Parents have been asking me some pointed questions about what to do when their children experience a puncture wound.  Well, let me take a stab at this one and provide some information on the topic.

A puncture wound is usually a deep wound created by a sharp object such as a nail or jagged piece of metal or wood.  They account for almost 5% of pediatric emergency injuries and commonly involve the bottom of the foot.  While they may seem small on the outside, they can become easily infected as dirt and germs are introduced deep into the tissues of a hand, foot or other part of the body.  In fact, 10% of these wounds will become infected and the chance for that to happen increases if medical attention is delayed. 

What can you do?

· First, calm your child and then apply pressure with a clean cloth to stop the bleeding. 

· Once bleeding has stopped, use soap to help clean the area, and wash the wound well for at least 5 minutes under running water to allow the dirt to run out of the wound.

· Look, but do not probe, for objects inside the wound. 

· If you see some debris or suspect some might be there, seek medical attention since these small pieces may be the root of a subsequent serious infection. Your doctor can assist in the removal of this debris.   

You’ll need to apply a bandaid and change it daily, or sooner if it becomes wet or dirty.  Even if you do not feel the wound warrants a trip to doctor, at least call your child’s doctor to make sure your child’s tetanus status is up-to-date, and to discuss whether or not antibiotics are needed.  If over the next several days there is warmth, redness, swelling, or drainage from the wound, then treatment with an antibiotic is certainly in order. 

These symptoms can also mean that there are still small pieces of the object stuck in the wound that need to be cleaned out by your child’s doctor or a pediatric surgeon. The good news is that most puncture wounds heal well with good cleaning and do not need further intervention.     

Hopefully, sharp tips like this will puncture any concerns you have when it comes to knowing more about what to do for your child’s puncture wound.

Lewis First, M.D., is chief of Pediatrics at Vermont Children's Hospital at Fletcher Allen Health Care and chair of the Department of Pediatrics at the University of Vermont College of Medicine. You can also catch "First with Kids" weekly on WOKO 98.9FM and on WCAX-TV Channel 3. Visit the First with Kids video archives at http://www.FletcherAllen.org/firstwithkids