Pediatric woundcare requires collaboration in hospital, community

Toronto - Pediatric woundcare differs from adult woundcare, and that principle should guide what clinicians do in the community setting and in hospitals, according to clinicians here speaking at a pediatric woundcare symposium.

“We don’t tend to see many things like diabetic ulcers in pediatric woundcare,” says Irene Lara-Corrales, M.D., M.Sc., a staff pediatric dermatologist at the Hospital For Sick Children in Toronto, discussing community needs in pediatric woundcare. “If we see ulcers, these usually have other etiologies, like a genetically predisposed condition.”

The wound-healing process in children has not been well studied, and there is information lacking about timing of the phases in wound healing in children and how these phases and their timing may differ in adults. In addition, best practice guidelines in pediatric woundcare are lacking, according to Dr. Lara-Corrales, an assistant professor in the department of pediatrics at the University of Toronto.

Management gaps

There are management gaps in addressing issues such as pain and itch in pediatric woundcare, she adds.

Depending on the age of the child, there are different concerns about the care of wounds.

“If it is a teenager, the child does not want dressings to be noticed,” Dr. Lara-Corrales says.

Families are not always able to access woundcare for their children at pediatric tertiary centers, so family members need to be educated about the woundcare needs of their child. Other members of the collaboration team can include nurses in schools who may come into contact with children, family physicians, community pediatricians, and daycare workers, Dr. Lara-Corrales explains.

Healthcare providers and family members should be directed to informative websites and provided pamphlets with information about pediatric woundcare. Initiatives such as teledermatology will facilitate follow-up care of pediatric patients with wounds. The cost of pediatric woundcare can be expensive, she says.

Like pediatric woundcare in the community setting, in the hospital setting it is a collaborative effort, according to Joel Fish, M.D., F.R.C.P.C., medical director of the burn unit of the Hospital for Sick Children in Toronto, and a plastic surgeon and associate professor in the department of surgery and research director for the division of plastic surgery at the University of Toronto.

When approaching a pediatric wound, clinicians need to consider local and systemic factors.

“Local factors are sometimes missed in the clinic,” Dr. Fish says. “These are factors that are likely reversible. Compared to systemic causes, they are usually irreversible, and there is not that much that you can do.”

There are some areas in wound healing that are typically not considered such as nutritional requirements for neonates, according to Dr. Fish.

“There is rapid growth happening in a newborn, and the energy requirements are often underestimated,” he says, adding that the classification of wounds in neonates is another challenge.

The tolerance for repeated interventions in pediatric care is much different than in adult care, which is another variable to take into account, he says.

Leadership role

Clinicians should take a leadership role in pediatric woundcare at their hospitals with a goal to enhancing care, according to Dr. Fish.

“I urge you to have a woundcare committee at your hospital,” Dr. Fish says, noting the Hospital for Sick Children’s woundcare committee is aiming to standardize pediatric woundcare. Some of the committee’s initiatives include screening new woundcare products for their efficacy and safety, and studying the impact of negative pressure therapy in pediatric wounds.

Skin substitutes are being employed in pediatric woundcare, and the experience is that these substitutes are very effective, but these substitutes are not well studied, Dr. Fish says.

There are some areas of controversy in pediatric woundcare, such as the use of anesthetics in children under 1 year of age, Dr. Fish says.

The area of genetics is rapidly advancing, and a better understanding of genetic disorders that lead to wounds will have an impact on woundcare, he says.

Disclosures: Drs. Lara-Corrales and Fish report no relevant financial interests.