Introduction 

Pressure injuries happen when skin is damaged from constant pressure, sliding, or rubbing. They’re also called pressure ulcers or bed sores.

Skin and muscles need a good blood supply to stay healthy. If something presses too long on the same spot, blood flow to that area is reduced, and the skin can become damaged.

Sliding or rubbing, especially on wet skin, can also cause injury to the skin.

Common causes include:

• staying in one position for a long time
• splints or medical equipment pressing on the skin
• sliding down the sheets in bed
• regular contact with wet or wrinkled clothing or sheets.

Most children shift their bodies naturally, even during sleep. Children may be at higher risk if they:

• can’t move much on their own
• need medical treatment that limits their movement
• have equipment like nasal tubes or leg splints on for long periods
• have little or no feeling in parts of the body
• are below a healthy weight range for their age, or have a poor diet
• sit or lie in one spot for a long time, like in a wheelchair
• wear nappies, pads or can’t use a toilet on their own
• have immune system problems.

Pressure injuries can be painful and appear anywhere, especially where bones are close to the skin.

Common areas include:

• back of the head - especially in babies and toddlers
• ears
• tailbone
• heels
• elbows
• spine and shoulder blades.

Early signs of a pressure injury include:

• red marks
• grazed or broken skin
• blisters
• pain
• fluid leaking from the skin
• smell under a plaster, splint, or brace.

Signs of a more severe injury or infection include:

• fever
• sweating
• poor appetite
• distress or constant crying
• not wanting the area touched.

Encourage your child to tell you if something feels sore. Some children may not notice a pressure injury or be too young to explain it.

A doctor or nurse can diagnose a pressure injury by:

• checking your child’s symptoms
• doing a pressure injury assessment.

They will look at and touch the area to check how deep the damage is.

Injuries are graded from Stage 1 - mild to Stage 4 - severe. This helps decide the best treatment. 

The stage may change depending on the area and how visible the injury is.

Early treatment makes healing easier. The first step is removing the source of pressure.

Treatment depends on:

• how bad the injury is
• what caused it
• where it is on the body.

Some injuries need wounds cleaned and dressed by a doctor or nurse.

Other treatments may include:

• changing your child’s position often
• helping them move, if they can
• changing nappies and pads every 2 - 4 hours and immediately when dirty
• using slide sheets to move your child into bed
• keeping the skin from being too wet or too dry
• using pH-neutral soaps and creams
• using barrier creams
• using pressure-relief equipment recommended by your child’s treatment team
• making sure your child is getting enough nutrition and fluids
• checking the skin often to track healing.

Avoid:

• stretching or pulling the skin
• massaging or rubbing red areas
• using ring cushions unless advised by your child’s treatment team.

Healthdirect provides free, trusted health information and advice, 24 hours a day, 7 days a week online or via telephone 1800 022 022.