Cuts and other common wounds include injuries such as scrapes, abrasions and bites that break a child’s skin. These injuries can be minor or more serious. Infections and other ailments can follow one of these injuries.

The skin’s external location makes it susceptible to injuries such as cuts, lacerations, scratches, abrasions and puncture wounds. Children can also be bitten by animals or another person, and both types of bite can result in bacterial infection. Finally, some children develop chronic (ongoing) wounds due to illness, poor nutrition, surgery or other factors. These wounds may not heal or may heal slowly.

Cuts and other common wounds can be caused by a number of factors, such as a puncture with a sharp object or impact from a fall. Once the skin is broken, it may bleed as a result of torn blood vessels under its surface. Bruising may also accompany these wounds. In some cases, a child may develop an infection, including a particularly dangerous variety known as tetanus, caused by the toxin of the bacterium Clostridium tetani.

Parents can treat a child’s minor wounds using home-based care. However, more serious wounds require a visit to a medical professional. Treatments may include stitches to close the wound and antibiotics to prevent or kill any infection that may have resulted from the wound.

Cuts and other common wounds occur when a child’s skin is broken. Once the skin has been pierced, germs can get into the body and cause an infection. These injuries can range from minor events that heal on their own over time to more serious ailments that require the care of a physician or other medical professional.

The skin’s external location makes it susceptible to a number of wounds and injuries. Cuts (breaks or openings in the skin), lacerations (jagged and irregular types of cuts produced by the tearing of soft body tissue), scratches (minor injuries that result from sharp objects scraping along the skin), abrasions (scrapes that result from the skin being rubbed away) and puncture wounds (produced when a pointed object pierces the skin) are among the more common skin wounds.

Bites can also cause a variety of skin injuries. Many animals have the potential to bite when frightened, harassed or otherwise provoked. Humans also may bite each other on occasion. Most domestic cats and dogs are immunized against rabies, a life-threatening viral infection that can be transmitted through a bite. However, bites from non-immunized domestic animals and wild animals (e.g., raccoons, skunks, bats, foxes) carry the risk of rabies.

Cuts, bites and other common wounds may be minor or major. Although minor wounds tend to heal quickly without complications, some wounds can lead to extensive blood loss or an infection or injury to deeper structures (e.g., nerves, tendons, blood vessels). Complications may also result from foreign material remaining inside a wound. For example, bites, whether from an animal or a human, frequently become infected because bacteria from the mouth can enter the wound.

Some children develop chronic (ongoing) wounds due to illness, poor nutrition, surgery or other factors. These wounds may not heal or may heal slowly. They are often difficult to manage and require special treatment techniques.

The most common types of chronic wounds include:

• Diabetic wounds. Foot lesions are a common complication of diabetes and sometimes require hospitalization and, in severe cases, amputation (surgical removal of the affected limb).
  
  
• Bed sores (also called pressure sores or pressure ulcers). Areas of damaged skin and tissue that develop when sustained pressure, usually by a bed or wheelchair, cuts off circulation to parts of the body, especially the skin on the buttocks, hips and heels. Without adequate blood flow, tissue dies. Children who are bedridden or paralyzed are especially prone to bed sores, which can become infected if not treated properly.
  
  
• Surgical wounds. After surgery, wounds may be kept open or closed with stitches, sutures, staples or healing strips. People with wounds from surgical procedures may develop serious complications, such as bleeding, bruising, blood clots, infection, tissue necrosis (death) or splitting open of a surgical wound (dehiscence).

Chronic wounds that are left untreated can lead to serious complications, including:

• Infection. Some types of infection include cellulitis (acute inflammation of connective tissue of the skin), gas gangrene, sepsis (life-threatening blood infection), osteomyelitis (infection of the bone) and septic arthritis (bacterial infection of a joint).
  
  
• Endocarditis. Inflammation of the lining of the heart.
  
  
• Heterotopic bone formation. The occurrence of a bone growth in an abnormal location.
  
  
• Myiasis (maggot infestation).
  
  
• Meningitis. Inflammation of the membrane covering the brain and spinal cord.
  
