Information for children, parents and carers
What is a pressure ulcer?
A pressure ulcer is damage that occurs on the skin and underlying tissues when the blood supply to that area is stopped and the tissue is starved of oxygen and nutrients. A pressure ulcer can develop for a variety of reasons, especially if you are unwell. It can be very painful and lead to further complications.
Who is at risk?
Some children are always at risk of pressure ulcers. Everyone is at some risk when you move around less. This could be due to disability, medications, pain or ill health.
However you are more at risk if you:
- Don’t eat or drink enough.
- Are overweight or underweight.
- Have vulnerable skin, eg. dry, moist, paper thin, redness or sore skin.
- Have a damaged spinal cord / or cannot feel pain over part or all of the body.
Why are you at risk of a pressure ulcer?
Anyone can get a pressure ulcer, but some children are more likely to develop them than others.
For example, children who:
- Have reduced mobility; for example, if you are ill and have to stay in bed or in a chair or wheelchair for long periods of time or if your illness or medical condition makes it difficult for you to change position without help.
- Have a piece of equipment that can restrict your movement or cause pressure and/or friction, for example a wheel chair, urinary catheter tubing, gastrostomy tube, splint, body brace, plaster cast, saturation probe, facemask, intravenous catheter (for intravenous medications).
- Have a poor diet and don’t drink enough water.
- Are underweight or overweight, as this can affect your mobility and skin condition allowing it to become damaged more easily.
- Have circulatory or respiratory conditions that affect your blood flow.
- Have increased moisture due to incontinence or sweat resulting in ‘nappy rash’.
- Have had a pressure ulcer in the past.
- Are seriously ill or undergoing surgery.
- Have damaged your spinal cord and/or cannot feel pain over part or all of your body.
- Currently have a pressure ulcer.
- Have long periods with a high temperature.
Remember: SSKIN
Surface
Skin inspection
Keep moving
Incontinence
Nutrition and hydration
Surface
Pressure ulcers can also occur under medical devices used to treat your condition. For example an oxygen mask, tubing, catheter, cast, splints or neck collar. It is important that you inform your healthcare professional if you have a poorly fitting or painful medical device or if any of the equipment you have been provided with is not working or is uncomfortable.
Pressure relieving equipment such as a mattress, cushion, specialist seating, may be necessary to help reduce the amount of pressure on your body.
Skin inspection
Check your skin daily – when you are washing and dressing, you can help by looking closely at your skin for the warning signs of pressure ulcer development and reporting any areas of concern to a healthcare professional immediately.
What are the warning signs?
- red patches on fair-skinned children
- purple / bluish patches on dark-skinned children
- skin may feel hot, firm or soft and /or appear shiny
- blistering or cracks may form
- hard or swollen areas which may be painful
- pain over bony areas.
These are the areas of the body where pressure ulcers are most likely to occur:
- Head
- Shoulder blades
- Elbows
- Sacrum
- Buttocks
- Heel
- Toes
Noticing symptoms early is important so that steps can be taken to prevent a pressure ulcer developing.
Keep moving
Keep moving – this is done by moving around and changing position as much as possible. Encouraging and/or assisting your child to change their position as often as possible will help to relieve pressure on the bony parts of the body. If you use a wheelchair you need to move frequently in your chair to reduce pressure on your bottom. If you already have a pressure ulcer, lying or sitting on the ulcer should be avoided as this will make the ulcer worse.
Avoid pressure and friction – ensure you are not lying on any tubing, wires or other equipment. Keep your bed sheets free from creases which can cause rubbing. Always use a slide sheet for repositioning – it is important to avoid dragging your child when moving them. If your child wears a cast, splint or body brace etc, alert your child’s health care professional immediately if you have any concerns.
Check equipment regularly – ensure wheelchairs, cushions and splints are appropriately adjusted by your occupational therapist and physiotherapist and report any problems with this equipment to them as soon as possible.
Incontinence
Damp skin may be damaged more easily by pressure, for example wee (urine), poo (faeces) or sweat.
Keep the skin clean and dry and moisturised.
Check your skin at least daily.
Good personal hygiene is important. Ask a healthcare professional for help and advice to manage incontinence.
Nutrition and hydration
Make sure you eat and drink well – eat a well-balanced diet with plenty of fresh fruit, vegetables and protein rich foods (e.g. meat, fish, eggs, cheese and dairy products) or if you have enteral feeds ensure you have all the feeds and water as prescribed by your dietitian. Drink adequate fluids, particularly water, to keep the skin soft and supple.
Practical hints and tips
If you are a child’s parent/carer you have a very important role in helping to care for your child’s skin. Your health care professional should advise on how pressure is best reduced or relieved on areas of skin that are vulnerable to pressure ulcers.
Do…
- change your position frequently – while in bed or sitting in a chair, avoid being in one position for long periods of time
- take good care of your skin – keep it clean and free from too much moisture
- encourage a healthy balanced diet
- use the equipment as advised by your health care professional
- inspect your skin for red marks or dark purple areas and report these as soon as possible.
Don’t…
- sit on a rubber ring cushion (may cause more damage)
- massage or rub pressure areas
- drag yourself or your child over damp or creased bed clothes
- try to manage a pressure ulcer yourself – seek help from your healthcare professional.
If your child already has a pressure ulcer, lying or sitting on the ulcer should be avoided as this will make the ulcer worse.
Remember…
It’s important to look after your skin by:
- Telling a healthcare professional if you have any pain or discomfort
- Moving regularly
- Eating and drinking well
If you would like any more information or have any concerns, please speak to a healthcare professional or ask your mum, dad or carer to speak to them.
Staff are able to refer you to the Wound Prevention and Management Service, Children’s Nursing Team, Physiotherapists, Dietitians and Occupational Therapists if your needs are complex or if your condition is getting worse.
