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Just a reminder! Thanks for visiting us at Shots Hurt Less Blog! This is just a reminder that the information on this site is intended to be for informational purposes only. It should never replace the recommendations of your doctor - check with your doctor if you have any specific questions! We will always honor and protect patient confidentiality, and we ask that you all do the same, if you choose to comment on our posts. Thanks for visiting!

Entries in stitches (1)

Thursday
Nov282013

FYI: Ouch! Does your child need stitches?

My baby girl, now 9 months old, has started crawling, pulling up, and cruising over the last several weeks.  And boy, is she putting our baby-proofing to the test!  It seems like almost every time that she pulls up (squealing with delight), she falls or bumps her head on the way back down.  So, I am running to the store to buy more gates and locks every few days, but I am also bracing myself for an injury.   

Most kids wind up with an injury, a broken bone or a cut needing stitches, at some point.  But it can be hard to tell when a cut is bad enough to require closure with stitches (or sutures as we call them in the medical world).  Here are a few questions to ask to help you determine if they need a medical evaluation or if a band aid and a little extra TLC will take care of it.

1. Can you clean the wound well yourself?   Depending on where your child was at the time of the injury, there may be dirt and rocks or twigs deep in the wound.  It's crucial to clean the wound thoroughly to prevent infection and ensure proper healing.  At home, the best way to clean the wound is with water, using pressure. You can use the sink or tub (if you have a spray nozzle that can work well).  If, however, that isn't an option (or the location of the injury doesn't lend itself to easy cleaning) - seek medical attention!

2. Is your child up to date on his or her Tetanus shot? If your child has a dirty wound or any type of puncture wound (stepping on a nail, splinters, animal bites) and you're not sure when their last tetanus shot was - call us!  Tetanus  develops when bacteria releases a toxin that attacks a person's nervous system resulting in serious illness (many cases require intensive care and 10% of cases are fatal)!  You really don't want to mess with tetanus! 

3. Has the wound stopped bleeding?  The cut may need stitches (sutures) if your child's wound has not stopped bleeding within 10 minutes while applying pressure (use a clean cloth or gauze pad to hold firm pressure over the wound) or if the bleeding stops temporarily but then re-bleeds frequently (as often happens when the wound is over a joint and bending of the knee or elbow, for example, causes the wound to re-open).

4. Where is the injury?  Cuts that are close to the eye, vertical cuts on the cheek or forehead, and cuts that cross the line between the lip and the face (the red border of the lip) often heal badly (very noticeable scar) if left to close on their own. 

5. What does the wound look like? Cuts that are large (deep or longer than 1/2 inch), especially if they have ragged or separated edges or are on the face, typically need to be closed with sutures.

If you determine the injury may need to be closed with sutures - seek medical attention right away!  The risk of infection increases significantly after 12 hours or so.  Some wounds require sutures, while others may be able to be closed with staples (this is a great option for the back of the head) or even fancy super-glue called Dermabond.

One last piece of advice.  When I was a resident working shifts in the Pediatric ED, parents would often ask for the "boss" or the plastic surgeon to close a wound.  But that request may land you with either an older doctor whose skills are a bit rusty or a plastic surgery resident who's actually done far less suturing than the ED physician. But...if you get the impression that the person pulling on the gloves may not be comfortable closing a wound, certainly speak up!  Be respectful - it usually goes over best if you simply ask (rather than demand) whether an injury such as this requires a specialist.
And no matter how the wound is closed (sutures, staples, Dermabond) or who does the closure (ER physician or plastic surgeon) - no one can gaurantee a small scar.  People heal differently and some people form bigger scars.

When in doubt, have your child examined either at our office or in the ED.  You can call and speak with our triage nurses and describe the injury to figure out whether it's something that we can see in clinic or if you should go straight to WFBH Brenner's Pediatric ED.