Wounds and abrasions in children: symptoms, causes and treatment

Childhood wounds come in various forms, and each type requires a specific approach. It's helpful to know the main categories so you know how to act.

An abrasion occurs when the superficial layer of skin rubs over a rough surface. This typically occurs when falling on asphalt, pavement tiles or other hard surfaces. An abrasion only damages the top layer of the skin, the epidermis and sometimes a little bit of the underlying dermis. You see an erratic, red spot where the skin has been scraped away. Some blood comes out of small blood vessels that have been affected, but this usually stops quickly. While abrasions can be painful due to the exposed nerve endings, they are rarely serious. The skin has a good ability to recover and an abrasion usually heals within a week to ten days without leaving any permanent marks.

A cut is deeper and has a tidier edge than an abrasion. This is caused by contact with a sharp object such as a knife, glass, a sharp edge of a toy, or even paper. A superficial cut only affects the skin and the wound can usually simply be cared for at home. A deeper cut creates a visible gap or defect between two pieces of skin. You could fit the tip of a knife into it, which indicates that the wound goes through multiple layers of skin. These deep cuts may require stitches to bring the wound edges together properly, so that the wound can heal nicely without major scars.

Bite wounds are a separate category that deserves extra attention. These occur when an animal or other child bites your child. Dogs and cats are the most common causes of animal bite wounds, but rodents or other pets can also bite. Human bite marks are common among young children in daycare or preschool when toddlers are not yet able to communicate properly and bite out of frustration. Bite wounds have a more erratic pattern than cuts and are rarely neatly lined. The danger of bite wounds lies mainly in the bacteria in the bitter's mouth or mouth. These can cause serious infections, so bite wounds always deserve medical attention.

Each type of wound requires appropriate care. Abrasions especially need cleaning and protection. Cuts may require closure when they are deep. Bite wounds often require preventative treatment with medications to prevent infections. Recognizing the type of wound helps you provide the right first aid and determine when professional medical care is needed.

Children suffer wounds during their daily activities, and the cause is often related to their age and developmental phase. Understanding how these wounds form helps prevent them.

Abrasions are by far the most common type of wound among children. They are almost always caused by falls. When children learn to walk, falls are the order of the day: they lose their balance, trip over their own feet, or bump into things. Toddlers and preschoolers are constantly moving, running, climbing and jumping, with falls inevitable. School children scrape themselves while playing outside, cycling, skateboarding or sporting activities. The most common areas are knees, elbows, palms and sometimes the face when the child falls forward.

Cuts occur in various ways. In the home, kids can cut off on shards of glass, kitchen knives, scissors, cans, sharp-edged toys, or even paper that can cause surprisingly sharp cuts. Outside, there are risks such as sharp stones, metal edges of playground equipment, or broken glass on the ground. A common scenario is a fall where the child lands on the chin. The chin is a prominent spot that is often the first to touch the ground when falling forward. If you fall from any height, for example from climbing equipment, bicycles or stairs, this can cause a deep incision in the chin that requires stitches.

Animal bite wounds often occur in familiar situations. Many children are bitten by their own dog or cat, or by family or friends' pets. This mainly happens when children approach the animal suddenly, are too rough while playing, harassing the animal while eating or sleeping, or when young children accidentally hurt the animal by pulling it too hard. Cats usually bite the hands or fingers while petting, while dogs can also bite the face, arms, or legs. Cat bites are often deeper than they appear because of the sharp, pointed teeth that cause deep punctures.

Human bite wounds in children occur primarily in group care and in schools. Toddlers in daycare do not yet have the language skills to express their frustration or anger and sometimes bite out of impotence. Biting can also occur during a fight over toys or when overstimulated. These bites are usually in the arms, shoulders or sometimes the face. Although human bites are less deep than animal bites, they still contain dangerous bacteria from the mouth.

The context in which wounds occur is also important. Wounds that have been sustained outside are often dirtier due to contact with sand, soil or mud. Wounds that occur in and around water may be contaminated with specific bacteria. Wounds near the face deserve extra attention because of the risk of visible scarring.

Recognizing the characteristics of different wounds helps you to assess how serious the injury is and what care is needed.