  
• Amyloidosis. A rare disease that causes the accumulation of amyloid (a protein and starch) in tissues and organs that can result in impaired function of organs.

Cuts and other common wounds can be caused by a number of factors. For example, sharp objects such as knives typically cause cuts that result in a break or opening in the skin. Or, a child may skin a knee after running and falling, or become hurt when playing sports without wearing proper protective gear. Once a child suffers a cut, scratch, bite or abrasion, the wound may start to bleed. This occurs because these wounds break or tear the blood vessels under the skin’s surface.

The majority of animal bites come from domestic pets. Dogs are more likely to bite than cats, but cat bites are more likely to cause infection. Dog bites usually have a ragged, torn appearance, whereas cat bites often produce deep puncture wounds. Cows, horses, pigs and other domestic animals bite less often, but their size and strength enable them to cause serious wounds. Bites from wild animals are rare, but can be life-threatening if the animal is infected with rabies.

Human bites can be as dangerous, if not more dangerous, than animal bites. Human bites are considered serious because of the types of bacteria and viruses found in the human mouth. Human teeth are not sharp. As a result, most human bites only cause bruises or shallow tears (lacerations). Bites on the fleshy appendages (e.g., ears, nose, penis) are an exception because these parts can be severed.

Cuts, scratches, abrasions, bites or other wounds may be accompanied by bleeding and/or bruises. These injuries can also become infected. Symptoms of infection include:

• Fever
• Red streaks around a cut, scrape or bite
• Thick, green or yellow liquid oozing from the injury
• Pain in the injury or warmth coming from the injury
• Numbness or swelling in the area below the injury

Some wounds result in tetanus, a type of serious infection. The disease is caused by the toxin of the bacterium Clostridium tetani. Spores of the bacteria live in the soil. When they are introduced to the body through a wound, the toxins affect the central nervous system (the brain and spinal cord). Tetanus is also known as “lockjaw” because stiffness of the jaw is the condition’s most common symptom. It may also result in stiffness and spasms of various other muscle groups (e.g., neck, chest, abdomen, back), seizures and, in rare cases, death.

Parents can treat a child’s minor wounds using steps outlined in First aid for common wounds. However, in some cases, treatment by a medical professional may be necessary to adequately treat a cut, bite or other wound.

Certain symptoms may indicate infection or the need for more serious treatment. Wounds that are deep may not bleed, leaving them appearing to be less serious. However, deeper wounds sometimes damage underlying nerves and tendons, and therefore should be examined by a physician. In addition, deeper wounds can lead to scarring that can be reduced by properly stitching or taping together a wound.

Parents of children who have suffered a cut or other common wound should call a physician if any of the following apply to the child’s wound:

• The wound spurts blood, blood soaks through the bandage or bleeding continues after 10 minutes of firm and continuous pressure
  
  
• The wound is longer than a third of an inch (0.8 centimeters)
  
  
• Redness surrounds the wound or red streaks have formed near the wound
  
  
• A thick, creamy, grayish or greenish fluid (pus) drains from the wound
  
  
• There is warmth or numbness in the area of the wound or swelling around it
  
  
• The wound is jagged, appears deep, is located on the face, head or hand or becomes tender or inflamed
  
  
• The edges of the cut gape open
  
  
• Contaminated wound (e.g., dirt or debris is embedded in the wound despite attempts to clean it)
  
  
• A long or deeply embedded object is present in the wound
  
  
• The child cannot move comfortably or develops a temperature over 100 degrees Fahrenheit (38 degrees Celsius)
  
  
• The wound is failing to heal

Children who have been bitten by an animal or person should see a physician if any of the following apply:

• The bite was from a cat, because they tend to inflict deeper puncture wounds that often become infected.
  
  
• The bite is on the hand, foot or head.
  
  
• The bite is deep or gaping.
  
  
• Bleeding continues after applying firm and continuous pressure for 15 minutes.
  
  
• There are signs of infection (e.g., redness, swelling, warmth, increased pain or tenderness, oozing of pus, fever).
  
