By Lauren Brave, M.D., PAMF Pediatric Urgent Care

Unintentional injury is one of the most common reasons for which parents bring their children to urgent care centers and emergency rooms. According to the National Center for Injury Prevention and Control, more than 200,000 children are treated in emergency departments for playground injuries each year, 40 percent of whom have a laceration (cut) or abrasion (scrape). In addition, the National Safety Council reports that a dog bite occurs every 40 seconds.

When a child incurs a minor injury, such as a cut, scrape or bite, it is important for the parent or supervising adult to be able to determine whether or not the child needs medical attention. Most wounds, regardless of depth, will bleed. Areas of the body that receive a large amount of blood flow, such as the face and scalp, will often bleed profusely. In these circumstances, it is important to remain calm and apply pressure to the wound. Even though blood loss may seem impressive, injuries are almost always minor. If the wound is deep, however, and direct pressure does not stop the bleeding within a few minutes, the child should be taken to the nearest emergency department immediately.

An abrasion or superficial cut will stop bleeding within five to 10 minutes. These types of injuries do not require stitches and generally heal well with minimal scarring. However, any time the skin is compromised, the most common complication is infection. It is important to wash all cuts and scrapes thoroughly with soap and water. The wound should be kept dry for the next 24 hours to aid in healing. Bandages and antibiotic ointments are not necessary and have not been proven to prevent infection. Signs of infection include a spreading redness on the skin, any cloudy or thick drainage from the wound, or pain at the wound site. If any of these symptoms are present, it is important to seek immediate medical attention.

At the Palo Alto Medical Foundation's (PAMF) Pediatric Urgent Care Center, we attend to lacerations that require simple stitches or gluing. If the wound pulls apart at all, it most likely requires stitches. The purpose of stitches is simply to minimize the potential scar by bringing the skin together. Any wound will heal regardless of stitches. A non-stitched wound will have a wide scar, while a stitched wound will have a very thin scar (often barely visible). The healing process begins immediately after a laceration occurs. If it is unclear whether or not a wound requires stitches, have the child assessed by a health care provider within six hours of the injury. After six hours, the wound begins to heal and stitching may no longer be possible.

Scar formation can continue for six to nine months after the initial injury. No medication or ointment has been proven to minimize scar formation. The most important intervention is the use of daily sunscreen, preferably SPF 30+, as scars retain pigment from tanning differently than the normal surrounding skin.

Puncture wounds and animal bites require immediate cleaning with soap and water and, in most circumstances, should be evaluated by a physician. Deep punctures or bites are much more likely to become seriously infected by bacteria. Rabies from cat and dog bites is uncommon in the United States. However, bites from wild animals like raccoons, skunks, bats and foxes require immediate attention.

Finally, whenever any wound occurs, parents should ensure that their child's tetanus shots are up to date.

PAMF's Pediatric Urgent Care Center is open every day of the year to provide for your child's urgent health care needs. Our new telephone number is 650-853-6558. For more information, visit www.pamf.org/pediatrics/urgentcare.html.