What interventions support wound healing in a child and what treatment plan should be implemented?

Wound Healing Support in Children: Treatment Plan

For pediatric wound healing, implement a structured approach prioritizing thorough wound cleansing with warm water or sterile saline, appropriate moisture-retentive dressings, adequate pain management, and optimized nutrition—while avoiding antimicrobials as first-line treatment unless infection is present. 1, 2, 3

Initial Wound Assessment and Cleansing

Irrigate wounds thoroughly with warm sterile saline or clean tap water to remove debris and contaminants, as higher irrigation pressures are more effective for proper cleansing. 1, 4 Warm cleaning solutions may reduce pain during the procedure. 2

• Debride necrotic tissue or slough to promote healing, but recognize that wound debridement in neonates is rare and should only be performed when ineffective or delayed treatment necessitates it. 1, 2
• Complete wound assessment at each dressing change, documenting exudate, odor, pain, surrounding erythema, and edema. 2

Dressing Selection and Application

Apply non-adherent contact layers directly to the wound bed to maintain a moist wound environment, which results in faster epithelialization compared to dry dressings. 1, 4

• Use gauze or tubular bandages to secure dressings instead of tape to minimize skin trauma. 2
• Add a secondary foam or absorbent dressing to collect exudate. 1
• For scalp wounds specifically, apply emollient or foam pad and avoid shaving hair, as this increases risk of long-term follicular damage. 2, 4
• If tape is necessary, use silicone medical adhesive removers (SMARs) for removal to prevent skin trauma, particularly in neonates where skin reaction is unknown. 2, 4

Alternative Dressing Options

Consider glycerin hydrogel dressings as a cost-effective alternative to daily standard dressings, which have demonstrated statistically significant reduction in infection scores. 2

• These can be applied after initial placement and changed weekly for four weeks. 2
• After stoma healing (approximately one week), dressings can be reduced to once or twice weekly, cleansed with soap and water. 2

Pain Management Protocol

Always monitor pain using validated pediatric pain scales such as the Neonatal Infant Pain Scale (NIPS) or Face, Legs, Activity, Cry and Consolability (FLACC). 2

• First-line pain medications: sucrose, paracetamol/acetaminophen, and/or oral morphine/oxycodone for significant wounds. 2
• Implement non-medication strategies: swaddling, patting, rocking, calm music, and singing as standalone or adjunctive relief. 2
• Prepare wound care products (precut templates, warmed cleaning solution, adequate pain relief) prior to commencing care. 2
• Changes in behavior and pain scores should prompt investigation for infection and reassessment of wound care strategies. 2

Infection Prevention and Monitoring

Antimicrobials are NOT recommended as first-line wound treatment in children unless infection is clinically evident. 2, 1

• Change dressings at least daily to allow wound inspection and reapplication of clean dressings. 1, 4
• Monitor for infection signs: increased pain, redness extending beyond wound margins, swelling, foul-smelling drainage, or fever. 1, 4
• Use clinical judgment and microbiology results (when available) to determine whether topical antimicrobials or systemic antibiotics are required. 2
• For nonsymptomatic positive wound cultures, use antimicrobial soaks and rotate antimicrobials if using long-term. 2

Nutritional Optimization

Calculate nutritional requirements considering wound losses and feeding capacity, as suboptimal nutrition alters immune function, collagen synthesis, and wound tensile strength. 2, 3

• Work with a dietitian to assess oral intake, feed tolerance, nutritional requirements, and wound burdens. 2
• For children with chronic illness (Crohn's disease, renal failure, neurological conditions), healing may be problematic due to poor nutritional state, complications of surgery, infection, or chemotherapy. 5
• All nutrients should be viewed as components of a broader, complete diet rather than isolated supplements. 3

Friction Reduction Techniques

Use preventative care to reduce friction during wound care, particularly important in children where mechanical forces during childhood (ages 2 through puberty) are associated with more hypertrophic scars. 2, 6

• Attend to wound care one limb at a time, keeping the child wrapped throughout to reduce blistering from friction-related movement. 2
• Use emollients on wound care products to reduce shearing on removal. 2
• Ensure dressings are not applied too tightly, which could compromise circulation, especially on extremities. 1

Parental Education and Involvement

Include parents in wound care and gradually increase their participation, considering their emotional distress and learning capacity. 2

• Offer repetitive education to promote practice, as parents may find mastering new skills difficult while coming to terms with diagnosis. 2
• Teach parents pain management techniques in hospital and promote use after discharge to minimize fear and procedural anxiety. 2
• Provide clear verbal communication and written or visual materials for caregivers, identifying which department can serve as an emergency advice point. 2

Follow-Up and Long-Term Considerations

Maintain attentive follow-up until adult age, as body growth rate can be responsible for specific complications such as contractures, alopecia, and scar intussusceptions. 6

• After wound healing, complementary treatments (hydration, massage, bracing, silicone, hydrotherapy) represent efficient factors to minimize tissue scarring during childhood. 6
• Psychological repercussions from pathologic scars must be prevented and investigated. 6
• Ensure adequate tetanus prophylaxis for all children with injuries. 7

Critical Pitfalls to Avoid

• Do not delay debridement of necrotic infected material when clinically indicated. 1
• Avoid shaving hair around wound sites, particularly on the scalp, as this causes unnecessary follicular damage. 2, 4
• Do not apply adhesive tape directly to skin without proper removal technique using SMARs. 2, 4
• Monitor distal perfusion when applying circumferential dressings to prevent compromised circulation. 1
• Do not leave wounds uncovered, as this increases infection risk and delays healing. 4