Kids Health Info

Pressure injury prevention

  • A pressure injury (also known as pressure sore, pressure ulcer or bed sore) is an area of the skin that has been damaged due to constant pressure, poor blood flow or chafing and rubbing of the skin. People of all ages, including babies and children, are at risk of developing pressure injuries. Children with spina bifida, a spinal cord injury, neurological impairment or any other medical condition which restricts their ability to move have an increased risk of developing a pressure injury.

    A pressure injury may appear as a red area (or, in darker toned skin, a blue or purple area), a blister or a break in the skin.

    Many pressure injuries are preventable with careful management of your child, both in hospital and at home following discharge.

    Where pressure injuries can occur

    Pressure injuries can appear anywhere on the body, however, common areas on children are:

    • back of the head (especially in babies, infants and toddlers);
    • ears;
    • tailbone (sacrum/coccyx);
    • heels;
    • elbows;
    • spine and shoulder blades;
    • hips and buttocks;
    • under plasters, casts, splints or braces;
    • around medical equipment such as tubes, masks, drains, etc.

    Why pressure injuries occur

    A number of factors may increase the risk of developing a pressure injury, including:

    • reduced activity;
    • sitting or lying in the one place for too long;
    • sitting in wet clothing, a wet bed or a wet nappy for long periods;
    • poor nutritional or fluid intake;
    • reduced skin sensation;
    • pressure or friction to one area of the body;
    • depressed immune system;
    • children who are extremely unwell.

    Prevention in hospital

    While in hospital, nursing staff will assess and monitor your child for pressure injuries on a daily basis. If your child is at risk of developing a pressure injury, staff will discuss a management plan with you.

    The plan may include a number of ways to reduce your child's risk whilst in hospital. These may include:

    • Positioning in bed.
    • Applying a dressing to bony or reddened areas.
    • Using special 'slide sheets' to move your child in bed.
    • Using barrier creams.
    • Using absorbent bedsheets.
    • Frequent inspection of susceptible areas of skin.
    • Increasing nutritional and fluid intake.  This may be via a tube if your child is unable to eat or drink.
    • Helping your child to change their position frequently (every two to four hours) during the day and night.  It is always best if your child can do this themselves.  However, if they are not able staff will assist.
    • Repositioning medical equipment such as face masks, probes and tubing.
    • Use of pressure relieving products such as gel pads, air mattresses or other products.

    Nursing staff may refer your child to other members of the healthcare team to contribute to the management plan. These may include an occupational therapist, a physiotherapist or a dietitian. If your child has an existing pressure injury which requires dressings, a stomal therapist may also be asked to assess your child.

    Prevention at home

    Pressure injuries can be serious and may take months to heal. They can be painful and add to a child's existing health problems. Careful attention to the condition of your child's skin, prompt attention at any sign of damage and maintaining a healthy diet is important for your child following discharge from hospital. The more active your child is, the lower their risk of a pressure injury.

    Observe

    • Check your child's skin regularly, morning and night.
    • Look for changes in skin colour (redness or darkening), blisters, bruising, cracks, scrapes or dry skin.
    • Closely inspect high risk areas such as bony areas (heels, ears, buttocks, hips, elbows, etc) and skin under and around casts, splints, braces or medical equipment.
    • Watch for areas that are constantly moist, such as the groin and buttocks, especially if your child is incontinent or not toilet trained.
    • As you cannot look under plaster, note for any increased pain or discomfort.

    Positioning

    • Encourage your child to change their position if sitting for long periods.
    • If your child is spending extended periods of time in bed, encourage them to change their position regularly - every two hours during the day and four hourly overnight. If they require your assistance to change position in bed, be careful not to drag their skin when moving. Position changes can include left side, back, right side.
    • Encourage your child to be active where appropriate.

    Hygiene care

    • Use lukewarm water for bathing and showering.
    • If using soap or liquid cleanser, try to use a product that is pH neutral, unperfumed and alcohol free.
    • Avoid massaging or rubbing the skin, especially over bony areas.
    • Apply moisturisers gently over dry areas; do not rub.
    • A barrier cream (available at any pharmacy) on moist areas may benefit your child.

    Nutrition

    • Good nutrition is important for healthy skin and wound healing.
    • A balanced diet helps your child maintain an appropriate weight.
    • Encourage your child to drink adequate fluids throughout the day. Caffeinated drinks such as cola should be kept to a minimum or avoided all together.

    Pressure relieving devices

    If your child requires long periods of bed rest and has reduced activity at the time of discharge, an occupational therapist may recommend the use of some specific equipment for your child at home to reduce the risk of pressure injuries.

    These may include:

    • An Australian medical sheepskin.
    • Gel pads.
    • Specialised foam mattress.
    • Specialised air mattress.

    The occupational therapist will advise you where these products can be hired or purchased.

    If you have not seen an occupational therapist and would like to, nursing staff can organise a referral for you.

    Things to avoid:

    • Stretching or pulling the skin, e.g. do not drag your child when moving in bed or transferring in and out of bed.
    • Massaging or rubbing red areas as this may cause further damage.
    • Using 'donut' or 'ring' cushions. These actually increase your child's chances of developing a pressure injury.

    If your child develops a pressure injury

    Common signs of a pressure injury include:

    • red marks;
    • blistering;
    • broken skin and pain.

    If your child develops a pressure injury at home:

    • Identify the cause and remove it where possible.
    • Try not to position your child directly on the pressure injury.
    • If the pressure injury does not heal within 24 hours or the skin is broken, contact your local doctor or treating healthcare provider.

    Key points to remember

    • A pressure injury is much easier to prevent than treat.
    • Pressure injuries can be a sign of a deeper wound and need to be treated as soon as possible.
    • Be aware of the signs of a developing pressure ulcer.
    • Find the cause and, where possible, remove it.
    • Talk to your health professional if your child is at risk.

     

    Developed by The Royal Children's Hospital Nursing Innovations, in consultation with Occupational Therapy, Medical Nursing, Adolescent and Rehabilitation Care and Surgery. First published: April 2012

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Disclaimer
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.