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Should Your Child See a Doctor?

Splinter or Sliver – Foreign Body in the Skin

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Definition

  • A foreign body (e.g., splinter, fishhook, sliver of glass) is embedded in the skin.

Symptoms of a Foreign Body (FB) in the Skin 

  • Pain: Most tiny slivers (e.g., cactus spine) in the superficial skin do not cause much pain. Deeper or perpendicular foreign bodies are usually painful to pressure. FBs in the foot are very painful with weight-bearing.
  • Foreign Body Sensation: Older children may report the sensation of something being in the skin. ("I feel something there")

Types of Foreign Bodies 

  • Wood-organic FBs: splinters, cactus spines, thorns, toothpicks
  • Metallic FBs: bullets, BBs, nails, sewing needles, pins, tacks
  • Fiberglass spicules
  • Fishhooks: May have a barbed point that makes removal difficult
  • Glass
  • Pencil lead-graphite
  • Plastic FBs

When to Call Your Doctor for Splinter or Sliver

Call Your Doctor Now (night or day) If

  • Deeply embedded FB (e.g., needle or toothpick in foot)
  • FB has a barb (e.g., fish hook)
  • FB is a BB
  • FB is causing severe pain
  • You are reluctant to take out FB
  • You can't remove the FB
  • Site of sliver removal looks infected (redness, red streaks, swollen, pus)
  • Fever occurs
 

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

  • You think your child needs to be seen
  • Deep puncture wound and last tetanus shot was over 5 years ago
 

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
 

Parent Care at Home If

  • Tiny, superficial pain-free slivers that don't need removal
  • Tiny plant stickers, cactus spines or fiberglass spicules that need removal
  • Minor sliver, splinter or thorn that needs removal and you think you can remove it
 

Home Care Advice for Minor Slivers

  1. Tiny, Pain-Free Slivers: If superficial slivers are numerous, tiny, and pain-free, they can be left in. Eventually they will work their way out with normal shedding of the skin or the body will reject them by forming a little pimple which will drain on its own.
  2. Tiny Painful Plant Stickers: Plant stickers (e.g., stinging nettle), cactus spines or fiberglass spicules are difficult to remove because they are fragile. Usually they break when pressure is applied with a tweezers.
    • Tape: First try to remove the small spines or spicules by touching the area lightly with packaging tape, duct tape or another very sticky tape. If that doesn't work, try wax hair remover.
    • Wax Hair Remover: If tape doesn't work, apply a layer of wax hair remover. Let it air dry for 5 minutes or accelerate the process with a hair dryer. Then peel it off with the spicules. Most will be removed. The others will usually work themselves out with normal shedding of the skin.
     
  3. Needle and Tweezers: For large slivers or thorns, remove with a needle and tweezers.
    • Check the tweezers beforehand to be certain the ends (pickups) meet exactly (if they do not, bend them). Sterilize the tools with rubbing alcohol.
    • Cleanse the skin surrounding the sliver briefly with rubbing alcohol before trying to remove it. If you don't have any, use soap and water but don't soak the area if foreign body is wood (Reason: can cause swelling of the splinter).
    • Use the needle to completely expose the large end of the sliver. Use good lighting. A magnifying glass may help.
    • Then grasp the end firmly with the tweezers and pull it out at the same angle that it went in. Getting a good grip the first time is especially important with slivers that go in perpendicular to the skin or those trapped under the fingernail.
    • For slivers under a fingernail, sometimes a wedge of the nail must be cut away with fine scissors to expose the end of the sliver.
    • Superficial horizontal slivers (where you can see all of it) usually can be removed by pulling on the end. If the end breaks off, open the skin with a sterile needle along the length of the sliver and flick it out.
     
  4. Antibiotic Ointment: Wash the area with soap and water before and after removal. To reduce the risk of infection, apply an antibiotic ointment such as Polysporin once after removal (no prescription needed).
  5. Call Your Doctor If:
    • Can't get it all out
    • Removed, but pain becomes worse
    • Starts to look infected
    • Your child becomes worse
     

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


References

  1. Benya E. A 5-year-old girl with a swollen erythematous foot. Pediatr Ann. 2005; 34(3): 172-175.
  2. Blankenship RB, Baker T. Imaging modalities in wounds and superficial skin infections. Emerg Med Clin North Am. 2007 Feb;25(1):223-34.
  3. Chan C, Salam G. Splinter removal. Am Fam Physician. 2003;67:2557-2562.
  4. Halaas GW. Management of foreign bodies in the skin. Am Fam Physician. 2007 Sep 1;76(5):683-8.
  5. Shafi S and Gilbert JC. Minor pediatric injuries. Pediatr Clin North Am. 1998; 45:831-852.

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: 9/1/2010

Last Revised: 9/22/2010

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

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