Scenario: A 4 year old boy sustains an injury to the forehead while playing with his sibling by hitting the edge of a door in his house. There is a wound on the right eyebrow and is bleeding profusely. The mother gets panicked and rushes him to a nearby hospital.
This is a very common scenario particularly in young children seen almost on a daily basis. So let’s discuss about pediatric facial lacerations– i.e. cuts over the face in children and attempt to answer some of the common concerns of the parents.
What should I do when my child accidentally sustains a cut over the face?
- Firstly, do not panic. Try to comfort your child.
- DO NOT feed the child in an attempt to calm the child down.
- Note the site and number of cuts and look for any active bleeding.
- Apply pressure with a clean cloth, or a guaze for 5 to 10 minutes. Do not repeatedly lift the cloth/guaze to see the wound as the clot formation process will be interrupted.
- Wash the wound with water to remove any dirt or foreign bodies, but don’t scrub the site.
- Visit your nearby hospital after covering the wound with a clean cloth/guaze dressing.
When would a specialist be required to assess my child?
Remember: A B C D E
- Animal bites
- Bleeding without stopping after 10 minutes of direct pressure, or that start to bleed again.
- Crooked edges
- Deep or long wounds more than 5mm
- Embedded with debris, such as dirt, stones, or gravel that remain after washing.
Will all lacerations require surgery?
Suture repair is warranted in cases where laceration extends through the dermis and where apposition of wound edges, promote wound healing and improve outcomes. This is done by a specialist after thorough assessment in a procedure room in the emergency or a minor operation theatre.
Those that are superficial, clean and in no/low tension areas of the face can be managed by through cleaning and tissue adhesive/skin glue application.
What are the goals of surgery for facial lacerations?
The goal is to approximate wound edges with minimal compromise of skin integrity or function ideally within 18 hours of injury, at the most within 24 hours. This will help in prevention of wound infection and in subsequently reduce the chance of developing a prominent scar.
Will my child develop an ugly-looking scar after surgery?
Every child is different and similarly every wound is different. It is nearly impossible to predict the kind of scar that a particular child with a particular wound can develop.
Having said that, all measures will be taken by your treating specialist to minimise the chances of developing a prominent scar – thorough toileting of the wound to remove any dirt or gravel that can cause intense inflammation, trimming of loose/uneven skin edges, multilayered closure to provide strong support to the overlying skin and avoiding tight knots are some of them.
Some children genetically have a prominent scar (=keloid) forming tendency. This subset of children might require subsequent treatment of those scars by other methods like topical creams, local steroid injections, lasers etc.
Will my child have pain during or after the procedure?
Absolutely not. Your team of doctors will ensure your child remains pain-free throughout the hospital experience. From administering a local anesthetic cream before the insertion of an IV cannula to discharge on oral pain-killer medication, there are several modes of administering medication to prevent pain.
Older children usually co-operate for surgery under local anesthesia, whereas younger and apprehensive children require sedation to keep the child calm and free from pain. In the latter group, your specialist will still administer local anesthetic agents to prevent pain as soon as the child wakes up after procedure.
How long should my child be kept in the hospital after the procedure?
A child who undergoes suturing done under local anesthesia can be discharged right after the procedure, while a child who was sedated requires a short 4-6 hour hospital stay and then will be discharged.
What is the recommended diet after surgery?
There is no diet restriction following this procedure.
For children with wounds inside the oral cavity including the inside of lip, gums, cheek, tongue etc., your doctor might advise giving your child ice-creams and avoid hot liquids/solids for 48 hours.
FAQs for Accidental Cuts on Children's Faces: Causes, Treatment & Prevention Tips for Parents
When your child sustains a cut on their face, stay calm and try to comfort them. Apply gentle pressure with a clean cloth or gauze for 5-10 minutes to stop the bleeding, wash the wound carefully with water to remove any dirt, and take your child to the hospital for professional evaluation.
To stop the bleeding, apply direct pressure with a clean cloth or gauze to the affected area for 5 to 10 minutes. Avoid lifting the cloth too often as it can disrupt the clotting process. If bleeding continues after this period, seek immediate medical attention.
You should take your child to a specialist if the bleeding doesn’t stop after 10 minutes of direct pressure, if the wound is deep or longer than 5mm, or if there is embedded debris like dirt, stones, or gravel that remains after cleaning. Additionally, animal bites require immediate specialist attention.
Not all cuts need surgery. Superficial cuts that are clean and not under tension may be treated with tissue adhesives (skin glue). Deeper or longer cuts, or those that involve significant tissue disruption, may require suturing by a specialist.
The goal of surgery is to close the wound in a way that promotes optimal healing while minimizing the appearance of scars. The wound should ideally be closed within 18-24 hours to prevent infection and reduce the risk of scarring.
The appearance of scars varies from child to child and from wound to wound. While some children may develop noticeable scars, your child’s doctor will take steps to minimize scarring, including proper cleaning of the wound, careful suturing, and using techniques to promote the best possible healing.
If the procedure is done under local anesthesia, your child can typically go home immediately after the treatment. If sedation was required, a short stay of 4-6 hours may be necessary for monitoring before discharge.
There are no specific dietary restrictions after the procedure. However, if the wound is inside the mouth (e.g., lip or cheek), the doctor may advise soft foods like ice cream and to avoid hot liquids or solids for 48 hours.
Complications of facial cuts can include infection, excessive scarring, or keloid formation. Prompt medical treatment and proper wound care help minimize these risks.
Author: Dr. Y.N.V.S Siva Kamesh
Consultant Pediatric Surgeon & Pediatric Laparoscopic Surgeon