Introduction
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.
Signs and symptoms
Pressure injuries can be very painful and can appear anywhere on a child’s body. Common areas are
- back of the head (especially in babies, infants, toddlers)
- ears
- tailbone (sacrum/coccyx)
- heels
- elbows
- spine and shoulder blades
- under plasters, casts, splints or braces
- around medical equipment such as tubes, masks, drains, etc.
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
- sweating
- 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
Diagnosis
Medical staff will be able to make a diagnosis.
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 hard to decide on the score. This may be because it can be hard to decide how deep the wound is.
Treatment
If you think your child could develop a pressure injury or may already have one, please talk to your child’s doctor, nurse, occupational therapist, community nurse or other health care worker. You can discuss treatment and 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
- 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 and look out for common signs of pressure injuries noted above in ‘Signs and symptoms’ section of this factsheet.
Management
Risk factors 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.
Complications of pressure injuries
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.
It is important 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.
Resources and more information
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