In order for a child to make it through the first few years of life with trying new activities and testing limits, there are bound to be bumps and bruises along the way. How does a parent know when to take care of that “boo-boo” with love and when to request a specialist? Parents routinely call their pediatricians for advice and thankfully, pediatric offices are finely tuned to handle these calls and staffers know when to refer a patient to the ER or to a plastic surgeon. Anyone would agree that a child’s face or knee or hand is delicate and sacred…what parent would want a scar on his/her child that has the potential to be permanent? Call in the specialists…call the plastic surgeon STAT! Right? Well, sort of…here’s an abbreviated guide on what to know…if there’s ever any question, call your pediatrician, for sure!
When Burns Require a Specialist
Curious little ones are destined to touch a warm hair dryer, knock over a bowl of hot soup or reach up to the stove and touch something hot. Should this happen, the first step is to run cool water over the burned skin. Ice can stick to skin and cause more damage so stick to cool water. Take a look at the injured skin. If it remains pink or turns white, call your doctor. Chances are, the burn is superficial and will be okay but a pediatrician can recommend an ointment to provide some anti-bacterial protection. If the area is larger than the size of a dime, has blistering or if the cause was chemical, grease, electrical, or boiling water, ask your pediatrician for the name of a plastic surgeon. These wounds can be worse than they appear and should be taken care of by a specialist.
When Scrapes and Cuts Leave Permanent Scarring
Playground injuries are pretty common and pretty easy to treat. Most scrapes and cuts can be treated with soap and water, an anti-bacterial ointment and a bandage. If there is bleeding that persists for more than five minutes, apply pressure with a clean towel and elevate the area that is injured above the child’s heart if possible. If the wound continues to bleed, or if the cut appears deep, gaping or if there is missing skin, call your pediatrician. Look at a clock when holding pressure. It’s easy to think that it has been five minutes when holding a screaming and scared child when actually it’s only been a minute or two.
Applying a thin layer of anti-bacterial ointment via cotton-tipped applicator and keeping the injury covered with a clean bandage best treat scrapes. After the wound has been cleaned with soap, there is no need for peroxide or iodine as these slow down wound healing. As clean as we think our hands are after washing, they are still not clean enough to touch broken skin so use a cotton-tipped applicator when applying ointment. Wounds that are kept covered heal quicker so the old practice of letting a scrape stay open to air to dry out is not true. Keep it covered for a few days.
If stitches are needed, who should administer them? It is reasonable to have a plastic surgeon take care of a laceration to a face or an area that will be visible such as a hand or an arm. Parents routinely ask: “Is it going to scar?” Well, yes, if the skin is cut, most likely a scar will remain. But, the good news is that a plastic surgeon will apply enough sutures so that the skin is closed without tension so that the skin will heal with the best possible scar. And, unlike an ER visit, there will be follow up when parents are taught about scar creams and sunscreens to help the scar heal and fade. The sun is a big enemy for newly injured skin so keeping it protected with sunscreen is a MUST! And, there are a lot of scar ointments out there that do not work but have great marketing campaigns …scar products with silicone are the best for wound healing and for helping a scar fade.
Will Insurance Cover Plastic Surgery?
Is it going to be covered by insurance? Hopefully. Talk to the plastic surgeon by phone before deciding to meet in the ER or an office. Ask if the surgeon takes your insurance or what his fee schedule might be. Find out if you have out of network benefits for emergencies with your insurance plan. Most insurance companies cover emergencies when they are taken care of in the ER but not always when taken care of in a doctor’s office so meeting in the ER may be a smarter move for your wallet.
Article By JoAn Monaco, MD, MS, Mom and Plastic Surgeon in NYC
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