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10. Bruising, abrasions and lacerations: minor injuries in children I
Simon J Young1, Peter L J Barnett, Ed A Oakley
1Department of Emergency Medicine, Royal Children's Hospital, Parkville, VIC. simon.young@rch.org.au
Insights
Managing minor childhood injuries requires careful assessment to rule out serious conditions. Prompt pain relief, trust-building, and appropriate wound care, including tetanus prophylaxis, ensure optimal healing and outcomes for pediatric patients.
Area of Science:
- Pediatric emergency medicine
- Wound care
- Trauma management
Background:
- Minor injuries are common in children, necessitating early evaluation for serious underlying conditions.
- Effective management hinges on establishing trust, managing pain, and employing adaptable examination techniques.
- Recognizing patterns in bruising is crucial for identifying potential non-accidental injuries or bleeding disorders.
Purpose of the Study:
- To outline best practices for assessing and managing minor injuries in pediatric patients.
- To emphasize the importance of differential diagnosis in pediatric trauma.
- To provide guidance on wound cleaning, anesthesia, closure, and prophylactic measures.
Main Methods:
- Clinical assessment focusing on trust, pain management, and flexible examination.
- Wound evaluation for foreign bodies, depth, and potential neurovascular or tendon involvement.
- Application of topical anesthetics and tissue adhesives for wound closure.
- Consideration of antibiotic use and tetanus prophylaxis based on wound characteristics.
Main Results:
- Superficial wounds can be effectively managed with thorough cleaning and removal of foreign material.
- Deeper wounds require surgical exploration under general anesthesia.
- Topical anesthetics and tissue adhesives offer good local anesthesia and cosmetic results for many lacerations.
- Antibiotics and tetanus prophylaxis are indicated in specific high-risk scenarios.
Conclusions:
- A systematic approach to pediatric minor injuries balances thoroughness with child-centered care.
- Appropriate wound management, including timely intervention and prophylaxis, minimizes complications and optimizes cosmetic outcomes.
- Early identification and management of potential serious injuries are paramount in pediatric emergency care.
Abstract:
Minor injuries in children (those that could reasonably be expected to heal with minimal medical intervention) are extremely common. The possibility of more serious injuries should be considered and excluded early. Successful examination requires gaining the child's trust, relieving pain early, and using a flexible and creative examination technique. Bruising may suggest a more serious underlying injury, or the bruising pattern may indicate non-accidental injury or a bleeding disorder. Superficial abrasions and lacerations can be safely cleaned with good quality water, and all foreign material should be removed. Deeper wounds with suspected damage to nerves, tendons or circulation need formal exploration under a general anaesthetic. Good local anaesthesia can be produced by topical preparations, and many wounds can be closed with tissue adhesives with an excellent cosmetic result. Antibiotics should be prescribed for specific circumstances, such as wounds with extensive contamination or tissue damage, and all children with injuries should be checked for adequate tetanus cover for prophylaxis.
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