By Drs. Sally Robinson and Keith Bly
Many kids will need stitches at some time in their lives. The most common places for children to get cuts that require stitches are the hands, feet, chin and forehead. Cuts that require stitches are usually one-quarter inch deep, have jagged edges, are large and gaping, and are on the face, eyelids, lips, and the palm of the hand or fingers.
For deep cuts or scrapes that are bleeding, apply pressure with a clean cloth, paper towel or bandage to stop the bleeding. If the bleeding does not stop within 10 minutes and appears to need stitches, take your child to the doctor.
Getting the cut stitched within eight hours (sooner, if possible) reduces the risk of infection and helps prevent scarring. Waiting longer than that is too late, as the cut may begin healing on its own and will need to be re-sliced in order to prevent scarring.
Stitches are required for large cuts that may not heal well or grow back together properly on their own. Stitching a cut is similar to sewing, but doctors use special string, called sutures, that are sometimes made of nylon, silk or vicryl, a special type of string that dissolves in the skin. Nylon and silk sutures need to be removed, but vicryl will not. For smaller cuts, doctors sometimes use a special type of glue that falls off by itself in about five to ten days, or a special bandage called a butterfly strip, to hold a cut together until it heals.
When you need stitches, the doctor will first clean your cut with sterile water and a disinfectant to remove any dirt, debris or germs, so that the wound will not get infected. After it is cleaned, the doctor will numb the area with an anesthetic, and then, using a very small needle, will sew the cut together.
You will be given instructions on how to care for your child's stitches, and it is important to follow these carefully. The doctor will probably tell you to keep the area dry for at least 24 hours. Some types of stitches can get wet, but others cannot, and some may need to be coated in a thick antibiotic ointment and covered with a bandage. If the doctor glued your child's cut, you should not put ointment on it. Also, make sure that your child does not tug on the stitches.
If a stitch appears to have popped or torn or if the cut appears to be infected (it is hot, red, swollen or oozing pus), take your child to the doctor. If your child is in pain, administer acetaminophen or ibuprofen according to the directions on the package.
Never try to remove your child's stitches. Vicryl stitches, glue and butterfly strips come off or out on their own, but other stitches should be removed by a doctor so that the doctor can make sure that the cut has healed properly. The doctor will cut the knot that he tied in the string and pull it out. Then you will get instructions on how to care for the skin, which may include avoiding direct sunlight, and you will probably be given a cream to put on the scar.
Dr. Sally Robinson is a pediatrician in the division of children's special services at the University of Texas Medical Branch at Galveston. She teaches medical students about caring for children with chronic medical conditions. Dr. Keith Bly is a hospitalist and assistant professor of pediatrics at UTMB. This column is not intended to replace the advice of a physician.
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