4. Assessment of skin in a child
• Proper setting
▫ Well lit room
▫ Clothes off
• Proper documentation of the lesion
▫ Distribution (location of the rash), pattern
(organization and configuration), lesion color
5. Dermatitis
• Broad description of changes that occur in the
skin in response to various stimuli
• 4 most common types:
▫ Atopic
▫ Contact
▫ Allergic
▫ Seborrheic
6. Contact dermatitis
• Localized inflammatory reaction
▫ Common irritants include soaps, detergents,
lotions, etc
• Nursing education
▫ Mild soap, wash clothes before first wearing
▫ Recognizing signs and symptoms of infection
7. Dermatlas.org
Diaper dermatitis (contact)
▫ One of the most common skin
disorders of infancy
▫ Sparing of the inguinal folds
▫ Treatment –gentle, thorough
cleansing and application of
lubricants
▫ May be complicated by
candida albicans
10. Atopic dermatitis (Eczema)
“The itch that rashes”
• Affects 17% of infants, children and adolescents
• 65% develop symptoms the first year of life
▫ 90% by age 5
12. Acute atopic dermatitis
• Intense itching
• Characteristic rash in locations
typical of the disease
▫ Infants- face, trunk,
extremities
▫ Childhood- flexural creases,
wrists and ankles
▫ Adolescents- flexural creases,
hands, face and neck
• Chronic or repeatedly
occurring symptoms
• Personal or family history of
atopic disorders (eczema,
allergies, asthma)
15. Nursing education for atopic
dermatitis
• Skin care
▫ Daily bathing with unscented soap
▫ Topical steroids if prescribed, then
▫ Lubrication, lubrication, lubrication
16. Common bacterial pediatric skin
infections
Impetigo
• Highly contagious
• Most common bacterial skin
condition in children
• Staphylococci or
streptococcus, or both
• Vesicles that easily rupture
forming honey crusted lesions
17. Pediatric abscesses
Methycillin resistant staphylococcus
aureus (MRSA)
• Resistant strain of staph
infection
• Historically seen only in
hospitalized patients
▫ MRSA now most common
cause of abscesses in all
patients
▫ CA-MRSA
• Most commonly present as
skin abscesses
18. CA-MRSA
Causes
• Crowded living conditions
• Sharing of personal items (towels, razors, sports
equipment, etc)
• Frequent skin to skin activities
• Frequent antibiotic use
19. Treatment and nursing education
• Incision and drainage
• Antibiotics
• Keep wounds covered
• Wash hands
• Bath regularly
• Avoid sharing of hygiene products
20. Viral skin infections in children
• Can range from benign and self limited
conditions to life threatening
• For a number of viral illness in children
▫ The rash gives the clue to the diagnosis
24. Fungal infections
• Tinea capitis
▫ Broken off hair
▫ Erythema and scaling of
underlying scalp
▫ Needs treatment with oral
antifungals
25. Skin injuries in children
Burns
• A leading cause of injury related deaths in
children <9 year of age
• Causes
▫ Inadequate adult supervision
▫ Child inquisitiveness
▫ Inability to get away from burning agent
▫ Intentional abuse
▫ Experimentation/risk taking activities (teens,
young adults)
26. Burn types
• Thermal
▫ Flames, scalds, contact
▫ 80% of all thermal burns in toddlers are from hot
liquids or grease
Scalds
The most common type of inflicted burn,
particularly between the ages of 1-3
28. Exposure time
• Temperature and time to cause a full thickness
burn:
150°F (66°C) 2 seconds
140°F (60°C) 6 seconds
125°F (52°C) 2 minutes
120°F (49°C) 10 minutes
** coffee and other hot beverages are often served
at temps of 160-180 º
29. Emergency management
• 1- Circulation, Airway, Breathing
• Followed by:
▫ Injury hx and mechanism
▫ Secondary survey for additional injuries
Remove all clothing
Apply cool, saline soaked gauze - NO ICE- or large
blanket to prevent hypothermia
Labs-CBC, CMP, urinalysis (for presence of
myoglobin), CO levels for fire related burns and CXR
30. Treatment of major burns
• Focus on
▫ Decreasing burn fluid loss
▫ Preventing infection
▫ Controlling pain
▫ Promoting nutrition
▫ Salvaging viable tissue
31. Pain management
• Opioids. Morphine or Dilaudid, Sometimes
Methadone preferred for action on peripheral nerve
pain. PCA preferred for dressing changes.
