Management of Superficial Scratch Wounds in Toddlers
For a simple superficial scratch in a toddler, irrigate thoroughly with tap water, apply plain petrolatum (not topical antibiotics), cover with an occlusive dressing, and give tetanus toxoid if the last dose was more than 5 years ago for contaminated wounds or more than 10 years for clean wounds. 1, 2, 3
Wound Cleaning
- Irrigate the scratch with 100–1000 mL of warm tap water to remove all debris and contaminants 1, 2, 4
- Tap water is as effective as sterile saline and superior to antiseptic solutions like povidone-iodine for wound irrigation 4
- Continue rinsing until all visible debris and foreign material are completely removed 4
- Room temperature or warm water is acceptable and more comfortable than cold water while being equally effective 4
Topical Treatment
- Apply plain petrolatum or petrolatum-based ointment WITHOUT antibiotics as first-line treatment 1, 2
- Petrolatum maintains a moist wound environment and promotes healing of superficial scratches 1
- Do NOT use topical antibiotics routinely for simple scratches—they provide no benefit over petrolatum for clean wounds 1, 4
- This recommendation is supported by the American Heart Association, which notes that occlusive dressings or topical agents significantly shorten healing time compared with no treatment 1, 2
Wound Coverage
- Apply an occlusive, non-adherent dressing over the petrolatum to maintain moisture and protect against contamination 1, 2, 4
- Occlusive dressings result in better healing than dry dressings 4
Tetanus Prophylaxis
- Administer tetanus toxoid (0.5 mL intramuscularly) if:
- This is critical: a recent case report documented generalized tetanus in a patient whose last booster was 7 years prior to a contaminated agricultural injury, highlighting the importance of the 5-year rule for dirty wounds 3
When Antibiotics Are NOT Needed
- Simple superficial scratches do NOT require topical or systemic antibiotics when properly cleansed and dressed 1, 2
- Clean lacerations and superficial puncture wounds similarly do not require antibiotics 2, 6
- The evidence shows no benefit for antibiotics in properly managed superficial wounds 1
When to Consider Antibiotics
- Reserve oral systemic antibiotics ONLY for wounds that develop clinical signs of infection: 1, 2
- Increasing pain beyond the initial injury
- Progressive erythema spreading beyond wound margins (>5 cm)
- Swelling or warmth at the wound site
- Purulent or foul-smelling discharge
- Fever or systemic symptoms
- If antibiotics become necessary, amoxicillin-clavulanate offers the best coverage for pediatric skin infections 7
High-Risk Wounds Requiring Immediate Medical Evaluation
- Any scratch caused by an animal or human bite, or contaminated with saliva, requires prompt medical facility evaluation for possible systemic antibiotic prophylaxis 4
- Hand wounds are particularly serious and warrant closer attention 5
- These wounds carry significantly higher infection risk and may require prophylactic antibiotics 4
Follow-Up Instructions
- Instruct parents to seek medical care if any signs of infection develop: 4
- Progressive redness or spreading erythema
- Increasing pain or tenderness
- Swelling, warmth, or purulent drainage
- Fever or systemic symptoms
- The wound can get wet within 24–48 hours without increasing infection risk 6
Common Pitfalls to Avoid
- Do NOT routinely prescribe topical antibiotics—this is unnecessary and promotes resistance 1
- Do NOT use antiseptic agents like povidone-iodine for irrigation—they provide no benefit over tap water 4
- Do NOT forget tetanus prophylaxis—use the 5-year rule for contaminated wounds in toddlers 3
- Do NOT close infected wounds—they should heal by secondary intention 5