How to figure out if your child needs stitches
Last weekend (on Mothers Day!) my 3yo needed stitches on his face. I wasn’t home but I was able to talk my husband through exactly what to do in that moment — and I thought this might be a useful post for you as well!
This post covers exactly what to do if you find yourself in that moment, along with some of red flags that suggest your child might need an ER visit and/or stitches.
**Of course, you should also reach out to your child’s doctor if this happens because they will be able to give you individual advice based on your specific situation.**
Laceration First Aid
Kids get injured. It is part of growing up. But when you see blood everywhere and have a crying child, it’s hard to think clearly. This is a good post to bookmark in case that happens!
As with all emergency care, your very first step is always to make sure you and your child are in a safe location where there is no further risk of injury. If your child is unresponsive or not breathing, you should proceed with CPR.
The Pediatrician Mom Tip: I recommend every adult (and most teens) get CPR certified! You never know when you will need the skill.
What to do immediately
—TAKE A DEEP BREATH.
—WASH YOUR HANDS BEFORE TOUCHING THE WOUND.
Soap and water is best!
—STOP THE BLEEDING
Apply direct pressure to the wound with a CLEAN bandage or gauze immediately to help stop bleeding.
In most cases, the bleeding will stop in under 10 minutes. If blood soaks through the cloth, add a second cloth (rather than replacing).
If the wound is on an arm or a leg, you can also raise the area above the heart to help decrease bleeding.
Let water (or better yet, sterile saline) run over the wound for several minutes to remove debris so you can get a better look at what you’re dealing with.
I always use individual sterile saline pods, but you can also use a bottle of sterile saline and a large syringe. Its a good thing to have in your wound care kit. But there IS some evidence that the risk of infection with tap water isn’t higher than with sterile saline.
Here is a link to my Amazon medicine cabinet essentials (note: affiliate link)
The amount of fluid that you use to irrigate the wound matters! Use enough volume to clean it out!
Pat dry — no vigorous rubbing.
We don’t recommend using hydrogen peroxide, alcohol, or other disinfectants.
—TOUCH BASE WITH YOUR DOCTOR FOR ANY WOUND THAT CONCERNS YOU
Your doctor will want to know:
How it happened (and in what environment)
Where the injury is
What symptoms you have noticed (not just the wound itself, but to figure out the chances are of other injuries eg: concussion, broken bone)
How long ago it happened
Date of last tetanus shot
If your child has any complicating medical conditions (eg immune compromise, diabetes)
Based on this information, your doctor should be able to give you advice about whether or not your child needs to go to the ER (see below for more on this).
WOUND AFTERCARE.
If the wound is just a graze and does not need any additional care such as stitches, you can apply a thin layer of Vaseline (not Bacitracin or Neosporin!)
Depending on the wound’s location, you can also cover it with clean gauze or a bandaid, which is helpful to keep your child from messing with it or getting it dirty.
Replace the covering once daily (sooner if it becomes wet or soiled).
The Pediatrician Mom Tip: Wounds heal faster if they are kept moist, not dry (but you don’t want it to be wet either!)
Do I need to take my child to the ER for this laceration?
Remember that all information on this website is for education, and not medical advice. NEVER disregard reaching out to your own healthcare provider because of something you have read here.
Some reasons that a child might need an ER visit.
Large or gaping wounds
Deep wounds (eg: if you can see fat, fascia, muscle, bone)
Dirty wounds (eg: due to an animal bite, or caused by a rusty or dirty object)
Persistent bleeding beyond 10 minutes
Possibility of needing stitches or other wound closure (see below)
Wounds in cosmetically significant areas (eg: face)
Wounds that might have deeper or more serious underlying injuries (eg: tendon / blood vessel / nerve damage, broken bone, or where there may be embedded foreign bodies)
Extremely painful wounds
Wounds may need stitches include those that:
Are deep (you can see fat, fascia, muscle, bone)
Are long (more than half an inch)
Are continuing to bleed
Are gaping
Are in areas of a lot of skin tension or movement (eg: anywhere that does not allow the two edges of the wound to sit next to each other and facilitate healing, such as forehead / chin / joints)
Are in cosmetically significant places (eg: face)
The Pediatrician Mom Tip: There *are* situations where wounds might be left open (eg: if there is a higher risk for infection, or when there is a long delay of 12-24 hours between when the wound happened and when they are evaluated — especially if there is a concern that the wound was not adequately cleaned out).
Skin closure options
When we think of skin closure we usually think of stitches. But there are many other options, and one that is used depends on the location, extent of injury, and patient.
Stitches (also called sutures) are best for:
Clean linear wounds where the edges can be placed nicely together
Areas of the body where cosmetics matter more
Areas of the body where the skin naturally has more tension (eg forehead, chin)
The Pediatrician Mom Tip: The type of suture can also vary based on the wound. Some will dissolve on their own, and others may need to be removed 5 - 10 days later.
Glue (also called “skin adhesive) is best for:
Smaller cuts with straight edges that are not in areas of high tension
Usually the edges are held together and then multiple layers of glue are placed on the wound, with time allowed for drying between applications
Sometimes steri-strips are also used to keep edges together
Staples are best for:
The scalp
Areas where the wounds are long and need to be closed fast
They are not great for cosmetic areas
The Pediatrician Mom Tip: The “Hair Apposition Technique” or HAT technique is a lesser-known option that can be used for wounds in the scalp if a person’s hair is long enough. Rather than using stitches or staples, the physician uses hair on either side of the wound to tie small knots.
Other things to know
For more serious wounds, other options that may be discussed include:
Tetanus boosters / antibody
Tetanus is a very serious bacterial illness that can come from contaminated wounds, such as those caused by a rusty object. We have criteria for when a tetanus booster and / or tetanus immunoglobulin might be needed, based on the number of prior tetanus shots, how long ago the last one was, and a clinical assessment of how contaminated / high risk the wound was.
Antibiotics
Not every wound will need antibiotics. The decision about this will be based on the risk of contamination and infection (eg: higher with animal bites)
Imaging
Sometimes an X-ray or an ultrasound will be done to rule out injury or a foreign body. Remember, only radio-opaque foreign bodies can be seen on an X-ray image.
Part of being able to handle these types of injuries seamlessly is being prepared — not only knowing what to do, but also making sure your medicine cabinet is well-stocked. Here is a link* to some of the products I keep on hand as a pediatrician mom.
Injuries can be scary and overwhelming. My hope is that this post gives you the practical tips and information you need to handle routine childhood injuries with ease!
*affiliate link
