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Should Your Child See a Doctor?

Puncture Wound

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Definition

  • The skin is punctured by a narrow, pointed object

Causes 

  • Commonly caused by a nail, sewing needle, pencil, toothpick
  • Pencil lead is actually graphite (harmless), not poisonous lead. Even colored leads are not toxic.

When to Call Your Doctor for Puncture Wound

Call 911 If…

 
  • Your child has a puncture on the head, neck, chest or abdomen that may go deep
 

Call Your Doctor Now (night or day) If

  • You think your child has a serious injury
  • Bleeding that won't stop after 10 minutes of direct pressure
  • Puncture on the head, neck, chest, abdomen that isn't deep
  • Puncture overlying a joint
  • Tip of the object is broken off and missing
  • Feels like something still in the wound
  • Won't stand (bear weight or walk) on punctured foot
  • Needle stick from used or discarded injection needle
  • Sharp object or setting was very dirty (e.g., a barnyard)
  • No previous tetanus shots
  • Dirt (debris) or pencil lead pigment is not gone after 15 minutes of scrubbing
  • Severe pain
  • Wound looks infected (redness, red streaks, swollen, tenderness)
  • Fever occurs
 

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen
  • Last tetanus shot over 5 years ago
 

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
 

Parent Care at Home If

  • Minor puncture wound and you don't think your child needs to be seen
 

Home Care Advice for Puncture Wound

  1. Cleansing:
    • Wash the wound with soap and warm water for 15 minutes.
    • For any dirt or debris, scrub the wound surface back and forth with a wash cloth to remove it.
    • If the wound re-bleeds a little, that may help remove germs.
     
  2. Trimming: Cut off any flaps of loose skin that seal the wound and interfere with drainage or removing debris. Use a fine scissors, after cleaning them with rubbing alcohol.
  3. Antibiotic Ointment: Apply an antibiotic ointment such as Polysporin (no prescription needed). Then, cover with a Band-Aid to reduce the risk of infection. Re-wash the area and re-apply an antibiotic ointment every 12 hours for 2 days.
  4. Pain Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen for any pain.
  5. Expected Course: Puncture wounds seal over in 1 to 2 hours. Pain should resolve within 2 days.
  6. Call Your Doctor If:
    • Dirt in the wound persists after 15 minutes of scrubbing
    • Pain becomes severe
    • It begins to look infected (redness, red streaks, tenderness, pus, fever)
    • Your child becomes worse
     

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.


References

  1. American Academy of Pediatrics: Committee on Infectious Diseases. Wound Infections. In Pickering L, ed. 2009 Red Book. 28th ed. Elk Grove Village, IL: 2009.
  2. Baldwin G and Colbourne M. Puncture wounds. Pediatr Rev. 1999;20:21-23.
  3. Inaba AS, et al. Update on the evaluation and management of plantar puncture wounds and pseudomonas osteomyelitis. Pediatr Emerg Care. 1992;8:38-43.
  4. Inaba AS. The rusty nail and other puncture wounds of the foot. Contemp Pediatr. 1993 Mar;10:138-155.
  5. Leung A, Eneli I, Davies HD. Necrotizing fasciitis in children. Pediatr Ann. 2008;37(10):704-710.

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 8/1/2010

Last Revised: 9/18/2010 6:26:54 PM

Copyright 1994-2011 Barton D. Schmitt, M.D.

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