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How to Treat Cuts
Q: My boys are very active and play "hard."They're always ending up with cuts and scrapes. What's the best first aid for them? How do I know if a cut needs stitches or if it's infected?
A: Look to see if the cut is very deep, won't stop bleeding after 10 minutes or so using direct pressure, or the skin is really split apart. If this is the case, call your doctor immediately. Otherwise, clean the area well with warm water and soap. With this cleaning, you want to get rid of any dirt or other things that aren't normally there, so you can get a better look and help it to heal.
When the edges are spread wide apart, bringing them together with stitches will help the healing process and minimize the scarring. One is particularly careful about the face for cosmetic reasons. If you think stitches may be necessary, it's better to contact a doctor sooner rather than later. If you wait too long (more than four to eight hours), the benefits of stitching may be lost, or there may be more scarring. Any deep or dirty cut in a child who hasn't had a tetanus shot in the last five years warrants a booster (normally tetanus boosters are given every 10 years).
Small cuts, scrapes, and abrasions are extremely common and many of them can be taken care of at home. These are often superficial and tend to begin to look better quickly. Cleaning the area and using an over-the-counter antibiotic cream, like neosporin, can help prevent infection. Leaving the area open to the air also helps it to heal, although the psychological benefits of a band-aid in younger children is fine. Watch for signs of infection like increasing redness, warmth and tenderness in the area, drainage of puss-like fluid, or even a fever. Antibiotics by mouth aren't routinely indicated for preventing infection, only for treating it.
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Henry Bernstein, M.D., is currently the associate chief of the Division of General Pediatrics and director of Primary Care at Children's Hospital, Boston. He also has an academic appointment at Harvard Medical School.