Pediatric Lacerations (Minor Trauma)

Stitches (sutures) are special types of thread that hold wound edges together while they heal. They help speed healing, stop bleeding and reduce scarring. They also lower the chance of the wound becoming infected.

Sterile adhesive strips can sometimes be used on small, shallow wounds instead of stitches. They have many of the same benefits as stitches, but they are much easier to apply.

Lacerations may need stitches if they involve the face or are longer than 1/2 inch. They may also need stitches if they're deep, spread open at rest or bleeding heavily.

• Calm your child, and let them know that you can help.
• Apply pressure with a clean cloth or bandage for several minutes to stop bleeding. If the bleeding is heavy, hold pressure for 5 to 10 minutes without stopping to look at the cut. If the cloth becomes soaked with blood, put a new cloth on top of the old one. Don't lift the original cloth.
• After bleeding has stopped, wash your hands with soap and water. Then wash the wound area well with soap and water. Do not touch the wound area until you've washed your hands well. This helps prevent germs from getting into the wound. Don't scrub the wound. Remove any dirt particles from the area, and let the water from a faucet run over it for several minutes. You may have to apply pressure again if bleeding starts again after cleaning.
• Cover the area with an adhesive bandage or gauze. Change the bandage 2 times a day or whenever it gets wet or dirty.
• Call your child's health care provider. If bleeding is severe, call 911 or take your child to the emergency room (ER) as soon as you can.

Your child's health care provider will decide how to treat lacerations that need more than minor treatment at home. In general, contact your child's provider for lacerations that are:

• Bleeding heavily and haven't stopped after 5 to 10 minutes of direct pressure.
• Deep or longer than 1/2 inch.
• Located close to the eye.
• On the face.
• Caused by a puncture wound or a dirty or rusty object.
• Embedded with debris, such as dirt, stones or gravel.
• Ragged or have separated edges.
• Caused by an animal or human bite.
• Excessively painful.
• Showing signs of infection, such as increased warmth, redness, swelling or drainage.
• Involved with another injury, especially a head injury or a broken bone.
• Linked to numbness or weakness of a finger, toe or joint. This may mean damage to a nerve or tendon has happened.

Also call your child's provider if:

• Your child hasn't had a tetanus vaccination in the past five years or if you aren't sure when your child's last tetanus shot was given.
• You are concerned about the wound or have any questions.

If your child's healthcare provider or an emergency room provider needs to place stitches or use sterile adhesive strips to close a laceration, you will be given instructions for how to care for them. Treatment at home will be based on the location, depth, and size of the laceration; the type of stitches used; and any special needs noted by your child's provider. Antibiotics may be given to help prevent infection in the wound. A tetanus booster may be needed depending on your child's wound.

Some stitches dissolve and don't need to be removed. Other stitches need a provider to remove them. The provider will let you know when to come back to have stitches removed. Don't try to remove your child's stitches yourself.

Here are some general guidelines for caring for lacerations with stitches or sterile adhesive strips:

• Keep the area clean and dry.
• Carefully follow the provider's instructions for care of the wound.
• Make sure your child doesn't do any activity that may reinjure or open the wound.
• Watch the wound for signs of infection. These signs include increased warmth, swelling, redness, drainage or pain.
• Watch the stitches to make sure they are intact and keeping the wound edges together.
• Return for follow-up care, as advised by your child's provider.
• Keep the wound out of prolonged direct sunlight. After the wound is completely healed, use sunscreen to help protect the area of new skin. Sunburn or sun exposure can increase scarring.
• Keep butterfly strips in place until they start to loosen. They will fall off after a few days.