What is the management for a 2-year-old patient with a laceration on their tongue?

Management of Tongue Laceration in a 2-Year-Old

Most tongue lacerations in young children do not require suturing and heal well with conservative management alone, including soft diet, good oral hygiene, and monitoring for complications. 1

Initial Assessment

Screen for child abuse first - trauma affecting the lips, gingiva, tongue, and palate in children younger than 5 years should raise suspicion for non-accidental injury. 2, 1 Document the mechanism of injury and assess whether it is consistent with the child's developmental stage and injury pattern. 2

Determine if Repair is Needed

Most intraoral lacerations, including tongue lacerations, heal spontaneously without intervention due to the excellent blood supply and healing capacity of oral tissues. 1

Indications for formal repair include:

• Large gaping wounds (>1-2 cm)
• Lacerations extending through the tongue border
• Persistent bleeding despite direct pressure
• Lacerations that significantly interfere with function (eating, speaking)
• Through-and-through lacerations

If repair is not indicated, proceed directly to conservative management below.

Conservative Management (Most Cases)

Immediate Care Instructions

• Soft diet only for 10 days following the injury - avoid hard, sharp, or irritating foods that could disrupt healing 1
• Maintain good oral hygiene with gentle brushing to optimize healing 2, 1
• Restrict pacifier or digit sucking for the first 10 days if applicable 2, 1
• No routine antibiotics needed unless specific medical condition requires coverage 2

Monitoring and Follow-Up

• Monitor for signs of infection: gingival swelling, increased pain, purulent drainage, fever, or systemic symptoms 1
• Watch for breathing difficulties (though unlikely with isolated tongue laceration) which should prompt urgent re-evaluation 1
• Educate caregivers to watch for complications over subsequent weeks 2

If Repair is Required

Sedation Considerations

For a 2-year-old requiring laceration repair, procedural sedation may be necessary as children younger than 6 years often require increased depth of sedation to gain behavioral control for procedures requiring immobility. 3

Key sedation principles:

• Practitioners must be able to rescue from one level deeper than intended sedation 3
• Continuous monitoring of oxygen saturation and heart rate is required 3
• Have functioning suction and capacity to deliver positive-pressure ventilation available 3
• Children younger than 6 years may be at greatest risk of adverse sedation events 3

Anesthesia Options

• Topical anesthetics (lidocaine-epinephrine-tetracaine) can provide effective, safe, and painless local anesthesia for oral lacerations 4
• Local infiltration with lidocaine if topical anesthesia insufficient 4, 5

Repair Technique

• Absorbable sutures are preferred for intraoral repairs to eliminate need for removal 4, 6
• Tissue adhesives are not appropriate for intraoral use 4, 6

Common Pitfalls

• Do not assume all tongue lacerations need suturing - most heal well conservatively and unnecessary repair exposes the child to sedation risks 1
• Do not miss child abuse - always consider non-accidental trauma in young children with oral injuries 2, 1
• Do not prescribe routine antibiotics - they are not indicated for simple intraoral lacerations 2