What is a pressure ulcer?

Pressure ulcers happen when the surface of the skin or its underlying layers get damaged preventing blood being supplied to the area and starving it of oxygen and nutrients.

A pressure ulcer can develop for a variety of reasons, when there is pressure or friction against the skin, for instance, rubbing on a bed sheet, equipment, sliding down a chair. Bony areas are particularly at risk.

Moisture can also make it more likely for a sore area to start. Areas that can be affected in children include: the back of the head, ears, heels, elbows, base of the spine and the nappy area.

SSKIN will help you to understand more about this

Skin inspection

Check your child’s skin daily – this can be carried out when you are giving personal care. Look closely at your child’s skin when they are in the bath or shower, during a nappy or pad change or when you are changing their clothing.

Some medical devices can cause pressure ulcers, for instance CPAP masks, nasogastric tubes, wheelchairs, hoists, splints. Be aware of these areas. Pressure ulcers can range from discoloured skin to a blister.

When a pressure ulcer is first developing, the area can just look a bit bruised. In light-skinned people, the area might look reddened or in darker-skinned people, the area might look darker. The skin might seem shinier than usual and feel ‘stretched’.

• Check if this is the first sign of pressure damage by applying light finger pressure on the reddened/discoloured area for 5 seconds.
• When you remove your finger, the area should go white then flush red very quickly (3 seconds). If the area remains red this is pressure damage.

If you see any of these signs, please report immediately to a health care professional

Surface

Being aware of the surface your child is on and frequent re-positioning is important. For example, frequently repositioning any tubing or equipment to ensure your child is not lying or sitting on anything that may cause pressure.

Talk with your health care professional about specialist pressure reducing mattresses and equipment to support your child and help you decide what may be suitable.

Keep moving

Keep moving means just that! The best ways to reduce pressure are:

• Move your child at least every four hours or more often if at high risk of pressure damage
• Relieve pressure from feet and heels by using pressure reducing pads or positioning aids (such as cushions)
• Reposition or rotate any tubing or devices if possible to avoid pressure in one area

Incontinence and moisture

Prolonged exposure to moisture, including sweat, saliva, urine, faeces, mucus, can lead a child’s skin becoming red and sore

Prevent this from happening by

• Regular pad changes or a frequent toileting regime
• Keep your child’s skin as clean and dry as possible
• Avoid rubbing the skin dry as this can cause further damage to fragile skin
• Apply barrier cream to affected areas
• Avoid soap based products as they may cause irritation
• Oil based creams should be avoided as they can prevent pads/nappies from absorbing moisture
• Seek advice from a health care professional about appropriate emollients/creams

Nutrition and hydration

A good balanced diet packed with vitamins and nutrients alongside hydrating fluids will increase skin integrity and help prevent damage. Things to consider:

• Dehydration can cause skin to become dry and fragile
• Weight loss can contribute to loose and fragile skin
• For enterally fed children adhere to advice from your dietician to ensure adequate nutrition and fluid intak

If you have any further queries or concerns relating pressure ulcers, please seek further advice and support from a healthcare professional