Avoiding pressure ulcers in children and young people

Pressure ulcers can be painful, distressing and can leave disfiguring scars. Although the prevalence and incidence of skin breaks due to pressure is reported to be less than 5% in the general paediatric inpatient population, it appears to be higher in critical care patients. The prevalence of pressure ulcers on paediatric wards is lower than that on geriatric wards, although very young children and infants normally have restricted mobility. Children differ from adults in that they tend to have fewer co-morbid conditions, their skin is more elastic and resilient, and young children and babies are normally picked up frequently. Although pressure ulcers in children can develop on skin in contact with a support surface (predominantly on the occiput, sacrum and heels), over 50% of hospital acquired pressure ulcers appear to be related to devices pressing or rubbing on the skin. The most widely used paediatric pressure ulcer risk assessment scale may be the Braden Q scale. This was adapted from an adult scale, for use in paediatric intensive care. The Glamorgan scale is also widely used, this was developed from a statistical analysis of multi-centre paediatric patient data, and is used with general inpatients. General tips for preventing pressure ulcers are to observe skin frequently, especially children with reduced mobility and under medical devices, remove pressure at the first sign of skin redness (or sooner), change position frequently if possible, protect skin from pressure, and consider factors associated with reduced tissue tolerance.