  
• The bite may have resulted in a fractured bone, nerve damage, tendon damage or other injury.
  
  
• The child has a condition that weakens the ability to fight infection (e.g., diabetes, cancer, AIDS).
  
  
• The child is taking immunosuppressive medication (drugs that inhibit or prevent activity of the immune system). These agents are used for preventing rejection of transplanted organs and tissues as well as for the treatment of autoimmune diseases, such as lupus and Crohn’s disease.
  
  
• The wound is deep and dirty and the child’s last tetanus shot was more than five years ago.

Most domestic cats and dogs are immunized against rabies, a life-threatening viral infection that can be transmitted through a bite. However, bites from non-immunized domestic animals and wild animals (e.g., raccoons, skunks, bats, foxes) carry the risk of rabies. Parents of children who have been bitten by a pet should determine if the animal has been vaccinated against rabies and seek immediate medical attention if the animal has not been vaccinated. In cases where the animal has not been immunized against rabies or such information is not available (e.g., wild animals), the child may need to be administered a series of rabies shots to prevent infection. 

Parents are also urged to contact a physician if their child’s last tetanus shot was more than five years ago. To prevent tetanus, it is recommended that people receive a tetanus booster every 10 years. However, people with wounds that are deep and dirty may require a booster shot if they have not had a tetanus shot in the last five years. Tetanus shots should be given within 48 hours of injury.

In diagnosing the nature of a child’s injury, a physician will perform a physical examination and compile a through medical history. When examining an animal wound or bite, the physician will first check the wound for signs of nerve damage, tendon damage or injury to the bone. If damage to the bone is suspected, an x-ray may be performed. The physician will also look for signs of infection.

In cases of chronic wounds, a physician may also conduct tests to determine whether an underlying condition or disease may be impairing the healing process. Tests include:

• Blood test. A test that determines the amount of any given substance in the blood and identifies abnormally high or low levels.
  
  
• Tissue culture. A sample of tissue is removed from the wound and grown in the laboratory to determine if a known infection is impairing wound healing.
  
  
• Magnetic resonance imaging (MRI). Safe and noninvasive or minimally invasive imaging test that can help physicians diagnose diseases of numerous organs and vessels. MRI uses powerful magnets to produce images of internal organs and body structures on a computer screen and film.
  
  
• Ultrasound. An imaging technology that uses sound waves to produce images of the shape and outline of various tissues and organs in the body. The images produced are called a sonogram.
  
  
• Biopsy. A sample of tissue is removed from the wound and studied under a microscope to determine abnormalities that may be impairing the healing process, such as whether the tissue is infected.

Minor skin injuries do not usually require emergency medical attention. In order to prevent infection or other complications, parents are urged to take the proper first-aid steps when treating their child’s minor cuts, bites or other common wounds. These steps include:

1. Control the bleeding. Minor skin injuries usually stop bleeding quickly on their own. Wounds on the face, head or mouth may bleed longer because these areas contain a large number of blood vessels. When a child’s wound continues to bleed, parents should apply firm yet gentle pressure to the wound with a clean cloth, tissue or bandage. Using a finger or hand, pressure should be continuously placed on the injury for 10 to 15 minutes. Parents should avoid lifting the cloth or bandage during this time to check if the bleeding has stopped. Doing so can damage the blood clot that is forming in the wound and cause the bleeding to begin again. When blood soaks through the cloth or bandage, additional cloth or bandages should be placed over the existing material and more pressure should be applied.
   
   Raising the injury above the level of the heart can also help control bleeding. A child with a wound on the arm or leg, for example, should raise the limb.
   
   
2. Clean the wound. Cleaning a child’s wound is important because dirt and bacteria can lead to infection. Parents should use cool water to clean the wound. Parents can either hold the injury under running water or use a cup to pour water onto it. Contrary to popular notion, hydrogen peroxide, iodine or other sterilizing substances should not be used because they can irritate the injury and impair the tissue’s ability to heal. When dirt or other particles (e.g., glass, splinters) remain in the wound, tweezers that have been sterilized with isopropyl alcohol (rubbing alcohol) can be used to remove the debris. In many cases, a foreign object remaining inside a wound will cause part of the wound near the object to be painful when touched. Parents or other caregivers should not attempt to remove long or deeply embedded objects. Instead, the child should seek medical treatment.
   
