Pediatric Patients Require Special Wound Care

Published on September 21, 2021 by Carole Jakucs, MSN, RN, PHN, CDCES

Pediatric patients with chronic and acute wounds need caregivers who are well-versed in wounds and in young patients’ unique needs. We spoke with three pediatric wound care experts to learn more about the most common wounds seen in kids, their etiologies, treatments, and recommendations for making dressing changes less traumatic.

 Acute Wounds Seen in Pediatric Patients

Pediatric patients can need treatment for a wide range of wounds. In fact, the list is quite extensive, according to experts.

Some of the more common causes of acute wounds seen in the pediatric population are a result of motor vehicle accidents (MVAs), penetrating and blunt force trauma, acute spinal cord injuries, gunshot wounds (GSWs), and other wounds caused by violence, said Pushpa Abraham, MSN, WCNP, CPNP-PC, Inpatient APN Clinical Lead at Children’s Specialized Hospital in New Brunswick, New Jersey.

Marie E. Haddock, BSN, RN, WCC, a wound care specialty nurse at Nemours duPont Hospital for Children in Wilmington, Delaware, added to the list.

“The majority of acute wounds we see are due to trauma, orthopedic surgical wounds, including the management of negative pressure wound therapy, utilized both as an adjunct to primary surgical closure and also delayed, and animal bites,” she said.

Margaret ‘Maggie’ Salzbrenner Hoopes, MSN, CPNP-AC, WCC, a nurse practitioner in the Department of Orthopedics also at Nemours duPont Hospital for Children said, “Our patient population is unique and also includes patients with acute wounds as a result of skeletal dysplasia, osteogenesis imperfecta, cerebral palsy, spinal disorders, and limb and hip deformities.”

Standard Treatments

Initial wound care in the emergency department for pediatric patients’ acute wounds has an individualized approach just as it does for adults, said Hoopes.

“Wound care is determined by the type of wound and the family’s ability to execute wound care later at home,” she said.

Haddock pointed out that initial care after cleansing the wound typically involves applying an antibiotic ointment and covering the wound with a primary non-adherent dressing and a foam dressing with a silicone border. “If a systemic infection is evident or probable, diagnostics are also obtained prior to antibiotics being administered,” she said.

Abraham said systemic antibiotics may need to be administered and continued for a time, depending on the severity of the wound or wounds.

Chronic Wounds Seen in Pediatric Patients

Hoopes points out that several pediatric conditions create higher risk for a chronic wound or wounds. “We have a large population of medically complex children,” she said. “Some have altered mobility status, spinal conditions, and sequalae of peripheral nerve neuropathies as a result of chemotherapy and neurologic conditions.”

Chronic conditions often make children dependent on equipment for mobility (i.e., orthotics, gait trainers) or transport (wheelchairs), said Haddock. “Pressure injuries are always a concern with immobility, being insensate or having a cognitive impairment that prevents communication with care providers,” she said.

Abraham said for patients who are non-verbal and/or insensate, it’s essential to maintain a continuous and watchful eye for skin breakdown.

Haddock and Hoopes pointed out just as with adults, pediatric patients are at risk of chronic pressure injuries if the patient:

  • Is nutritionally compromised
  • Has had a tracheostomy (trach site wounds)
  • Has peristomal skin breakdown at enteral tube sites (gastrostomy and jejunostomy)
  • Is immobile
  • Has neuropathic conditions
  • Uses multiple medical devices
  • Has poor oxygen perfusion
  • Has incontinent associated dermatitis
  • Is exposed to excess moisture on the skin

Wounds also occur in children who have orthopedic hardware such as fixators and in children who are wheelchair dependent because of pressure on bony prominences, said Abraham.

“For children who are immobile, frequent positioning and working to relieve pressure over pressure points is key,” she said.

Preventing and Treating Chronic Wounds

Thorough assessment with a goal of eliminating any source of pressure is paramount for first line treatment, said Haddock. “Interdisciplinary collaboration with a rehabilitative medicine engineer, physical/occupational therapists, and an orthotist (brace maker), in addition to wound care is crucial. Children may need to be on a rigid offloading scheduling until their wound or wounds heal.”

For chronic wounds due to moisture exposure, you’ll want to take a team approach to identify and reduce the root cause of the moisture in conjunction with integumentary care, said Hoopes. “One example is diarrhea in a short gut patient secondary to necrotizing enterocolitis (NEC),” she said.

Abraham said treatments for chronic wounds include:

  • Topical antibiotics, if indicated and according to wound culture and sensitivity results
  • Systemic antibiotics if indicated
  • Chemical debridement
  • Surgical debridement
  • Sharp debridement
  • Wound vacs

Haddock and Hoopes said pressure injuries require the consideration for negative pressure therapy. “Children generally show excellent results with its use.”

Additional treatments that are typically considered are:

  • Silver alginate
  • Medical grade honey
  • Skin barrier ointments
  • Foam dressings with silicone borders
  • Non-adherent dressings

A Gentle Touch for Children and Families

Haddock and Hoopes said when choosing dressings for children, the clinician needs to contemplate not only how its use impacts the child, but also the family. “Working in pediatrics means you have to consider both the developmental and cognitive levels of the child and the parent/caregiver,” said Haddock.

Taking a proactive approach with pain management is also important, said Hoopes. “Investigate age-appropriate non-pharmacologic comfort measures such as music, and work with your medical partner for an appropriate analgesic regimen.”

Providing wound care for children is different from the delivery of adult wound care, said Haddock. “It takes creativity to distract the child and make dressing changes as non-traumatic as possible.”

Hoopes suggested, “It helps to brush up on developmentally appropriate distraction techniques and consider reviewing Erikson or Piaget’s developmental stages to help develop your plan of care.”

Nemours often includes child life specialists to accompany a child during wound care procedures. “Pediatric care includes the whole family. Caregivers and patients need developmentally appropriate education,” said Haddock and Hoopes in a joint statement.

Take our engaging, evidence-based Wound Care Certification Courses for nurse, registered dietitians, physical therapists, and more professionals. Choose the format that suits you and get access to tools to help you ace your exam.

Carole Jakucs, MSN, RN, PHN, CDCES
Carole Jakucs, MSN, RN, PHN, CDCES

Carole Jakucs, MSN, RN, PHN, CDCES, is a freelance writer and diabetes educator. Her background in nursing includes tenures in healthcare management and as a care provider. She has worked in med/surg/telemetry, a pediatric emergency department and college health.

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