- The skin is punctured by a narrow, pointed object
- 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
- 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.
- 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.
- 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.
- Pain Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen for any pain.
- Expected Course: Puncture wounds seal over in 1 to 2 hours. Pain should resolve within 2 days.
- 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.
- American Academy of Pediatrics: Committee on Infectious Diseases. Wound Infections. In Pickering L, ed. 2009 Red Book. 28th ed. Elk Grove Village, IL: 2009.
- Baldwin G and Colbourne M. Puncture wounds. Pediatr Rev. 1999;20:21-23.
- Inaba AS, et al. Update on the evaluation and management of plantar puncture wounds and pseudomonas osteomyelitis. Pediatr Emerg Care. 1992;8:38-43.
- Inaba AS. The rusty nail and other puncture wounds of the foot. Contemp Pediatr. 1993 Mar;10:138-155.
- Leung A, Eneli I, Davies HD. Necrotizing fasciitis in children. Pediatr Ann. 2008;37(10):704-710.
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.