   The area around the wound should also be cleaned to reduce the risk of tetanus, a dangerous type of bacterial infection. Soap and a soft washcloth can be used to clean the surrounding area. Applying soap onto the wound should be avoided as it can irritate the skin.
   
   
3. Apply a topical antibiotic. A thin layer of antibiotic ointment or cream (e.g., bacitracin) should be applied to the wound once the area is cleaned. Antibiotic treatments are useful because they keep the surface of the wound moist, prevent infection and enable the body to close the wound more effectively. They also discourage heavy scabs from forming and reduce the size of scars. Although the majority of cuts and scrapes heal well without the use of a topical antibiotic, applying it can speed healing time and reduce scarring. Some children may develop a mild rash when using antibiotic ointment. The product should be discontinued if a rash develops.
   
   
4. Cover the wound. Wounds that are located in areas that will be exposed to dirt or rubbed by clothing should be covered. Applying a bandage to the wound keeps the injury clean and prevents harmful bacteria from entering the site. Adhesive bandages are commonly used to cover minor wounds. Other alternatives include adhesive-free dressings and sterile gauze. Medical tape can be used to keep small wounds closed. Certain types of wounds, such as scrapes that cover a large section of the body, require special bandages. Known as occlusive or semiocclusive bandages, these bandages reduce scarring and speed healing by keeping the wound clean and moist.
   
   
5. Change the bandages. Bandages should be changed at least once a day. A bandage should also be changed whenever it becomes wet or dirty.

Over time, the bleeding will stop and a scab (hard crust) will form over the injury. Scabs protect the wound and allow a new layer of skin to form and to cover the injury. The scab falls off on its own once the wound is completely healed. This usually occurs within one to two weeks. Parents are urged to discourage children from picking or scratching at a scab. This can cause the new skin under the scab to rip, resulting in longer healing time and possible scarring.    

Children with certain types of wounds may require a tetanus shot. Tetanus is a serious infection caused by the bacterium Clostridium tetani. In order to prevent tetanus, it is recommended that people receive a tetanus booster every 10 years. Whether a person requires the shot depends on the characteristics of the wound (e.g., dirty, clean, deep), as well as the timing of their last shot. Tetanus boosters should be given within 48 hours of injury.

More serious wounds, such as those with jagged edges or edges that gape open, may require more extensive treatment. In order to heal properly, these types of wounds often need to be sewn shut by a physician (stitches).

Stitches are used to join the sides of a cut together so it can heal properly. First, the physician cleans the cut and makes sure that there is no foreign matter remaining in the wound. Then, in a process similar to sewing fabric, a physician uses a small needle and suture string made of nylon, silk or Vicryl to join the edges of the cut together. Once the edges are joined together, the physician ties a knot in the string. The procedure is usually not painful because a local anesthetic (numbing agent) is typically applied to the area beforehand.

Once the stitches are in place, the physician provides the child and the child’s parents with instructions on methods of care, including when and how to wash the area. The physician may also recommend applying antibiotic ointment and elevating the wound above the level of the heart to lessen swelling, reduce pain and improve healing time.

The stitches stay in place until the wound is healed, usually between five and 10 days, depending on the location of the cut. Injuries around the joints, for example, may take longer to heal because of the movement associated with that area.

To remove the stitches, the physician will make a cut at the knot and pull out the string. The child may experience a slight pulling sensation but the removal of stitches is not usually painful. Vicryl string is absorbed by the skin, so this type of stitch does not require removal.  

Skin adhesive may also be used to close a small wound. An alternative to stitches, skin adhesive is a liquid film used by physicians. When applied to a wound and allowed to dry, the glue-like film holds the edges of a wound together. The adhesive is then left in place over the wound until it falls off. This usually occurs within five to 10 days.

