By Robin Stevenson
From the print edition, October 2011
Despite being only 11, Viola Galamini’s youngest son has received stitches not once, but twice. The first time, at age five, Dante required a few above his right eyebrow after he slipped and hit his head. Recently he received a matching set below the same eyebrow after falling off a chair at school. Galamini, a Hamilton, Ont., mom of three, agreed with the school nurse that the gash would require stitches. “The blood wasn’t clotting and it looked deep,” she remembers.
While some wounds can be taken care of at home with what’s in your first aid kit, others will need medical attention. We asked Dr. Derrick Smith, an emergency physician at the Alberta Children’s Hospital in Calgary, and Dr. Harley Eisman, medical director of the emergency department of The Montreal Children’s Hospital, what to do when faced with a child who has a serious cut.
Perform First Aid
The priority is to clean the area and stop the bleeding, says Dr. Eisman. Use water (without soap) to wash the cut, and try to stop the bleeding by applying localized pressure with a clean linen or disposable paper product. Next, cover the wound with a sterile dressing to keep it clean and provide a barrier to infection, says Dr. Smith. If something is embedded in or sticking out of the wound (e.g., glass), leave it in place and protect it from movement.
If the wound meets one of following criteria, see a health care professional, says Dr. Eisman.
“Lacerations will close on their own over time, but healing takes much longer and the risk of infection increases with depth and length,” notes Dr. Smith. Wounds should be attended to as soon as possible to further reduce the likelihood of infection.
Glue, Adhesive Strips and Stitches
As long as a wound is not under significant pressure and the edges come together very tightly, skin glue works well, says Dr. Smith. “Similarly Steri-Strips (thin adhesive strips) can pull wounds together nicely and may be all that is necessary.” Dr. Eisman says parents should keep in mind that well-equipped community clinics likely have both adhesive methods, so their first instinct should be to take a child to a clinic, not to an emergency department.
However, deep wounds that involve more than the skin, such as the fatty layer beneath, may need sutures (stitches) to prevent spaces in the tissue that can harbour pockets of blood from becoming infected, explains Dr. Smith. The same is true if the laceration involves muscles, tendons, nerves or larger blood vessels. What type of stitches you receive will depend on the wound. “Recently we have shifted to sutures, especially on the face, that are quickly absorbed so they will fall out on their own. Often on the arms and legs we need stronger stitches, so we tend to use the non-absorbable ones that need to be removed,” says Dr. Smith. As for pain relief during the procedure, most children do well with topical or local anesthetic (freezing), he says.
Take Good Care
Both doctors recommend your child keep the treated area as dry as possible for the first few days. This is especially important for a wound that has been glued, says Dr. Eisman. Antibiotic ointments like Polysporin can be used to keep the wound free of infection and to help with suture removal if necessary.
What About Scars?
While some people swear by the use of vitamin E and aloe vera to minimize scars, they may not provide a better outcome, says Dr. Smith. If anything, he suggests, parents should make sure their child applies sunscreen to the area since it will likely be sun-sensitive for the first few months. “Parents have to realize that there are no miracles and any cut or wound does scar,” says Dr. Eisman. But if your child is not like Galamini’s son, who likes his scars, don’t worry. “Fortunately, in kids, the scars do remodel over a period of one to two years and usually the result does improve.”