No more scabs – treating cuts and scrapes

To quote a well known child psychologist, ‘kids do stuff’. And active little people doing stuff are bound to acquire a few cuts, scrapes, bruises and bits that bleed along the way. In fact, according to the Wound Foundation of Australia, a third of Australian children injure themselves every week. And while the natural instinct of parents is to protect their children from danger and hurt, children need to explore and take risks if they are ever to learn new skills.

So the next time your child insists on removing the training wheels from their bike, climbs a tree or constructs a rickety cubby house made from salvaged roadside hard rubbish – draw a deep breath, check that the medicine cupboard is stocked and most importantly, brush up on first aid skills.

St John Ambulance Australia offer special first aid courses for parents, called Caring for Kids which focuses on the needs of children, including infant CPR, poisons, stings and acute illnesses, as well as the management of wounds, bleeding, burns and fractures.

It is important to know that the recommended first aid treatment of wounds has changed in recent years. While most adults are aware of what to do as far as cleaning a minor injury, many think that once the bleeding has stopped, a minor wound (ie one that doesn’t require stitches) is best left un-covered to dry out and form a scab. However, research in recent years has led to the discovery that wounds heal best when covered and kept moist (but not wet).

In the Wound Care Update Paper 2006, Assoc Professor Roy Kimble, says that ‘the public still doesn’t know enough about the most basic principles of wound management, such as moist wound healing. They are not aware that leaving a wound out to dry kills skin cells and increases the risk of scarring’.

Most childhood injuries which bleed fall into two categories – abrasions or lacerations.

Abrasions (grazes, scrapes or gravel rash)

An abrasion means that the surface layers of the skin have been broken. These injuries are very common and usually happen when a child and their bony bits – hands, knees, elbows or ankles - make contact with a hard surface such as the asphalt of the school playground.

The top layers of the skin are scraped off, especially when the impact is of a sliding motion and the resultant injury, while not deep, can be stinging and painful, traumatising the many nerve endings in the skin.

A large section of the skin may be broken, resulting in many small bleeding spots with dirt embedded into the scraped surface of the skin. The bleeding is not usually severe as the injury is generally shallow and affects the top layers of the skin, rather than major blood vessels.

First Aid treatment

Because falls are often a contributing factor, your child may be quite shocked and in pain, so comfort them first before dealing with the injury.

• Always wash hands before cleaning the grazed area.
• If the graze is a deep injury, stop bleeding first by applying even pressure with a clean cloth.
• Very gently, clean the injured area with a sterile gauze (if available), or a clean face washer and water. Antiseptic is not necessary.
• Use a dabbing motion; don’t scrub at the wound as that may embed dirt more deeply into the injured skin.
• If there is a lot of dirt it may be more effective to ‘sluice’ the wound over a basin, or fully immerse in a shallow bath.
• Rinse off with clean water and gently pat dry.
• Cover the wound with a large non-stick dressing; one which breathes, and keep it covered to protect the injury site.

Lacerations (incised wounds or cuts)

These are caused by sharp objects penetrating and slicing into the skin; colliding with the sharp edge of a wire fence or stepping on broken glass, for example. These kinds of cuts may bleed heavily, (especially those to the head) and it’s important to bring the bleeding under control.

• Stem by applying pressure with a clean cloth, pad or sterile dressing.
• Raise the injured limb to help slow the bleeding. The cut may need stitches or special hospital glue, if the edges are gaping, or if it is larger than about a centimetre.
• Smaller cuts require a similar treatment of clean, dry and cover with a sterile strip.
• If blood is spurting, a major artery may have been punctured. Call an ambulance immediately and in the meantime it is imperative to maintain strong pressure to the wound with a cloth, or even your hands.

The healing process

Once the skin barrier is broken, the body takes action. While bleeding is frightening for children, it is the first stage in the healing process.

Platelets gather at the site to form a clot, while white blood cells act against any bacteria which may have entered the site.

New skin cells start to form and knit the skin together, moving from one side of the wound to the other. If the wound is covered, the new cells are far more easily able to knit the skin from wound edge to edge. This is a slower process if left uncovered to ‘scab over’.

Why no scabs?

• A scab is dead tissue – the healing process is slower and there is a greater chance of infection.
• Scars are left after a scab falls off, because the new cells grow under the scab, not through it.
• Scabs can split or fall off prematurely, triggering new bleeding at the site.
• Scabs are itchy – children pick at them, which can lead to infection of the wound.
• Generally, scar tissue isn’t as strong as undamaged skin.

What kind of dressing?

There now seems to be a bewildering array of dressings available in the supermarket or pharmacy; in part because advances in the technology associated with the care of wounds have trickled down into mainstream pharmaceutical products.

Innovations include

Hydrocolloidal or gel strips - These bandages absorb fluid from the wound and form a gel over the wound which keeps the site moist. The wound pad does not stick to the wound, allowing for a painless removal of the strip without disturbing the healing process. These kinds of strips work best when left over the wound for several days.

Liquid or spray-on - forms a waterproof seal and is flexible so move with skin They’re good for sites such as elbows.

Ionized silver – the anti-bacterial properties of silver have been known for many years, and in an ionized form have now been adapted to bandages.

Silver ions – are slowly but continuously released from the wound pad, and migrate into the wound, where they penetrate bacterial membranes and can destroy the cell structure of bacteria.

Hypoallergenic – some children are allergic to either the adhesive used in plastic bandages, or the latex in the bandage itself. Products that are labeled as hypoallergenic are tested to show that they reduce the chance of allergic reactions.

Sources:

The Wound Foundation 

Better Health 

Child and Youth Health 
 

This article was first published in Australian Family Magazine, November 2006. Updated July 2009.