Skin and Wound Care for CYSHCN

Prevention of skin breakdown is critical to any skin care regiment. This section provides a general overview of common skin problems, how to prevent them, and wound care recommendations for children and youth with special health care needs (CYSHCN). Despite best intentions, some wounds will require skilled intervention from home health, a primary care provider, or wound and ostomy teams in hospitals. This page offers a primer in wound care with special attention paid to changes in wound management that every primary care provider should be aware of. See Related Topics for more detailed information about specific skin and wound issues for children and youth with special health care needs.
Related topics being developed on the Portal:

Fundamentals of Wound Care

The philosophy of managing wounds has changed in recent years. This information summarizes the current approach and rationale.
  • Clean, Moist Environment: Rather than using wet-to-dry or wet-to-damp techniques, such as applying saline-soaked gauze and then removing it once it dries on the wound, research is showing the benefits of maintaining a clean, moist environment in many types of wounds to take advantage of the body’s natural healing processes. Even something as simple as keeping a Band-Aid in place to keep a wound clean, protected, and moist, rather than exposing the wound to air and letting a scab form, can result in faster healing with less scarring.
  • Inflammation: In order to heal a wound, the body needs enough inflammation to signal that there is a wound. So, steroids, which decrease inflammation, can make it more difficult for the body to repair itself. Yet, too much inflammation can also tip the scales away from healing, such as with a foreign body or chronic infection.
  • Protein: Healing wounds need protein to form the building blocks of the repair, so adequate nutrition is important.
  • Perfusion: Optimize perfusion with adequate fluid intake, warmth, edema control, and pressure relief. Perfusion to the wound is also required; oxygen fuels energy for the healing processes.
  • Debridement: Finally, the environment in and around the wound must be conducive to healing. This typically means conducting debridement, keeping the wound moist but the surrounding skin dry and intact, managing exudates, and protecting the site from further injury.
  • Soap & Water: A daily shower with warm water and mild soap reduces the skin’s bacterial load and helps with wound healing. It is better than sitting in a tub or rinsing the wound with normal saline.

General Management of Open Wounds

Irrigate open wounds with saline. Debridement of tissues should be done to keep the wound clean-appearing. Debridement can be done in many ways, including surgical, enzymatic, or mechanical methods (such as irrigation), and it can be aided by specialized dressings. For example, a wound may heal better if it is kept moist and covered once it is thoroughly cleaned; however, the surrounding healthy skin needs to be kept dry. Dressings, such as gels, foams, gauzes, films, and treated bandages, can be selected to help in this process. Selection is based on the size, depth, location, and characteristics of the wound. Specialized wound care teams can be instrumental in managing advanced wounds. If the wound drains a lot of fluid, extra care may be needed to keep the healthy surrounding skin dry and protected; occasionally, the surrounding skin will need creams, ointments, or sprays to protect it. In all wounds, improving nutrition and providing adequate caloric and fluid intake support the body’s natural healing process. Adequate nutrition includes protein, vitamins A and C, zinc, and iron. Daily cleansing showers with warm water and mild soap are better for wound healing more than daily saline irrigation.
Note: The Medical Home Portal does not endorse any specific commercial wound care products. Throughout this site, and in many of the links and resources, commercial products are referenced for educational purposes but not as an endorsement of that specific product. Typically, a wound care team becomes familiar with a set of products and then uses them routinely, relying on lesser-known products when different treatments are required.

Resources

Information & Support

For Professionals

Wound Dressing (Family Practice Notebook)
A very detailed guide for clinicians on the proper wound dressing techniques for many different types of wounds.

International Society for Pediatric Wound Care
Membership organization that focuses on preventing, assessing, and treating pediatric wounds.

For Parents and Patients

Where Practice Meets Perspective: Understanding Skin & Wound Care (3M)
Short videos explaining pressure injury staging and ideal wound healing environments using items from everyday life, including fruit, pasta, bread dough and candles; provided by 3M, a commercial manufacturer of wound care supplies. Discussion of commercial products in these videos does not constitute endorsement on the part of the Medical Home Portal; the videos are provided as an educational resource.

Patient Education

Changing a Dressing (Intermountain Healthcare) (PDF Document 82 KB)
Patient handout about post-surgical dressing changes and when to call for help.

Changing a Dressing (Spanish) (Intermountain Healthcare) (PDF Document 85 KB)
Patient handout in Spanish about post-surgical dressing changes and when to call for help.

Wound Care: Home Instructions (Intermountain Healthcare) (PDF Document 174 KB)
Printable patient instructions for wound care and dressing changes.

Wound Care: Home Instructions (Spanish) (Intermountain Healthcare) (PDF Document 179 KB)
Printable patient instructions in Spanish for wound care and dressing changes.

Helpful Articles

Hopf HW, Rollins MD.
Wounds: an overview of the role of oxygen.
Antioxid Redox Signal. 2007;9(8):1183-92. PubMed abstract

King A, Stellar JJ, Blevins A, Shah KN.
Dressings and Products in Pediatric Wound Care.
Adv Wound Care (New Rochelle). 2014;3(4):324-334. PubMed abstract / Full Text

Bianciardi Valassina MF, Bella S, Murgia F, Carestia A, Prosseda E.
Telemedicine in pediatric wound care.
Clin Ter. 2016;167(1):e21-3. PubMed abstract

Jull AB, Cullum N, Dumville JC, Westby MJ, Deshpande S, Walker N.
Honey as a topical treatment for wounds.
Cochrane Database Syst Rev. 2015(3):CD005083. PubMed abstract

Authors & Reviewers

Initial publication: May 2019
Current Authors and Reviewers:
Author: Jennifer Goldman-Luthy, MD, MRP, FAAP