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• Head Trauma
• Skin Trauma

1. cuts and scratches
2. scrapes ( abrasions )
3. puncture wounds
4. bruises

• Sutured Wound Care

• History of a blow to the head
• Scalp trauma ( cut, scrape, bruise or swelling )

Every child sooner or later strikes their head. Falls are especially common when your child is learning to walk. Most bruises occur on the forehead. Sometimes black eyes appear
3 days later because the bruising spreads downward by gravity.

Most head trauma simply results in a scalp injury. Big lumps can occur with minor injuries because the blood supply to the scalp is so plentiful. Only 1% to 2% of injured children get a skull fracture. Usually there are no associated symptoms except for a headache at the site of impact. Your child has not had a concussion unless there is temporary unconsciousness, confusion and amnesia.

Wound Care
If there is a scrape, wash it off with soap and water. Then apply pressure with a clean cloth
( sterile gauze if you have it ) for 10 minutes to stop any bleeding. For swelling, apply ice for 20 minutes.

Rest
Encourage your child to lie down and rest until all symptoms are gone (or at least 2 hours). Your child can be allowed to sleep; you do not have to keep them awake. Just have them sleep nearby so you can periodically check on them. DO NOT give any pain medicine. If the headache is bad enough to need acetaminophen, your child probably should be checked by a physician.

Diet
Only give clear fluids ( ones that you can see through ) until your child has gone 2 hours without vomiting Vomiting is common after head injuries and there is no need to have your child vomit up their dinner.

Pain Medicines
Do not give any pain medicine. If the headache is bad enough to require acetaminophen or aspirin, your child should be checked by a physician.

Special Precautions and Awakening
Although your child is probably fine, close observation for 48 hours will ensure that no serious complication is missed.

• Awakening your child twice during the night: Do this once at your bedtime and once 4 hours later. Awakening them every hour is unnecessary and next to impossible. Arouse them until they are walking and talking normally. Do this for two nights. Sleep in their room or have them sleep in your room for those two nights. If their breathing becomes abnormal or their sleep is otherwise unusual, awaken them to be sure a coma is not developing. After two nights, return to a normal sleep routine.

IMMEDIATLEY if :

• The headache becomes severe
• Vomiting occurs three or more times
• Vision becomes blurred or double
• Your child becomes difficult to awaken or confused
• Walking or talking becomes difficult
• Your child's neurological condition worsens in any other way.

1. cuts and scratches
2. scrapes ( abrasions )
3. puncture wounds
4. bruises

More cuts are superficial and extend only partially through the skin. They are caused by sharp objects. The cuts that need sutures are deep and leave the skin edges separated. Another rule of thumb is that cuts need sutures if they are longer than 1/2 inch ( 1/4 inch if on the face ).

Treatment

• Apply pressure for 10 minutes to stop any bleeding.
• Wash the wound with soap and water for 5 minutes.
• Cut off any pieces of loose skin using a small scissors ( for torn skin with scrapes )
• Apply an antibiotic ointment and cover it with a Band-aid or gauze. Wash the wound, apply the ointment and change the Band-aid or gauze daily.
• Give acetaminophen or ibuprofen as needed for pain relief.

Common Mistakes in Treating Cuts and Scratches

• Do not use alcohol or Merthiolate on open wounds. They sting and damage normal tissue.
• Do not kiss an open wound because the wound will become contaminated by the many germs in a normal person's mouth.
• Let the scab fall off by itself; picking it off may cause a scar.

IMMEDIATLEY if :

• Bleeding will not stop after 10 minutes of direct pressure.
• The skin is split open and might need sutures.
  Note: Lacerations must be sutured within 12 hours of the time of injury, and the infection rate is far lower if they are closed within 4 hours.
• There is any dirt in the wound that you can not get out.
• The cut looks infected ( yellow pus, spreading redness, red streaks ).

During regular hours if :

• If your child has not had a tetanus booster in more than 10 years ( 5 years for dirty cuts ).
• The wound does not heal by day 10.
• You have other questions or concerns.

An abrasion is an area of superficial skin that has been scraped off during a fall ( e.g., a floor burn or skinned knee ).

Cleaning the Scrape
First, wash your hands. Then wash the wound vigorously for at least 5 minutes with warm water and liquid soap. The area will probably need to be scrubbed several times with a wet piece of gauze to get out all the dirt. You may have to remove some dirt particles
( e.g., gravel ) with a pair of tweezers. If there is tar in the wound, it can often be removed by rubbing it with petroleum jelly, followed by soap and water again. Pieces of loose skin should be cut off with sterile scissors, especially if the pieces of the skin are dirty. Rinse the wound well.

