Summer is injury season. I don’t usually see mildly scraped knees in my office, but I do see the consequences of wounds not properly cared for. Hopefully a 3-minute review can prevent your child’s next simple wound from turning into a big problem.

Steps to caring for a wound

1. Quickly assess. Is this something that I need a doctor to help me with?
2. If yes, cover with a cloth, gauze, or paper towel
   1. Apply pressure to control bleeding
   2. Go immediately to the Doctor’s office/urgent care/ER.
3. If no, see below (How to clean out the wound and dress it)

1. Cleaning the wound (I usually do this over a sink):
   1. Rinse with an antiseptic solution (e.g., hydrogen peroxide or Provodine)
   2. If there is dirt, rocks, or debris use running water and gauze to thoroughly wash out (be prepared for your child to cry as this can be quite painful).
   3. Direct dirt and drainage as you are washing away from the wound (e.g., a scraped knee and leg should be washed from the knee towards the foot or off to the side).
   4. Give a final rinse with the antiseptic solution (after the running water step).
   5. Clean up/dry the healthy skin around the wound (but leave the antiseptic solution untouched on the wound itself).
2. Stop any bleeding AFTER the wound is cleaned out. Stop bleeding by applying pressure directly to the wound with a piece of sterile gauze. The process of bleeding will help rinse out dirt and bacteria as you are cleaning, so don’t stop it until after the wound itself is cleaned.
3. Dress the wound:
   1. Depending on the size of wound a simple Band-Aid may do. If it is bigger or over a body part where a Band-Aid won’t stick as well (like a knee or elbow), try a layer of sterile gauze and wrap to hold it in place. Tape can be used, but kids hate having tape taken off as it hurts. For this reason, I prefer to use a wrap like Coban (it’s a self adherent wrap), but an ace bandage would also work.
   2. Use an antibiotic ointment (e.g. Neosporin). I think it is easier (less messy and less painful) to put the ointment on the bandage (either pad of the Band-Aid or gauze itself) and then carefully position the bandage with ointment directly on the wound rather than try and put the ointment on the wound itself.
4. Changing the dressing:
   1. Change the dressing AFTER giving your child a bath. The old dressing will provide a barrier to dirt and water draining into the wound. Once the bath is done, you’ll need to change the dressing as it will be all wet.
   2. Most dressings should be changed 1-2 times a day (depending on the nature and location of the wound).
   3. New dressings should have a new bandage (Band-Aid or gauze) and antibiotic ointment only. If the wound itself is really wet from the bath, pat dry with sterile gauze BEFORE applying a new dressing.
   4. NEVER, NEVER, NEVER reapply antiseptic solution to the wound. These products are designed to kill everything—the good and the bad. Daily use with hydrogen peroxide to clean out a wound is a common reason wounds end up in my office not healing properly. So only use antiseptic solutions (e.g. hydrogen peroxide, Provodine, etc.) once at the beginning, NEVER after the initial cleaning.

Go to the doctor if:

1. The wound/scrape is very deep or gaping (such that it might need stiches)
2. Any special situations (e.g., result of a bite, involves metal, possible broken bones, associated head injury, in a sensitive area, etc.).
3. You have been caring for a wound and it doesn’t appear to be healing or seems to be getting worse (new surrounding redness, new pain, or fever).

With proper wound care you will promote rapid healing, decrease pain, and decrease scarring. Good luck! You can do this!