Lip Lacerations in a 28.6kg Child

For this child with traumatic lip lacerations, clean the wound thoroughly with water or saline, avoid soap on the wound itself, do NOT prescribe prophylactic antibiotics, and provide acetaminophen 60 mg/kg/day divided into four doses for pain control.

Wound Care

Initial Cleaning

• Clean the wound with copious amounts of water or sterile normal saline to remove debris and reduce infection risk 1
• Do not use soap directly on the wound—soap is appropriate for cleaning intact skin around the wound but can irritate exposed tissue
• Ensure the wound base is completely dry before any closure method is applied 1

Wound Closure Considerations

• For low-tension lip lacerations that can be easily approximated, tissue adhesive (octyl cyanoacrylate) provides essentially painless closure 1
• Apply the least amount of glue necessary to seal the wound 1
• For wounds under high tension or those that cannot be easily approximated, consider sutures instead 1
• Ensure adequate lighting to properly visualize the wound before beginning any procedure 1

Antibiotic Management

Prophylactic antibiotics are NOT indicated for simple traumatic lip lacerations. 2

• The 2011 AAO-HNS guidelines specifically recommend against perioperative antibiotics for routine procedures 2
• Antibiotics should only be considered if there are signs of established infection (increasing pain, redness, swelling, purulent discharge) or if the wound is heavily contaminated
• If antibiotics become necessary due to infection, amoxicillin 60 mg/kg/day divided into two doses orally would be appropriate for this 28.6kg child (approximately 860mg twice daily) 3

Pain Management

Administer acetaminophen at 60 mg/kg/day divided into four doses for adequate pain control 3

• For this 28.6kg child, this equals approximately 430mg every 6 hours (total 1,716mg/day)
• This dosing provides effective analgesia while remaining well below toxic thresholds 3
• The European Society for Paediatric Anaesthesiology emphasizes that non-opioid drugs like acetaminophen are cornerstones of pediatric pain management 2
• Reassess pain regularly and adjust as needed 2

Local Anesthesia (if wound closure needed)

• Maximum lidocaine dose without epinephrine for children is 1.5-2.0 mg/kg 4
• For this 28.6kg child, maximum dose would be 43-57mg of lidocaine
• Using 1% lidocaine (10mg/mL), this equals 4.3-5.7mL maximum volume 4
• Allow 1-2 minutes after injection before beginning the procedure 4

Lip-Specific Care

While the provided guidelines focus on severe conditions like Stevens-Johnson syndrome, basic principles of lip care apply:

• Keep lips moisturized with white soft paraffin ointment or petroleum jelly to prevent cracking as the wound heals 2
• Encourage gentle oral hygiene with warm saline rinses 2
• Monitor for proper wound edge approximation during healing 1

Follow-up and Warning Signs

Instruct caregivers to watch for signs of infection:

• Increasing pain, redness, or swelling beyond the first 24-48 hours
• Purulent discharge from the wound
• Fever
• Wound dehiscence (separation of wound edges)

Common Pitfalls to Avoid:

• Do not prescribe antibiotics prophylactically—this contributes to resistance without proven benefit 2
• Do not underdose acetaminophen—60 mg/kg/day in four divided doses is the recommended analgesic dose, not the lower antipyretic dose 3
• Do not use soap directly in the wound—only water or saline 1
• Do not exceed maximum lidocaine doses if local anesthesia is needed 4