An abrasion appears as a rough, red area where the top layer of skin has disappeared. The area can range from a small spot to a large, irregular surface, such as the entire knee or elbow. The wound often looks damp due to the tissue fluid that seeps out of the exposed layers of skin. Small blood droplets may be visible, but they usually do not bleed profusely. The red color is due to the exposed subcutaneous blood vessels. There is often dirt, sand or soil in the wound, especially when falling outside. This dirt must be removed to prevent infections.

The pain associated with an abrasion can be considerable, even though it is a superficial injury. This is because the nerve endings in the skin are exposed and sensitive to touch and air. That's why your child can cry a lot and do not want to touch or have the wound cared for. This pain usually subsides when the wound is cleaned and covered.

A cut has a different presentation. The edges are neater and straighter than with an abrasion. A shallow cut shows a thin red line that doesn't bleed much. In the case of a deeper cut, the wound is open and you can see a gap between the two wound edges. The depth of the wound is often difficult to estimate when there is a lot of blood, but a good indicator is whether you can see or feel structures under the skin. Can your child still move the injured body part normally? Is there a feeling? These are important questions to rule out possible damage to tendons, nerves or blood vessels.

Bleeding from cuts can range from minimal to severe. SuperSurface wounds usually stop bleeding within minutes when you put pressure on them. Deep wounds or wounds in areas with many blood vessels can bleed longer. If the blood still comes through the compress after 5 to 10 minutes of constant pressure, this is a sign that the wound is deep enough to require professional help.

Bite wounds often have a typical shape where you can see the imprint of teeth. With dog bites, you can sometimes see multiple holes or cracks in a pattern that matches the teeth. Cat bites cause deep, small puncture wounds that look like two or four small holes. These wounds often bleed little but can reach deep. Human bite wounds sometimes show an oval shape with multiple small prints of teeth. The area around the bite wound is usually swollen and painful.

Signs of infection may develop in the days following the injury. Increasing redness around the wound, swelling that is getting worse, increasing pain, warmth, or the development of pus are alarm signals. Fever can also indicate an infection. Bite wounds cause infections more often and more quickly than other wounds, often within 24 to 48 hours.

The location where children suffer wounds follows certain patterns related to their developmental phase and activities. This knowledge helps you to anticipate possible injuries.

In babies and toddlers who are just learning to walk, wounds are mainly found on the head and face. Due to their relatively large head in relation to their body and their still uncertain balance, they often fall headfirst. Forehead, eyebrows, and chin are common areas for bumps and cuts. Bruises and sometimes wounds also occur on the back of the head, where toddlers end up when they fall backwards. Palms are another typical location, as children reach out when falling.

As children become more active and run, jump, and climb more, the pattern shifts. Knees and elbows become the most common locations for abrasions. These joints stick out and are often the first to touch the ground when falling. At playgrounds, during the gym at school, when playing outside on the street or in the park, children repeatedly suffer from abrasions in these areas. Some children have almost permanent crusts on their knees from one wound after another.

The forearms and especially the palms are also common locations. Children reach out to break their fall, causing their palms to scrape over rough surfaces. When climbing, they can scratch their forearms on rough surfaces.

The chin deserves special attention as a location. When falling forward, especially from a height, the chin often hits the ground hard. Due to the prominent position of the chin and bone directly under the skin, deep cuts that require stitches occur relatively often here. Chin wounds also often bleed heavily due to the good blood flow to the face. In addition, facial wounds are cosmetically more sensitive, making careful treatment extra important.

Feet and toes are at risk of cuts outdoors, especially in the summer when children walk barefoot or in sandals. Broken glass, sharp stones, or other objects on the ground can cause injuries. Footstools also occur in swimming pools and on the beach.

In case of animal bite wounds, hands and arms are the most common locations. Children reach out to the animal, try to pet it or pick it up, causing these body parts to make the first contact. Dog bites can also affect the face, especially in young children who are closer to the animal's head. Human bite wounds from other toddlers are often in the upper arm, shoulder, or sometimes the face.

