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:
- Step one is DON'T PANIC. If you stay calm, then your child may stay calm
- Step two is to cover the cut with whatever you can get your hands on the
fastest. If you can cover the cut quickly, then your child will panic less.
- Step three is to look at the cut. Get an initial impression if it is minor
- Step four is to stop the bleeding. Find a more appropriate item such as a
clean towel or cloth and gently but firmly press it to the cut. Don't keep
peeking underneath every 10 seconds. Hold it in place for at least two minutes
(longer if necessary).
- For cuts that involve a large bump or bruise, such as on the head, you may
also want to apply some ice wrapped in the towel.
- Once the bleeding has stopped or dramatically decreased, take a closer look
at the wound to assess how severe it is. Proceed to the next step below.
THERE IS BLOOD EVERYWHERE! I'M WORRIED MY CHILD HAS LOST TOO MUCH
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
If you are not sure whether or not stitches are needed, here are some
- Check to see if the cut is gaping open. If it is not, then gently tug on it
to see if it gapes open. If it does, than it probably will need to be closed.
- Any cut that is gaping open with visible dark red muscle or yellowish fat
should probably be closed, even if it is small.
- Any cut that is gaping and is larger than ½ cm (or 3/16 of an inch) should
probably be closed. Get a ruler and measure it if you are not sure. Cuts
smaller than this may not require closure, but if they are gaping, than it is
best to have a doctor check out the cut.
- Small cuts that are not gaping may not require actual stitches, but may
still benefit from steri-strips (see below)
- Any cut, even a small one, that is gaping open on the face should be seen by
a doctor because of the risk of a scar.
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
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
FOUR OPTIONS FOR CLOSING A CUT
There are four ways to close a cut. Your doctor will discuss these options
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
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.
- Plastic surgeon. The most common reason to use a plastic surgeon is for
cuts on the face. An ER doctor or pediatrician could easily handle very small
cuts on the face, but a plastic surgeon will be most able to minimize the scar.
You can have the stitches done in the surgeon's office or in an ER by the
- ER doctors have the advantage over pediatricians of doing stitches more
often. They often put in stitches several times a day. This allows an ER
physician to become quite skilled in stitches.
- Your pediatrician. For simple cuts anywhere besides the face, your
pediatrician is probably the best place to go for the stitches, unless the
office is very busy that day. Remember, there will be a scar no matter who does
the stitches. Your pediatrician will do an excellent job in minimizing the
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:
- For 24 to 48 hours, do not allow it to get wet in the bath or shower.
- After 48 hours, it is ok to get the wound wet.
- Steri-strips are an exception. Keep them dry for at least 5 days. After
that, they have been on long enough and you may get them wet to encourage them
to come off. Do not pull them off unless they come off easily.
- Avoid the build-up of a scab. A thick scab within the wound can increase
the scar and prevent the skin from growing together well. You can prevent scab
build-up by dabbing diluted peroxide (½ water mixed with ½ peroxide) to the
wound and then gently removing any loose scab. Do not pick away any scab that
is still firmly stuck. Wait for it to loosen up from the peroxide. Do this
twice a day.
- Apply antibiotic ointment twice a day.
- Keep the wound covered for at least 48 hours. You can continue to cover it
if it is convenient to do so for several more days.
WHAT CAN I DO FOR THE LONG-TERM TO MINIMIZE THE SCAR?
- Sun protection. Damaged skin is very susceptible to becoming permanently
discolored by the sun for up to 6 months following an injury. It is very
important to minimize sun exposure to the healing cut. Keep it covered with a
hat or clothing as much as possible. When necessary (especially for long days
at the park, beach, or swimming pool), apply a strong sunscreen or even a sun
block (the white stuff that doesn't soak in). Do not apply sunscreen until two
weeks after the cut.
- Flax seed oil. This is an oil you can buy in a nutrition store. It
contains all the essential fats that are necessary for skin to grow and heal
itself. It is not proven that this actually helps for sure, but theoretically
it will. It is very healthy to take anyway, even without a wound. Give 1 tsp
each day for infants, and 2 tsp for children mixed in a smoothie. Do not apply
the oil to the skin; it needs to work internally.
- Vitamin E oil. You can rub this oil onto the cut after the stitches are
removed. There is not a definite proven benefit, but it may help the healing.
WHEN DO I GET THE STITCHES REMOVED?
- Face. These should be removed in 3 to 5 days. Why so soon? Because by
five days the stitch thread starts to react with the skin and this can leave a
mark for each stitch. If the stitches are not turning red where they enter the
skin, then it is best to wait the full 5 days. If a stitch reaction is
occurring sooner, then see your doctor before 5 days to consider having them
removed. Your doctor may put steri-strips over the cut to provide a few more
days of strength. Do not wait more than 5 days.
- Body and scalp. (within the hair) 7 to 10 days.
- Extremities. 10 to 14 days. If the stitches are done over a joint area
that bends and stretches, then you should wait 14 days. If not, then 10 days is
- Ask the doctor who puts in the stitches when they should be 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.
- Wash off the scrape as soon as possible with soap and warm water. Rinse or
gently wipe away any dirt.
- See your doctor if there is any dirt or gravel stuck in the scrape that you
- Do not let the scrape dry out and form a scab. A thick scab may lead to
- Follow these steps twice a day until the scrape is healed:
- Wash with warm water under a faucet to rinse away debris and germs. Dab it
- Apply a diluted peroxide solution (½ water mixed with ½ peroxide) and let it
sit for two minutes.
- Dab or wipe away any scab what has accumulated.
- Rinse away the peroxide.
- Apply an antibiotic ointment. See antibiotic ointment
- For large scrapes, instead of an antibiotic ointment, call your doctor for a
prescription cream called Silvadene. It is used for burns, but also works well
on large scrapes. Do not page your doctor after hours for this cream. You can
use antibiotic ointment for a day until you can get the cream. This cream
contains silver, so it may form a "tarnished" black color on the bandages.
- Apply a non-stick gauze pad over the cream or ointment. One brand name is
called Telfa, but you can use any non-stick gauze.
- Tape or wrap gauze over this pad.
- For small scrapes, you do not need to meticulously follow all these steps.
Simply use the peroxide and an antibiotic ointment, and try to prevent a scab
- Sun protection is very important. See the section above under long-term
steps to minimize the scar.
- You can stop putting on the cream and dressing once the scrape has healed to
a light pink color, with no more red, sore areas.
- Watch for infection according to the guidelines above.