Children and Wounds

Dear Readers,   When was the last time you and a colleague discussed the treatment of a neonate or child with a wound? Usually that is not a topic high on our list to discuss, but neonates, infants, and children suffer from wounds at a surprising rate. Up to 10% of patients in the neonatal intensive care units can suffer from an intravenous infiltration wound, 3%–4% of patients admitted to a pediatric hospital each year develop a pressure ulcer,¹ many thousands of children suffer from burns each year, and many other infants and children develop skin defects as a result of congenital problems, trauma, operative procedures, and medical interventions. Unfortunately, when most think of children with wounds, they treat them as “small adults” with the same techniques, dressings, and bandages they would use on the adult population. We know that many adult treatments can be ineffective when used for infants and children, and many can be dangerous. A timely example is the use of some silver dressings on children. Commonly used to treat adults without concern, some silver dressings used in the treatment of infants and children can result in systemic absorption of silver and raise the serum silver level 800 times above normal!² Good information about pediatric wound management is not readily available and products designed for the treatment of these patients are virtually nonexistent. The extensive regulations involved in any type of clinical research in the pediatric population, the lack of industry sponsorship of such research because it’s considered a “niche” market, and the lack of recognition of the problem are sources of the information deficit. This must change in order to advance care for these patients.   I have just returned from the First International Symposium on Pediatric Wound Care, held October 27–29, 2011 in Rome, Italy. This symposium, organized by Dr. Guido Ciprandi and Dr. Corrado Durante of Rome, Italy, and Dr. Marco Romanelli of Pisa, Italy, brought together 425 international experts and attendees from more than 50 countries to discuss 25 selected topics on the evaluation and treatment of wounds in infants and children. The symposium was held in Rome at the Pontifical University of St. Thomas Aquinas, commonly known as the Angelicum. One of the distinguished graduates of this university was Pope John Paul II. This was the first scientific medical meeting I have attended in a historical seminary! I was honored to give three presentations on our work with infants and children with wounds treated at our clinic in Montgomery, Alabama. The worldwide attention to wounds in this age group is long overdue. I encourage you to visit the website (www.ISPeW.eu) to view the program in its entirety. I think you will be impressed with the scope of the topics. The organizers are to be congratulated for an excellent program and for bringing attention to this unappreciated and under-recognized problem.   Over the next several months, I hope to bring some of the information discussed at the meeting to you. These are very important topics for all who treat infants and children, even if it is on an occasional basis. Most importantly, remember that infants and children are not just “small adults” and their treatment must be done with care and thought. In the meantime, I encourage you to consider joining the International Society for Pediatric Wound Care and start planning now to attend the 2nd International Symposium on Pediatric Wound Care to be held in the United States in 2013.

References

1. McLane KM, Bookout K, McCord S, McCain J, Jefferson LS. The 2003 national pediatric pressure ulcer and skin breakdown prevalence survey. J Wound Ostomy Continence Nurs. 2004;31(4):168–178. 2. Denyer J. Safe topical antimicrobial use in paediatric wounds. Presented at: The First International Symposium on Paediatric Wound Care; October 28, 2011: Rome, Italy.