The treatment of wounds in children has several goals: reducing pain, preventing infections, promoting healing and limiting scarring. The approach depends on the type and severity of the wound.

The first step with any wound is to calm your child down. A frightened or stressed child does not cooperate with care and experiences more pain. Reassure your child in a calm voice, explain what you're going to do, and offer comfort. For young children, a toy, favorite toy or a distraction with a movie can help. You can involve older children in care by having them watched and helping out where possible.

Pain management is important and can be given early on. A dose of acetaminophen painkiller, adjusted to your child's weight, helps to reduce discomfort. Preferably give this before you start cleaning so that the medication has time to work. In case of severe pain, a medicine containing ibuprofen can also be used, provided that there are no medical concerns.

Cleaning the wound is crucial to prevent infections. At home, it's best to do this with clean tap water or physiological salt. Run lukewarm water over the wound to wash away dirt, sand, and bacteria. In case of abrasions with a lot of ingrained dirt, you can gently pat the wound with a clean cloth or gauze. This can hurt, so do this slowly and explain to your child why it's necessary. Do not use alcohol, iodine, or other harsh disinfectants on the wound itself, as they cause additional pain and can interfere with the healing process. In most cases, cleaning with water is fine.

After cleaning, dry the wound gently by dabbing with a clean cloth or sterile gauze. Rubbing hurts and can damage the wound. First, apply a product that keeps the wound moist. Then cover the wound with a band-aid or sterile bandage. This protects against dirt and bacteria, keeps the wound moist, which promotes healing, and prevents clothing from sticking to the wound. Check the bandage daily and replace it when it gets dirty or wet.

In case of bleeding wounds, place a clean compress or cloth on the wound and press firmly. Keep the pressure on it for at least 5 to 10 minutes without seeing if it has already stopped. If the bleeding doesn't stop after 10 minutes of constant pressure, or if the blood keeps coming through the compress, see a doctor. The wound is likely to require stitches.

If a cut is deep, has gaping edges, is longer than about 1 inch deep, is in the face, or still bleeds after 10 minutes, you should see a doctor. Fresh wounds are best closed within 6 to 12 hours for optimal results. The doctor decides whether sutures are necessary or whether other closure methods such as tissue adhesive or wound closure strips are sufficient. In the case of smaller, not too deep wounds with smooth edges, the doctor can often seal them painlessly with special glue or strips.

For deeper wounds that need to be stitched, the doctor first gives a local anaesthetic via an injection. This stings for a while, but after that, your child no longer feels the stitches themselves. The doctor sutures the wound with threads that hold the wound edges neatly together. These stitches should be removed after approximately 5 to 10 days, depending on the location. Facial wounds heal faster and stitches come out earlier, after about 5 days. Sutures on the torso, arms or legs stay in place longer.

Bite wounds receive special treatment. A doctor almost never stitches bite wounds, as this increases the risk of a deep infection. Instead, the wound is thoroughly cleaned and remains open to drain. Often, the doctor prescribes a course of antibiotics preventively to prevent the dangerous bacteria from the bitter's mouth from causing an infection. This is especially important for cat bites, which often make deep puncture wounds where bacteria can easily stay in.

The tetanus protection should always be checked. Children who have been vaccinated according to the Dutch national vaccination program are protected against tetanus. The tetanus shot is included in the standard vaccination schedule and is given at 2, 3, 4 and 11 months, and then at 4 and 9 years. If your child is vaccinated according to this schedule, an extra tetanus shot is not necessary for a wound.

When caring for wounds in children, there are some common misconceptions and practices that may be ineffective or even harmful.

Using alcohol, iodine, or hydrogen peroxide directly on the wound seems logical to kill bacteria, but these remedies do more harm than good. They cause additional pain, damage healthy tissue around the wound and thus delay healing. Ordinary clean tap water or physiological salt is sufficient and friendlier for the vulnerable wound tissue.

The idea that a wound should “breathe” and therefore not be covered is outdated. Modern wound healing shows that wounds heal better in a humid environment, protected against dirt and bacteria. An open wound dries out, forms crusts that are tearing and sore more quickly, and is more likely to be infected. Always cover wounds with a band-aid or bandage, especially with active children.

