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You hear a loud thud and then screaming from the next room. You run in to find your three-year-old sitting on the floor, holding her forehead, while blood streams down her face. You look at the cut and blood seems to be pouring out. By the time you get her to the ER, her whole shirt and the back of your car looks like it's covered in blood, but your daughter actually appears well. You are confused, and perhaps embarrassed, when the ER nurse takes a look at the wound and says, "oh, she'll be alright. It's just a little cut."
This scenario happens to many parents. It is often difficult to assess cuts, especially when they are actively bleeding. Here is the Dr. Sears guide to what to do if your child is injured with a cut or scrape, how to decide if stitches are needed, and guidelines for proper wound care for scrapes and stitches.
WHAT IS THE FIRST THING I SHOULD DO WHEN MY CHILD GETS CUT?
For actively bleeding cuts:
THERE IS BLOOD EVERYWHERE! I'M WORRIED MY CHILD HAS LOST TOO MUCH BLOOD!
Try to remain calm. It is virtually unheard of for any one to lose so much blood from a cut that it puts them in any danger. Cuts on the head and face bleed more than anywhere else on the body. This is because there are many more blood vessels in the skin here. Many parents worry that these cuts have caused a lot of blood loss. You can rest assured; the blood looks like a lot more than it really is.
HOW DO I DECIDE IF I SHOULD GO TO THE DOCTOR?
Simple cuts that do not require stitches do not need to be seen by your doctor.If it is obvious that your child does need stitches, do not rush in to your doctor's office. Instead, call the office to find out what time would be best to come in. Since stitches usually take at least a half hour to do in the office, most offices would prefer to try to make some time later during the day, rather than squeezing you in immediately. Some offices may prefer to direct you to an ER or a plastic surgeon for the stitches, so calling ahead may save you a trip.
If you are not sure whether or not stitches are needed, here are some guidelines:
There are two main reasons to get stitches:1. To stop active bleeding. If a cut is large and continues to bleed, then closing it is obviously beneficial. Most cuts, however, will stop bleeding after a while if pressure is applied with a towel or cloth.2. For cosmetic reasons. Cuts on the face obviously will have a better cosmetic outcome if they are closed. However, for a small cut on a body part where you are not concerned about a scar, then closing it is not as important. Decide if the trauma of doing stitches will be worth it.
Dr. Sears suggests: Stitches do not decrease the risk of infection in a cut if properly cared for.Most important – if you are not sure whether or not a cut should be closed, then see your doctor. It is much better to waste a trip than to have a big scar that was avoidable.
HOW SOON DO I NEED TO SEE A DOCTOR FOR STITCHES?
Most cuts can generally be closed as long as 24 hours after the accident. Some cuts should be closed sooner, but it is very safe to wait at least 8 hours to have a cut closed. Therefore, if the cut occurs at night, it is generally ok to wait until the next morning, as long as you can get the bleeding to stop. Very important – if you do decide to wait, wash the cut under the faucet to get out any dirt. Do not let the cut dry out. The best thing to do is to buy a bottle of sterile saline and some gauze. Wet the gauze and tape it over the cut. Change this every two hours to keep it moist. If you cannot do this, then put some antibiotic ointment on the cut and cover it with gauze or a band-aid. Repeat this every few hours to keep it moist. Stitches generally don't require urgent care.
FOUR OPTIONS FOR CLOSING A CUT
There are four ways to close a cut. Your doctor will discuss these options with you:
1. Steri-strips. Also known as "butterfly" strips, these narrow strips are placed over the cut, with a bit of tension to keep it closed. A sticky liquid is placed on the skin to hold the strips on. These generally stay on for 2 to 5 days if kept dry and not accidentally pulled off. These are used for cuts that are small, not gaping open, not very deep and not over a joint or area of skin tension. If they stay in place for at least three days, the outcome can be just as good as stitches or even better because steri-strips avoid the "railroad track" appearance of some stitch lines. A big advantage is that they are quick and painless. A disadvantage is that they are not as strong and will not stay in place as long as stitches.
2. Stitches. These have the advantage of providing more strength and little to no risk of being pulled off too soon. An obvious disadvantage is the time and pain involved in putting them in.
3. Skin super glue. This is a skin glue that is applied by rubbing it over the cut while the cut is being held closed. It has the advantage of being quick and painless. It is a good choice for clean, straight cuts that are not gaping too much nor under tension. If you are hesitant to put your child through the trauma of stitches, but steri-strips are not enough, then this may be an option. If done well, the cosmetic outcome is the same as stitches.
4. Staples. These are often used in the scalp (within the hair). They are very fast, and close the cut almost as well as stitches.
WHO SHOULD DO THE STITCHES? A PLASTIC SURGEON, THE PEDIATRICIAN, OR AN ER DOCTOR?
No matter who does the stitches, there will be at least a slight scar. Even the best plastic surgeon in the world will leave a scar. It is, however, important to minimize the scar. Parents are naturally worried about this. Here are some suggestions on deciding where to have the stitches done.
HOW DO I TAKE CARE OF THE WOUND AFTER IT IS CLOSED?
Ask your doctor for some specific guidelines on proper wound care. Here are some general guidelines to follow:
WHAT CAN I DO FOR THE LONG-TERM TO MINIMIZE THE SCAR?
WHEN DO I GET THE STITCHES REMOVED?
HOW CAN I TELL WHEN IT'S GETTING INFECTED?
Over the first few days it is normal for the skin around cuts and scrapes to turn slightly red. If the redness continues to spread, your child develops a fever, or you see a foul- smelling greenish discharge from the wound, see or call your doctor. Your child may need an antibiotic by mouth. It is generally not necessary to page the doctor overnight for this. It can wait until morning.
Although scrapes are generally minor and do not warrant a trip to the doctor's office, large scrapes can leave a permanent discoloration to the skin if not properly cared for. Here are some guidelines to follow to help you properly care for scrapes.