Antibiotic Ointments and Dressing

• Apply an antibiotic ointment and cover the scrape with a Band-Aid or gauze dressing. This is especially important for scrapes over joint ( such as elbow, knee or hand ) that are always being stretched. Cracking and reopening at these sites can be prevented with an antibiotic ointment, which keeps the crust soft ( no prescription is needed ). Cleanse the area once a day with warm water and then reapply the ointment and dressing until the scrape is healed.

Pain Relief
Because abrasions can hurt badly, give acetaminophen or ibuprofen for the first day.

IMMEDIATLEY if :

• There is any dirt in the wound that you can not get out.
• Skin loss involves a very large area.
• The scrape looks infected ( yellow pus, spreading redness, red streaks ).

During regular hours if :

• If your child has not had a tetanus booster in more than 10 years.
• The wound does not heal by 2 weeks .
• You have other questions or concerns.

The skin has been completely punctured by an object that is narrow and sharp, such as a nail. The wound is not wide enough to need sutures. Since puncture wounds usually seal over quickly, there is a greater chance of wound infection with this type of skin injury. Puncture wounds of the upper eyelid are especially dangerous and can lead to a brain abscess. A deep infection of the foot can begin with swelling of the top of the foot 1 to 2 weeks after the puncture. Another risk is tetanus if your child is not immunized.

Cleansing
Soak the wound in warm water and soap for 15 minutes. Scrub the wound with a wash cloth to remove any debris. If the wound re bleeds a little, that may help remove germs.

Trimming
Cut off any flaps of loose skin that cover the wound and interfere with drainage or removing debris. Use a fine scissors after cleaning them with rubbing alcohol.

Antibiotic Ointment
Apply an antibiotic ointment and cover the scrape with a Band-Aid to reduce the risk of infection. Re soak the area and reapply antibiotic ointment every 12 hours foe 2 days.

Pain Relief
Give acetaminophen or ibuprofen for any pain.

IMMEDIATLEY if :

• Dirt in the wound remains after you have soaked the wound.
• The tip of the object could have broken off in the wound.
• The sharp object or place where the injury occurred was very dirty
  ( e.g., a barnyard ).
• The scrape looks infected ( yellow pus, spreading redness, red streaks ).

During regular hours if :

• If your child has not had a tetanus booster in more than 5 years.
• Pain, redness or swelling increases after 48 hours.
• You have other questions or concerns.

Bleeding into the skin from damaged blood vessels gives a black and blue mark. Since the skin is not broken, there is no risk of infection. Bruises usually follow injury caused by blunt objects. Unexplained bruises can indicate a bleeding tendency.
( Exception: " Unexplained " bruises overlying the shins are usually not a sign of bleeding tendency: children often bump this area and then forget about it.)

Bruises
Apply ice for 20 to 30 minutes. No other treatment should be necessary. Give acetaminophen or ibuprofen for pain. Avoid aspirin because it may prolong the bleeding. After 48 hours apply a warm washcloth for 10 minutes 3 times a day to help the skin reabsorb the blood. Bruises clear in about 2 weeks.

Blood Blisters
Do not open blisters; it will only increase the possibility of infection. They will dry up and peel off in 1 to 2 weeks.

IMMEDIATLEY if :

• Bruises are unexplained and several in number

Most contaminated wounds that are going to become infected do so 24 to 72 hours after the initial injury. Keep in mind that a 2 to 3 mm rim of pinkness or redness confined to the edge of the wound can be normal, especially if the wound is sutured. However, the area of redness should not spread. Pain and tenderness also occur normally, but the pain and swelling should be greatest during the second day and should thereafter diminish.

Do not wash the area for 24 hours. then begin gently washing it with warm water and liquid soap 1 or 2 times each day. Apply an antibiotic ointment afterward to keep a thick scab from forming over the sutures. Swimming and baths are safe after 48 hours.

Sutures are ready for removal at different times, depending on the site of the wound. The following table can serve as a guide.

Have your child's stitches removed on the correct day. Stitches removed too late can leave unnecessary skin marks or even scarring. If any sutures come out too early, call your child's physician. In the meantime, reinforce the wound with tape or butterfly Band-Aids. Continue the tape until the date when the sutures would have been removed.
Protection. After removal of sutures:

• Protect the wound from injury during the following month.
• Avoid sports that could re injure the wound. If a sport is essential, apply tape
  before playing.

If your child needs sutures, they will develop a scar. All wounds heal by scarring. The scar can be kept to a minimum by taking the sutures out at the right time, preventing wound infections and protecting the wound from being re injured during the following month. The healing process continues for 6 to 12 months, and only then will the scar assume its final appearance.

IMMEDIATLEY if

• An unexplained fever ( over 100°F [ 37.8°C ] ) occurs.
• A red streak or red area spreads from the wound.

Within 24 hours if

• The wound looks infected ( pus or a pimple ).
• The wound becomes more painful than it was on the second day.
• a stitch comes out early.
• You have other concerns or questions.