Applying ointment, cream or powder to fresh, open wounds does not help with initial care. While certain wound creams may be useful later in the healing process, they don't belong in fresh wounds unless it's a limited abrasion. They can even complicate the doctor's assessment when stitches are needed. Keep the wound clean and cover it, that's all you need at first.

Blowing on a wound to relieve pain seems intuitive and many parents do this automatically, but it brings bacteria from your mouth into the wound. This increases the risk of infection. Kissing the wound or licking your own finger and then touching the wound are also not hygienic.

In case of bleeding wounds, it is a misconception that you should keep watching it to see if it has already stopped. Every time you remove the compress from the wound, the clotting process restarts. Apply constant pressure for at least 5 to 10 minutes without looking. Only then do you carefully check whether the bleeding has stopped.

Delaying a doctor's visit for a deep cut in the hope that it will work out is not a good idea. Wounds are best closed within 6 to 12 hours after they occur. Thereafter, the risk of infection increases and closing becomes more difficult. Wounds that are stitched too late can also heal uglier with more scarring.

Ignoring bite marks that look superficial is risky. Cat bites, in particular, are deeper than they appear and infect very often. All bite wounds deserve medical evaluation, even if they appear minor. The bacteria in animal and human mouths are dangerous and can cause serious infections.

When does a wound need sutures?

Sutures are needed for wounds that are deep, have gaping edges that you can see between, are longer than about 1 centimeter and deep, or that are in the face where cosmetic results are important. Wounds that continue to bleed after 10 minutes of pressure also often require stitches. If in doubt, it's best to contact the doctor or GP office. Fresh wounds are best sutured within 6 to 12 hours.

Can I glue the wound myself with superglue?

No, never use regular store-bought glue on wounds. Household superglue is not made for medical use and may contain toxins that are harmful to wound tissue. Physicians use specially developed medical tissue adhesive that is safe for use on skin and wounds. Go to the doctor for professional wound treatment.

How do I prevent scarring?

You can't completely prevent scars, but you can take measures to minimize them. Ensure good wound care from the start by keeping the wound clean and covered. Don't let scabs pull away too early but let them come off on their own. Protect the healed area from the sun with sunscreen for at least six months to one year, as new skin tissue is sensitive to pigmentation. After complete healing, massage the scar daily with a greasy cream. For deep facial wounds, timely treatment by sutures can significantly improve the cosmetic result.

Is it bad if dirt stays in the wound?

Dirt, sand, or soil in a wound increases the risk of infection and can also cause permanent tattoo-like discoloration when it grows in. It is therefore important to clean the wound thoroughly. Rinsing with plenty of water usually helps remove most dirt. For stubborn dirt that doesn't come out, you can gently wipe the wound with a clean cloth or soft unused toothbrush. If you can't get it completely clean, let the doctor do it. Sometimes anaesthesia is needed to scrub the wound properly without it hurting too much.

Should I use antibiotics for wounds?

With normal, clean scrapes and cuts, antibiotics are not necessary. Your child's body can heal these wounds on its own without medication, provided the wound is properly cleaned and cared for. Antibiotics are indicated for bite wounds due to the high risk of infection, wounds that show clear signs of infection such as increasing redness, swelling, warmth, pus or fever, wounds contaminated with soil in situations where tetanus is a risk, or in children with a weakened immune system. The doctor determines whether antibiotics are necessary.

When should I come back to the doctor after a wound treatment?

Come back to the doctor if you have signs of infection such as increasing redness spreading from the wound, swelling that gets worse rather than decreasing, more pain that doesn't respond to pain relievers, pus or a smelling discharge from the wound, fever above 38 degrees, or red stripes running from the wound towards the heart. A check-up visit is also necessary for stitches that become loose, wounds that open, or when the wound is not clearly healing after 2 weeks. Remember to have stitches removed on time, usually after 5 to 10 days.

1. Health & Science, Childhood Wounds and Abrasions
2. Thuisarts.nl, Bite Wound
3. Thuisarts.nl, Abrasion
4. Thuisarts.nl, Cut or tear wound
5. EBP Net (Evidence-Based Practice Network)