Doctors' Orders: When are stitches needed?

Kids love to play. Between playgrounds, sports fields, and the ins-and-outs of everyday activities, bumps and scrapes can happen. Every once in a while medical attention is needed. Here are some common questions we get from parents about stitches, scrapes and scratches.

How do I know when my child needs stitches?

Any open wound that you think may need sutures should be seen by a doctor as soon as possible. Ideally, wounds should be checked and closed within six hours to prevent wound infections, however some open wounds can be closed within 12-24 hours.

Here are some indicators that your child may need stitches:

• A cut is split or gaping.
• A cut is longer than ½ inch (12 mm).
• Cuts on the face that are longer than ¼ inch (6 mm) usually need closure with sutures or skin glue.
• In the mouth or inside the lip, cuts less than 1 cm usually do not need stitches unless the cut continues to bleed.

How do I tell the difference between a cut and a scratch?

The skin is about 1/8 inch (3 mm) thick. A cut or laceration goes through the skin while a scratch or scrape does not break the skin.

Cuts that gape with or without movement need stitches to prevent scarring. Scrapes and scratches never need stitches, no matter how long they are.

When is a tetanus shot needed?

Your child may need a tetanus shot update if he/she gets a cut or open wound. Check your child’s vaccination records to know when he or she last received a tetanus shot, and follow this guideline:

For dirty cuts and scrapes: if your child has been vaccinated and the last tetanus shot was given more than 5 years ago, he/she will need a booster.

For clean cuts: if your child has has been vaccinated and the last tetanus shot was given more than 10 years ago, he/she will need a booster.

Be sure to see your child's doctor for a tetanus booster shot. It's safe for your child to receive the shot within 3 days or less of getting the cut.

All Children’s Hospital Urgent Care locations have tetanus shots available for wounds treated in the center.

What are signs that a cut is infected?

Here are some indicators that your child’s cut may be infected. If you notice any of these signs, you should see your child’s doctor immediately:

• A pimple or yellow crust has formed on the wound
• The scab has increased in size
• Increasing redness occurs around the wound
• A red streak is spreading from the wound
• The wound has become very tender and painful
• Pain or swelling is increasing 48 hours after the wound occurred
• The lymph node draining that area of skin is large and tender.
• A fever occurs
• The wound hasn't healed within 10 days after the injury

What is the process of getting stitches at Children’s Hospital Urgent Care?

We work with parents to decide which technique is best for repairing your child’s laceration. We discuss options for minimizing pain and discomfort during the procedure while doing everything possible to ensure the best outcome. Here is our typical process for evaluating your child:

• A nurse evaluates the cut to assess the need for stitches.
• We use a numbing cream, which avoids the need for a numbing shot in most patients.
• We clean the wound.
• We conduct the suture procedure while educating your family through the process to reduce any anxiety or fear.
• We apply a bandage to the area.

What are liquid stitches?

Liquid stitches are a skin adhesive used to close wounds. Doctors apply the liquid on small wounds and skin surfaces to securely hold the edges together.

Your doctor will have to evaluate your child’s wound before making the decision whether to use liquid or regular stitches since there are many factors that need to be considered before choosing one or the other.

Stitches are a common occurrence for children and a common reason patients visit a Children’s Hospital Urgent Care. For a location nearest you, visit www.childrenshospitalurgentcare.com

-- Reviewed by Dr. Matthew Blair, Medical Director, Children's Hospital Urgent Care

Doctors' Orders is an ongoing series featuring articles from the experts at East Tennessee Children's Hospital.