Parents should discourage the child from picking or scratching at the skin adhesive. Children with bandages over the adhesive should keep the bandage from getting wet. Physicians may also instruct the child’s parents to change the bandage daily. In addition, parents should not place antibiotic ointment or other types of ointment on the adhesive because it can cause the skin adhesive to loosen and fall off prematurely. The adhesive should also stay out of direct sunlight. 

Whether a wound is minor and treated at home or more serious and requires stitches, it is recommended that parents monitor the injury for signs of infection during the first several days after treatment. Although cuts and other minor wounds can be painful at first, the severity of the pain typically lessens after the first day. The first sign of infection is often pain that worsens a day or more after the injury. Other signs include redness or warmth in the area of the wound. In addition, pus may ooze from the wound and the child may develop a fever. Parents should contact a physician within several hours after signs of infection appear in a child.

Parents should also contact a physician when signs of nerve or tendon injury are present in the child. Numbness in the area of the wound can indicate this type of injury. Inability to fully move a body part may be a sign of serious injury.

Animal or human bites that break the skin require prompt medical treatment. The surface of the wound is usually sterilized with iodine and then irrigated or flushed with saline (salt water) or water to reduce bacteria. If necessary, any damaged tissue will be debrided (trimmed) from the edge of the wound. In some cases, stitches are used to close a bite. Stitches are usually used with facial bites. However, in many other situations (e.g., minor wounds, puncture wounds, hand wounds) the wound is left open to heal on its own. A tetanus shot will be provided if needed, and antibiotics are usually prescribed to fight infection. Following treatment, children may be asked to return for another examination in one or two days.

Severe bite wounds, as well as those that are infected but fail to improve with oral antibiotics, may require further treatment. In these situations, a physician may recommend intravenous antibiotics. For this treatment, children are hospitalized and antibiotics are administered intravenously (through a vein).

Most domestic cats and dogs are immunized against rabies, a life-threatening viral infection that can be transmitted through a bite. However, bites from non-immunized domestic animals and wild animals (e.g., raccoons, skunks, bats, foxes) carry the risk of rabies. If the animal is a pet, the bite victim’s parents should attempt to contact the pet’s owner and obtain the animal’s vaccination record. When the owner of the animal cannot be identified, or the animal is wild or stray, the bite victim’s parents should contact their local animal control agency or health department. These agencies will attempt to capture the animal, so it can be tested for rabies. People should not attempt to catch the animal themselves. If the animal cannot be found, if the offending animal begins to show signs of rabies, or if a test reveals that the animal has rabies, the bite victim will most likely receive a series of rabies shots to prevent the severe infection.

Parents who suspect their child may have contracted rabies from a bite should seek immediate medical attention. Although there is no cure for rabies once symptoms develop, children may be able to develop immunity by receiving a rabies vaccine soon after being bitten (before symptoms develop).  

Snakes also occasionally bite children. Anyone bitten by a snake should seek immediate medical attention because some snakes inject poison into the body as they bite, although poisonous snakebites are uncommon. Poisonous snakebites are treated with an intravenous injection of venom antidote (substance that counteracts the effects of poison). If the snake is not venomous, its bite is treated as a common puncture wound.

Chronic wounds may be treated with the following:

• Nutrition counseling. Children’s diets must provide enough nutrition to promote proper wound healing. Getting adequate amounts of protein, zinc and vitamins A, C and E are especially important.
  
  
• Antibiotic therapy. Infections that may be slowing the healing process can be treated with antibiotics (medications that kill or slow the growth of harmful microorganisms, such as bacteria).
  
  
• Removal of bodies. Fragments of dressing or suture materials or other foreign bodies may remain in wounds and impair healing. Removal of these foreign bodies can often speed the healing process.
  
  
• Wound irrigation. Wounds are sometimes washed with saline solutions to fight or prevent infection. Whirlpool treatments (hydrotherapy) are sometimes used for large and infected wounds. This can aid healing by keeping skin clean and removing dead or contaminated tissue.
  
  
• Wound dressings. Dressings may be used to protect wounds after surgery. Wounds are kept moist with an ointment that is covered by a bandage, which helps to promote healing. However, the bandage must be changed frequently because it can trap bacteria inside the wound and cause infection.
  
