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Should Your Child See a Doctor?

Cuts, Scrapes or Bruises (Skin Injury)

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Definition

  • Cuts, lacerations, gashes and tears (wounds that go through the skin [dermis] to the fat or muscle tissue)
  • Scrapes, abrasions, scratches and floor burns (superficial wounds that don't go all the way through the skin)
  • Bruises (bleeding into the skin) without an overlying cut or abrasion 

First Aid Advice For Severe Bleeding: 

  • Place 2 or 3 sterile dressings (or a clean towel or washcloth) over the wound immediately.
  • Apply direct pressure to the wound, using your entire hand.
  • If bleeding continues, apply pressure more forcefully or to a slightly different spot.
  • Act quickly because ongoing blood loss can cause shock.

First Aid Advice for Shock: Lie down with the feet elevated.

First Aid Advice for Penetrating Object: If penetrating object still in place, don't remove it (Reason: removal could increase internal bleeding).

When Sutures (stitches) are Needed 

  • Any cut that is split open or gaping needs sutures.
  • Cuts longer than ½ inch (12 mm) usually need sutures.
  • On the face, cuts longer than ¼ inch (6 mm) usually need closure with sutures or skin glue.
  • Any open wound that may need sutures should be checked and closed as soon as possible (ideally, within 6 hours). There is no cutoff, however, for treating open wounds to prevent wound infections.

Cuts Versus Scratches: Helping You Decide 

  • The skin (dermis) is 2 mm (about 1/8 inch) thick.
  • A cut (laceration) goes through it.
  • A scratch or scrape (wide scratch) doesn't go through it.
  • Cuts that gape open at rest or with movement need closure to prevent scarring.
  • Scrapes and scratches never need closure, no matter how long they are.
  • So this distinction is important.

When to Call Your Doctor for Skin Injury (Cuts, Scrapes, Bruises)

Call 911 If…

 
  • Major bleeding that can't be stopped

Call Your Doctor Now (night or day) If

  • You think your child has a serious injury
  • Bleeding won't stop after 10 minutes of direct pressure
  • Deep cut and can see bone or tendons
  • Skin is split open or gaping, especially on the face
  • Pain is SEVERE (and not improved after 2 hours of pain medicine)
  • Age under 1 year old
  • Dirt or grime in the wound is not removed after 15 minutes of scrubbing
  • Wringer-type injury
  • Skin loss from bad scrape goes very deep
  • Skin loss involves greater than 10% of body surface (Note: The palm of the hand equals 1%)
  • Cut or scrape looks infected (redness, red streak or pus)

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

  • You think your child needs to be seen
  • Several bruises occur without any known injury
  • Very large bruise follows a minor injury

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
  • No tetanus shot in over 5 years for DIRTY cuts (over 10 years for CLEAN cuts)
  • Doesn't heal within 10 days

Parent Care at Home If

  • Minor cut, scrape or bruise and you don't think your child needs to be seen

Home Care Advice for Minor Cuts, Scrapes or Bruises

  1. Cuts, Scratches and Scrapes
    • Apply direct pressure for 10 minutes to stop any bleeding.
    • Wash the wound with soap and water for 5 minutes. (Caution: never soak a wound that might need sutures, because it may become more swollen and difficult to close.)
    • Gently scrub out any dirt with a washcloth.
    • Cut off any pieces of loose skin using a fine scissors (cleaned with rubbing alcohol).
    • Apply an antibiotic ointment such as Polysporin (no prescription needed). Then, cover it with a Band-Aid or dressing. Change daily.
  2. Liquid Skin Bandage for Minor Cuts and Scrapes:
    • Liquid skin bandage is a new product that seals wounds with a plastic coating that lasts up to 1 week.
    • Liquid skin bandage has several benefits when compared to a regular bandage (e.g., a dressing or a Band-Aid). Liquid Bandage only needs to be applied once to minor cuts and scrapes. It helps stop minor bleeding. It seals the wound and may promote faster healing and lower infection rates. However, it is also more expensive.
    • After the wound is washed and dried, the liquid is applied by spray or with a swab. It dries in less than a minute. It's resistant to bathing.
    • This new product is available at your local pharmacy.
  3. Bruises:
    • Apply a cold pack or ice bag wrapped in a wet cloth to the bruise once for 20 minutes to stop the bleeding.
    • After 48 hours apply a warm wet wash cloth for 10 minutes 3 times per day to help reabsorb the blood.
  4. Pain Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen as needed for pain relief.
  5. Call Your Doctor If:
    • Bleeding does not stop after using direct pressure to the cut
    • Looks infected (pus, redness, increasing tenderness)
    • Doesn't heal within 10 days
    • Your child becomes worse

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

References

  1. Eaglstein WH, Sullivan TP, Giordano PA, Miskin BM. A liquid adhesive bandage for the treatment of minor cuts and abrasions. Dermatol Surg. 2002;28(3):263-7.
  2. Knapp JF. Updates in wound management for the pediatrician. Pediatr Clin North Am. 1999; 46: 1201-1214.
  3. Labbe J, Caouette G. Recent skin injuries in normal children. Pediatrics. 2001;108:271-276.
  4. Sugar NF, Taylor JA, Feldman KW, Puget Sound Pediatric Research Network. Bruises in infants and toddlers. Arch Pediatr Adolesc Med. 1999;153:399-403.

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: 10/1/2010

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

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