What is a Pressure Injury?
Pressure injury (also known as a pressure sore, bed sore or pressure ulcer) is an area of damaged skin caused by pressure, sliding and / or rubbing on the skin. The pressure stops blood getting to the skin and muscles to keep them healthy, or damages the skin by rubbing it away. An injury is most likely to occur where bones are closest to the skin.
Injuries to the skin are mostly caused by resting in the same position for a long time, having splints or medical equipment pressing or rubbing on the skin for long periods of time, or the regular slipping down of sheets on a bed.
When a pressure injury is found, hospital staff will look at the injury carefully and give it a score of 1 to 4. 1 is the least injury to the skin and 4 is the most serious injury to the skin and body. Sometimes it is difficult to determine the score. This may be due to the appearance of the wound and thus the depth of injury is not initially apparent.
Parts of the Body where Pressure Injuries are Likely to Occur:
Pressure injuries can appear anywhere on a child’s body. Common areas are:
- back of the head (especially in babies, infants, toddlers)
- tailbone (sacrum / coccyx)
- spine and shoulder blades
- under plasters, casts, splints or braces
- around medical equipment such as tubes, masks, drains, etc.
Are Pressure Injuries Serious?
The skin helps to stop germs from entering the body. Pressure injuries can create breaks in the skin that could allow germs to enter your child’s body and cause an infection. This can lead to serious illness for children who have problems with immunity or are already unwell. A deep or serious wound can lead to permanent scarring.
Who is at Risk of Getting a Pressure Injury?
Most children move their bodies and change position without realising they are doing it, even when they are asleep. Health problems and medical treatments can stop children from changing their position. Children most at risk are those who:
- cannot move much on their own.
- have limited or no feeling to parts of their body.
- are in contact with another surface for long periods of time, such as wheelchair, splints, etc.
- are in bed for long periods of time.
- have pressure or rubbing to an area of the body over long periods of time.
- are very unwell.
- have problems with immunity.
- have a poor diet or have not been receiving enough food and fluids.
- are below the healthy weight range.
What to Do for Prevention
If you think your child could develop a pressure injury or may already have one, please talk to your child’s: General Practitioner, Nurse, Occupational Therapist, Community Nurse or other health care worker. You can discuss options that are suitable for your child. Actions you can take may include:
- Checking your child’s skin regularly including under medical devices - morning and night.
- Changing your child’s position regularly. We recommend every two hours through the day and every four hours overnight.
- Changing your child’s nappy regularly. We recommend as soon as the nappy becomes wet or dirty. Every two to four hours is usual.
- Using slide sheets to help move your child in bed (slide sheets are slippery synthetic fabric).
- Using equipment to help relieve pressure. You may wish to speak with an occupational therapist.
- Using soaps or creams that are pH neutral.
- Making sure your child’s skin is not too moist or too dry.
- Encouraging your child to move (if suitable to their situation).
- Making sure your child is getting food and fluids that are right for them.
Things to Avoid
- Stretching or pulling on the skin e.g. do not drag your child up the bed over the sheet.
- Massaging or rubbing red areas. This can cause more damage to the skin.
- Using ring cushions without professional advice has been shown to cause or make pressure injuries worse.
Finding the Cause of a Pressure Injury
Most pressure injuries will heal if the reason for the injury can be found and corrected. It is important to find the source of pressure and address it. Common signs of pressure injuries are:
- red marks on the skin.
- broken or grazed areas on the skin.
- blistering of the skin.
- pain (unless your child has reduced or impaired sensation).
Ask your child to tell you if there are any sore areas on their body, or look for the following signs:
- unsettled behaviours, distress, your child is grizzling or will not stop crying
- unexplained fever
- not hungry and /or not eating
- an area of skin that your child will not allow you to touch
- an area under a plaster, splint or brace that smells or is leaking fluid.
- A pressure injury is easier to prevent than treat.
- Pressure injuries can be a sign of a more serious injury and need to be relieved and treated as soon as possible.
- Be aware of the signs of a pressure injury.
- Find the cause of the pressure injury and treat and remove the cause.
- Talk to your child’s health care worker if you believe your child is at risk.
- Australian Wound Management Association (2012) Pan Pacific Clinical Practice Guideline for the Prevention and Management of Pressure Injury. Cambridge Media Osborne Park, WA
- Butler, C. (2006) Paediatric Skin Care: Guidelines for Assessment, Prevention and Treatment Paediatric Nursing 32(5)
- National Pressure Ulcer Advisory Panel (2007) Pressure Ulcer Stages Revised by NPUAP www.npuap.org last accessed 1st April 2008
- Suddaby, E., Barnett, S. & Facteau, L. (2006) Skin Breakdown in Acute Care Paediatrics Dermatology Nursing 18(2):155-161
- Victoria Health Service, Better Health Channel (2008) Pressure Sores Fact Sheet www.betterhealth.vic.gov.au, last accessed 1st April 2008
- Paraplegic and Quadriplegic Association New South Wales, Skin Care Fact Sheet
- The Royal Children’s Hospital Melbourne – Kids Health Info: Pressure Injury Prevention