  
• Growth factors. Proteins that stimulate cell growth. The Food and Drug Administration (FDA) has approved the use of growth factors to treat diabetic foot ulcers. They are applied directly to the skin.
  
  
• Hyperbaric (high-pressure) oxygen treatment. Oxygen is essential to healing tissues. Children undergoing hyperbaric oxygen treatment are placed in a chamber where 100 percent oxygen is circulated. The oxygen is pressurized so that air pressure may be two to three times greater than normal. This allows the lungs and skin to absorb more concentrated oxygen in a shorter period of time.
  
  
• Removal of damaged tissue (debridement). Wounds need to be free of damaged, dead or infected tissue to heal properly. This may be accomplished with surgery, mechanical debridement (removing tissue with a high-pressure irrigation device), autolytic debridement (allowing the body’s own enzymes to break down dead tissue) or enzymatic debridement (applying topical debriding enzymes).

There are many factors that can interfere with wound healing. The most common reason for impaired wound healing is infection. All wounds are contaminated with bacteria. Infection occurs when a child’s immune system is unable to fight off the bacteria. Sometimes this happens because a child’s immune system has been weakened by a chronic disease, such as diabetes. The long-term effects of diabetes impair wound healing by reducing blood flow and sensation to the injured area. In some cases, people with diabetes do not even realize they have wounds.

Paralysis or other causes of limited mobility and hospitalization also increase a person’s risk for wound infection.

Other factors that impede wound healing include:

• Drugs. Some types of medications, such as corticosteroids (e.g., used to treat asthma, Crohn’s disease), can slow wound healing.
  
  
• Nutritional problems. Deficiencies in proteins, zinc and vitamins A, C and E can impact wound healing.
  
  
• Tissue necrosis (death). The death of tissue cells resulting from lack of blood supply or radiation injury may slow the healing process.
  
  
• Hypoxia (reduction of oxygen supply to tissue). This may occur due to loss of blood, unrelieved pain or hypothermia (abnormally low body temperature), especially in the extremities of the body, such as the hands and feet.
  
  
• Excessive tension on wound edges. This can restrict blood flow to a wounded area and impair healing.
  
  
• Presence of another wound. When a child has more than one wound, there may be “competition” among wounds, which may slow the healing process.
  
  
• Low temperature. The temperature of tissue in the upper and lower extremities of the body can slow the healing process in these areas.

Although it is impossible to prevent all cuts and other common wounds, parents can help lower their child’s health risk by making sure the child receives a tetanus shot at recommended intervals. This prevents tetanus, a disease that is caused by the toxin of the bacterium Clostridium tetani.

Although bite wounds cannot always be prevented, there are steps people can take to reduce the likelihood of being bitten by an animal. People should avoid teasing or otherwise provoking animals. In addition, children should be taught not to approach unfamiliar animals.

Preparing questions in advance can help children and parents have more meaningful discussions with their physicians regarding their or their child’s treatment options. The following questions related to cuts and other common wounds may be helpful:

1. What first aid steps should I take to treat my child’s cuts and other wounds?
   
   
2. When should I seek medical treatment for my child’s wound?
   
   
3. How long will it take for my child’s wound to heal? Will it leave a scar?
   
   
4. Does my child’s wound put him/her at risk for any complications?
   
   
5. How will I know if my child’s wound becomes infected?
   
   
6. What should I do if my child’s wound becomes infected?
   
   
7. Will my child’s wound require stitches?
   
   
8. Will my child need a tetanus booster shot?
   
   
9. Will my child require antibiotics?
   
   
10. When should my child seek medical treatment for a bite?
    
    
11. What are my child’s treatment options for a chronic wound?
    
    
12. Do you have experience treating chronic wounds, or should I seek a wound specialist?
    
    
13. What tests will you use to determine why my child’s wound is not healing?
    
    
14. My child has diabetes. Are there ways that my child can prevent diabetic foot ulcers?
    
    
15. My child just had surgery. Are there any special measures I should take to care for the wound?