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| Vol. 23, No. 15 |
| August 15, 2001 |
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New Tool Helps Prevent Pressure Sores in Children By MICHELLE KLOESEL Shriners Hospitals for Children-Houston When hearing the phrase "chronic wounds," most people think the only sufferers are the elderly or those who have endured trauma or spinal-cord injuries. However, children with orthopedic problems affecting the bones, joints or muscles also are susceptible to chronic wounds.
To determine why, a group of care providers at Shriners Hospital for Children in Houston initiated a Wound Care Team about a year ago. Team members began to examine reasons why children might be developing pressure wounds and set out to develop and implement pediatric wound-care standards of prevention.
Registered nurse Irma Samaniego lead the team in a retrospective review of pediatric wounds.
"We spent a lot of time researching how our patients acquired wounds," said Samaniego. "Our findings indicate that there are several variables, but if the appropriate steps are taken, pediatric wounds can be 100 percent preventable."
One of the findings revealed that children with certain types of orthopedic conditions, such as spina bifida, are prone to wounds. Spina bifida patients lack feeling in certain areas of their bodies, particularly in their legs. If an ill-fitting brace is irritating the skin, these children don't realize a wound is developing and therefore don't take steps to prevent its worsening. In addition, children with spina bifida often have urological problems. If the skin is not kept dry after bladder leakage, skin irritations may develop.
Other causes of pediatric wounds are devices such as prosthetics, wheelchairs or casts. Any of these may cause children to develop "pressure spots." To avoid this, orthotists, such as Shriner's orthotist David Eby, must ensure that these devices fit properly.
"It's important to make sure that there is clearance between the brace and the skin," said Eby. "If the brace touches the boney areas, then the skin can break down and cause a wound. If the patient outgrows the brace, we must create a new, properly fitted one to prevent unnecessary pressure wounds."
Korey Posey, an 11-year-old cerebral palsy patient at Shriners Hospital, uses a wheelchair and has begun wearing lower-leg braces.
"Because Korey's parents are so good about checking his body every day for skin irritations, he has not developed any pressure spots," said Eby.
Another factor associated with the development of wounds is protein malnutrition. When children are in the hospital, their nutritional needs are monitored with care. However, upon returning home, their diet can change.
"Kids go home and eat comfort food, which is normally unhealthy," said Samaniego. "Without enough protein, their bodies will have trouble healing."
Eleven-year-old Cynthia Duncan, who recently fractured her right arm, enjoys snacking on fruit, especially bananas. She claims that since she has been admitted to Shriners Hospital, she is never hungry due to all the good food provided by the hospital's nutritional services department.
In addition to these factors, different growth periods or patterns during a child's life may be related to pressure sores. From toddlers to teenagers, children can develop pressure sores from being too active or sedentary. Following are a few precautionary tips for wound prevention in children with orthopedic conditions:
After addressing reasons why pediatric wounds occur, the team then developed a standardized wound risk assessment by following guidelines from the Agency for Healthcare Research and Quality and the BRADEN scale, which is commonly used for geriatric patients.
"Our findings showed that the risk indicators in children were very similar to those described for geriatrics. We also found that the BRADEN scale could be used if it were specific to children's weights and functions," said Samaniego, "so we adapted the BRADEN scale for use by the pediatric orthopedic population."
Dr. Barbara Braden, who developed the BRADEN scale along with Dr. Nancy Bergstrom, reviewed the team's assessments and gave them permission to use the adapted version, which is now in use at the Houston Shriners Hospital.
"Eventually, our standardized wound risk assessment will be used by all 22 Shriners Hospitals for Children throughout North Amercia," said Samaniego. "Our long-term goal is for this scale to be used by all pediatric orthopedic medical facilities."
©2006 Texas Medical Center E-Mail: tmcinfo@texmedctr.tmc.edu URL: http://www.tmc.edu/tmcnews/08_15_01/page_13.html |