• Prevent pain, especially for first debridement or
dressing change.
• Round the clock medication in addition to pre-
medication for dressing changes.
• What pain assessment instrument would you
use for patients in each age group, and for
child with neurocognitive impairment?
32. American Burn
Association, 2007
Burn center referral
• Burn Center Referral Criteria
• * any patient with partial-thickness burns involving more than 10% TBSA
• * any patient with burns to the face, hands, feet, genitalia, perineum, or
major joints
• * any patient with third-degree burns, regardless of age
• * any patient with chemical and/or electrical burns, including injury by
lightning
• * any patient with inhalation injury
• * any patient with concomitant medical problems that could exacerbate
management, recovery, or mortality
• * any patient with burns and concomitant trauma in that the burn injury
presents the greatest risk
• * burned children in hospitals without qualified staff or equipment to care
for children
• * any patient who will need specialized social, emotional, or long-term
rehabilitation as a result of burn injuries
33. Prevention
• Hot water heater temperatures should be set at a
maximum of 120 degrees F
• Smoke detectors
BUT…….
90% of unintentional scald burns are not tap water
scalds
opening microwaves, older children cooking,
NOODLE SOUP
34. Psychosocial issues
• Coping skills, support, pain management
• Referrals: Nurse, child life specialist, social
work, psychiatry, pain team, physical therapy
• Association of body image changes with
traumatic event, possible loss of family and
home.
35. Home care/dressing changes
• Dressing changes
▫ Pre-medication to prevent pain.
▫ Give realistic choices.
▫ Distraction techniques.
▫ Clean hands. Prevent infection. Monitor for
infection.
▫ Do something calming and happy for child
when done.
▫ Support family, provide resources
Editor's Notes
Thin-very little sq fat- loses heat quicker, greater difficulty regulating temperature; also increased absorption of harmful chemicals and topical medications; Melanin- amount is low at birth-accounts for lighter skin in newborns of all races
Clothes off- this may be problematic in babies and teenagers to prevent cooling or embarrassment- may need to examine in segments
Why-bathed in urine and stool and occluded by a diaper (mostly stool)
The “contact” part of the dermatitis is the constant wetting and drying of the skin
How would you describe this? irregularly shaped, asymmetric, edematous, red, discrete, and confluent papules and plaques
red excoriated crusted lichenified scaly patches Comments: This toddler had recurrent flares of severe atopic dermatitis particularly when the weather was cold and dry. Exposed areas including the face and distal extremities were most severely affected.
Lichenification—darkened, thickened skin
Bathing once or twice daily (depending on the severity of AD) in warm water for 10-15 minutes is recommended to help hydrate and cleanse the skin, assist in the debridement of infected skin, and improve the penetration of topical therapies. Moisturizing cleansers are recommended while highly fragranced soaps should be avoided as they may irritate the skin. After bathing, the patient’s skin should be patted dry with a towel (so it remains slightly wet) and moisturizers and emollients (e.g., petroleum jelly, Eucerin, mineral oil, baby oil) should be applied liberally to help prevent moisture loss and drying of the skin.
Disproportionately affects children-in Baltimore in 2002, highest incidence was in children less than 2 years; often mistaken as spider bites
Antibiotic use- very important issue with young children- not treating viral infections with antibiotics
If they can’t keep wounds covered/maintain hygiene, then no sports participation
Early recognition-especially in immunocompromised patients is essential
School aged children-parvovirus, slapped cheek erythema, may have reticulated blanching erythema on trunk, fever, arthralgias
Common cause of oral lesions in toddlers and school age; red, friable gingiva, fever, irritability; lesions scattered on face and trunk; lesions frequently autoinnoculated onto the hands; clustered red papules, which evolve into vesicles; most is HSV type 1; can disseminate over entire skin surface in certain situations (ie eczema); enters dormancy
10-25% of all burns in children are due to abuse 4 types of burns- thermal (flames/scalds), chemical, electrical and radioactive
Chemical-ingesting or touching caustic agents Electrical-exposure to direct or alternating currents in electrical wires, appliances, etc Radioactive- radioactive substances or sunlight
