What is the treatment for a 2-year-old with a tongue laceration?

From the Guidelines

For a 2-year-old with a tongue laceration, the best course of action is to clean the area with water and observe if the cut is minor (less than 1 cm) and not actively bleeding, as most small tongue lacerations heal well without intervention due to the tongue's excellent blood supply and rapid healing capacity. This approach prioritizes minimizing morbidity and promoting quality of life by avoiding unnecessary medical interventions. According to 1, oral injuries are common in children aged 0 to 6 years, and the primary dentition is most susceptible to trauma at 2 to 3 years of age, highlighting the importance of careful management to prevent complications.

When considering pain management, it's essential to balance the need for relief with the potential risks and benefits of different treatments. For minor tongue lacerations, offering cold foods like popsicles or ice cream can help reduce swelling and pain, and children's acetaminophen (Tylenol) can be given at 10-15 mg/kg every 4-6 hours for pain management. However, as noted in 1, topical lidocaine may not provide complete pain relief, and its application should be discussed with parents, considering the child's potential tolerance and any sensory integration disorders.

Key considerations for managing a 2-year-old with a tongue laceration include:

• Monitoring for signs of infection, such as increasing pain, swelling, fever, or pus
• Avoiding spicy or acidic foods and having the child rinse with water after eating to promote healing
• Seeking immediate medical attention if the laceration is deep, gaping, actively bleeding, or crosses the border of the tongue, as these may require suturing under sedation or general anesthesia
• Offering soft foods for 2-3 days to minimize discomfort and promote recovery

By prioritizing a conservative approach for minor tongue lacerations and being mindful of the need for careful observation and potential medical intervention for more severe cases, healthcare providers can optimize outcomes in terms of morbidity, mortality, and quality of life for 2-year-olds with tongue lacerations.

From the FDA Drug Label

Directions adults and children 2 years of age and older: clean the affected area apply a small amount of this product (an amount equal to the surface area of the tip of a finger) on the area 1 to 3 times daily may be covered with a sterile bandage children under 2 years of age: ask a doctor For a 2-year-old with a tongue lac, bacitracin (TOP) can be used as the child is above the specified age limit of 2 years.

• Application instructions: Clean the affected area and apply a small amount of the product (equal to the surface area of the tip of a finger) 1 to 3 times daily.
• The area may be covered with a sterile bandage. 2

From the Research

Treatment for 2 Year Old Tongue Laceration

• The optimal treatment for tongue lacerations in children is still a challenge due to contradictory recommendations and a lack of current guidelines 3.
• A study found that suturing is not required in gaping tongue lacerations less than 2 cm long that do not involve the tip of the tongue 3.
• The majority of tongue lacerations reported in the literature heal with excellent outcomes regardless of management method, with minimal scarring and excellent return to normal functional status 4.
• Physician judgement along with patient and parental preference based on potential risks of the procedure should be used when deciding whether a tongue laceration requires primary repair 4.
• Tongue lacerations in otherwise healthy individuals are at very low risk of infection 4.

Management of Tongue Lacerations

• A retrospective study found that primary wound closure was performed in 16.4% of children with tongue lacerations, and these wounds were significantly larger than those of the secondary wound healing group 3.
• The group with wound suturing needed longer to recover and had a higher rate of complications compared to the group with secondary wound healing 3.
• The Zurich Tongue Scheme was developed as a guide for clinicians when deciding which tongue lacerations need suturing 3.

Use of Antibiotics

• A study found that there is a considerable amount of practice variance in prescribing prophylactic antibiotics for oral lacerations among emergency physicians 5.
• The use of prophylactic oral antibiotics for intraoral wounds is not supported by strong evidence, and careful wound preparation before primary repair may be sufficient to prevent infection 6.