Preventing pressure ulcers in children and young people

What is a pressure ulcer?

Pressure ulcers are areas of damage to the skin and underlying tissues. A pressure ulcer can be difficult to treat and can result in an extended stay in hospital and increased risk of infection. Pressure ulcers are also known as pressure sores or bed sores.

Pressure ulcers can damage not just the skin but also the layers of tissue underneath. This can cause pain and may lead to blood poisoning and bone infections.

If your child is already known to be at risk, you must let your nurse know so that it is noted in their nursing and medical paperwork.

What causes pressure ulcers?

Pressure

Normal body weight squashes the skin and damages the blood supply to the area. Your child lying in one position for a long time can cause this. It is important for you to make sure that your child moves and changes position regularly. If necessary, the nurses will help you to change your child’s position.

Shearing

Strain forces the upper layers of skin away from the deeper layers of skin. Pulling your child up or down a bed can do this. Your child’s skin may become sore and split.

Friction

This happens when your child’s skin is repeatedly rubbing against a surface. This can be caused by poor lifting and moving methods. If you need help when moving your child, please ask your child’s nurse.

What part of my child’s body can get a pressure ulcer?

Pressure ulcers can develop anywhere on the body however, they are mostly found over bony areas.

Babies and young children have large heads in relation to the rest of their body. This puts more pressure on the back of their head and ears and can cause pressure ulcers.

Areas of highest risk in all ages

Within the PDF below, see Figure 1: Areas of highest risk for pressure ulcers

What can increase the risk of pressure ulcers?

Weight

A child who is very under or over weight:

• An underweight child will have less fatty tissue to protect the bony areas that can rub against surfaces.
• An overweight child may find it more difficult to move and greater pressure will build up on skin and tissue.

Lack of normal movement

This is when your child is unable to move normally on their own:

• This might be due to a disability.
• Your child may be too sick or too sleepy to move by themselves.
• Your child may have had surgery or a trauma injury such as a broken leg or a head injury.
• Your child may have been given sedation (medicine to make them sleepy).

How I can help stop my child getting a pressure ulcer?

Signs to look for:

• Purple/blue patches on dark skinned people
• Red patches on light skinned people
• Pain over bony parts of the body, such as the elbows
• Swelling
• Blisters
• Shiny areas on skin
• Dry skin
• Cracks, calluses, wrinkles

Signs to feel for:

• Hard areas of skin
• Warm areas of skin

Things to do

• Change your child’s position regularly and avoid pulling when moving them. Ask your nurse if you need help with this.
• Each time you move your child, check their skin for the signs listed previously. Pay particular attention to their hips, bottom, elbows, heels, back of the head and ears.
• Check the areas of your child’s skin which are under direct pressure from objects such as feeding tubes, cannulas (thin tubes inserted in the skin) or wiring from monitors.
• Limbs in casts should be off loaded, for example a cast that covers the heel should be raised off the bed.
• Keep your child’s skin clean and dry; ask your nurse to help with a full wash daily.
• Do not rub your child’s skin.
• Make sure the bed sheets are not creased and your child is not lying on wires or tubes. Please ask your nurse for help if you are not sure what to do.

Can dressings help protect the skin?

There are many different dressings which may need to be used. The most common are:

• Film dressing – This is a clear film used to protect the skin from rubbing.
• Hydrocolloid dressings – This dressing, can be used to protect the skin from rubbing. It is often used in treating minor skin damage, preventing further deterioration.

Assessing the risk to your child

On admission, a member of the nursing team will examine your child and ask a few questions, this is a ‘risk assessment’. The assessment will be repeated at least daily, depending upon the individual needs of your child.

Pressure reducing mattresses

Your child may need a pressure reducing mattress. The mattress will help prevent pressure damage to your child’s skin.

Your child will still need to be repositioned regularly.

Moisture lesions

Lesions are skin damage caused by moisture or damaging body fluids such as urine and diarrhoea coming into contact with the skin for an extended period of time. Regular changing of nappies and keeping the skin clean and dry is important. The use of a recommended skin protection cream or a specialised wash and barrier cream system, may be prescribed.

Contact information

Tissue Viability Team

Gloucestershire Hospitals NHS Foundation Trust

Tel: 0300 422 5636

Monday to Friday, 8:30am to 4:00pm (excluding bank holidays)

NHS 111

Tel: 111

Further information

National Institute for Health and Care Excellence (NICE)

Website: www.nice.org.uk/guidance/cg179

Pressure ulcers: The management of pressure ulcers in primary and secondary care. 2014