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Pressure injuries, also known as bedsores or pressure ulcers, occur when skin presses or rubs against a harder surface such as a bed, chair, or medical device. This can occur when children stay in the same position for too long or when medical equipment puts pressure on skin. When skin presses against a harder surface, the pressure reduces blood flow to the area. This weakens and damages the skin.
In early stages, pressure injuries may appear as red, discolored, or dark patches on the skin. At later stages, the skin may break open resulting in blisters or open sores.
Pressure injuries are often caused by lying in bed or sitting in a chair or wheelchair without regularly changing positions. In children, the most common cause of pressure injuries is medical equipment that pushes against the skin such as:
Children are at highest risk for bedsores when they:
Prevention and care of pressure injuries is very important. At first sign of a pressure injury, remove the pressure from the area to protect the skin from further damage. Sores can become infected, especially in children with weak immune systems from cancer treatments. Untreated, they can even extend deep into the skin and expose muscle or bone.
There are some simple ways to lower the risk for pressure injuries.
The child’s skin should be checked regularly by the medical team and family caregivers. The medical team can teach caregivers how to examine skin thoroughly and what skin changes to look for.
Parents should be experts on their child’s skin. Check the skin every day. Remove clothing including socks, pajamas, underwear, diapers, and any other coverings to examine the skin underneath. Many children and teens do not speak up about sores until they have severe discomfort. Children might also be embarrassed and try to avoid being checked in certain areas.
Check the whole body, especially bony areas such as:
Pay special attention to places where medical devices might press on skin. These areas should be checked twice a day.
Keep an eye out for redness or dark areas, blisters, and sores. Early signs of pressure injuries can be especially hard to see on darker skin. Pay careful attention to places that the child says are even slightly sore or tender. Pressure injuries can be open or closed sores. Let the care team know about any changes in the skin’s appearance.
A red or discolored patch of skin that does not return to normal color is cause for concern. When skin is pressed, it should lighten or turn white, and then return to normal color. In children with dark skin tones, the area may appear slightly darker in color or just be tender to the touch. Skin may be warm or firm to the touch or appear swollen.
The best way to prevent pressure injuries is to change position often. Have children sit, stand, or walk as much as possible. If the child needs to stay in bed, a caregiver or member of the care team should help the child change position every 2 hours. Children in a wheelchair should adjust position every hour.
Cushions can be used to keep pressure off the bony parts of the body. Be sure to talk to the care team about what is best to use. Some types of cushions may make pressure worse.
Tips for repositioning a child in bed:
Taking good care of the skin may reduce the chance for pressure injury and lower the risk for infection if a sore does occur.
In some cases, the care team might recommend preventive dressings or bandages to take pressure off bony parts of the body.
Tell the care team if you see any sign of a pressure injury. Pressure injuries are easier to treat when they are caught early.
Reviewed: June 2018