Clinical Reference Systems: Pediatric Advisor 10.0
Spanish version

DESCRIPTION (Diagnosis must be confirmed by a physician.)

A break in the skin shows signs of infection, such as:

• Pus or cloudy fluid is draining from the wound.
• A pimple or yellow crust has formed on the wound (impetigo).
• The scab has increased in size (impetigo).
• Increasing redness occurs around the wound (cellulitis).
• A red streak is spreading from the wound toward the heart (lymphangitis).
• The wound has become extremely tender.
• Pain or swelling has increased 48 hours after the wound occurred.
• The lymph node draining that area of skin may become large and tender.
• Your child may develop a fever over 100 degrees F (37.8 degrees C).
• The wound hasn't healed within 10 days after the injury.

CAUSES

Most skin infections follow breaks in the skin (for example, from cuts, puncture wounds, animal bites, splinters, thorns, or burns). Bacteria (especially staphylococcus or streptococcus) then invade the wound through the "portal of entry" and cause the infection. Some infections start with a closed rash (that is, the skin is not broken). Examples are insect bites, chickenpox, scabies, or acne. If a child picks at these rashes, the skin can become broken and then infected.

Deeper wounds (for example, puncture wounds) are much more likely to become infected than superficial wounds (for example, scrapes). The hands are at increased risk for infection from puncture wounds. The penetrating claws or teeth of cats pose a major risk for infection.

Cellulitis can sometimes start without any recent wound infection. This type of cellulitis is spread from the bloodstream and can be serious it is not treated.

EXPECTED COURSE

With appropriate antibiotics and warm soaks, the wound infection should improve within 24 to 48 hours. By that time, your child should stop having any fever caused by the infection. Any red streaking (lymphangitis) or red patches (cellulitis) should stop spreading. The area of the wound should also be much less tender within 48 hours. Within one week after your child starts taking antibiotics, all signs of active infection should be completely gone.

TREATMENT

1. Antibiotics

   Your child needs the antibiotic prescribed by your physician.

   This medicine will kill the germs that are causing the wound infection. Try not to forget any of the doses. If your child goes to school or stays with a baby sitter, arrange for someone to give the afternoon dose.

   Even though your child will feel better in a few days, give the antibiotic until it is completely gone to keep the infection from flaring up again.

2. Warm soaks or local heat

   Proper cleansing of an open wound is important for healing. Soak the wounded area in warm water or put a warm, wet cloth on the wound for 20 minutes three times a day. Use a warm saltwater solution containing 2 teaspoons of table salt per quart of water. Use this solution to remove all the pus and loose scabs. (Don't use hydrogen peroxide because it is a feeble germ- killer.) Your physician may give you a syringe to help irrigate the wound.

   Continue soaking the wound three times a day until it looks clear of infection. Then cleanse the wound and change the dressing once a day until the wound has healed.

   If the wound is closed (for example, cellulitis), apply a heating pad or warm, moist washcloth to the reddened area for 20 minutes 3 times a day. This will help deliver the antibiotic to the infection.

3. Fever and pain relief

   Give your child acetaminophen or ibuprofen if he develops a fever over 102 degrees F (39 degrees C) or the wound is painful.

4. Contagiousness

   The pus from wound infections is somewhat contagious. It can cause skin infections in other people if the pus accidentally gets on other people's skin or on an open cut. Be certain that other people in the family do not use your child's towel or washcloth. Encourage your child not to touch the wound because it puts germs on his fingers. Also, ask him to wash his hands more often than usual, or wash his hands for him. Cut his fingernails short.

   Keep your child out of school until he has been treated with antibiotics for 24 hours and is free of fever.

5. Prevention of wound infections

   Wash all new wounds vigorously with soap and water for 5 to 10 minutes to remove dirt and bacteria. Soak puncture wounds in warm, soapy water for 15 minutes. Do this as soon as possible after the injury occurs, because the longer you wait, the less the benefit.

   Encourage your child not to pick at insect bites, scabs, or other areas of irritated skin.

   Teach your children that kissing an open wound is dangerous because the wound will become contaminated by the many germs in the mouth.

   Applying an antibiotic ointment after cleaning might be helpful.

CALL YOUR CHILD'S PHYSICIAN IMMEDIATELY IF:

• The redness keeps spreading.
• The wound becomes extremely painful.
• Your child starts acting very sick.

CALL YOUR CHILD'S PHYSICIAN DURING OFFICE HOURS IF:

• The fever is not gone 48 hours after your child starts taking an antibiotic.
• The wound infection does not look better 3 days after your child starts taking an antibiotic.
• The wound isn't completely healed within 10 days.
• You have other questions or concerns.