Cath Lab Digest

  Children are not small adults. Rapid growth rate stands at the forefront of distinction in relation to nutritional status. Children are in a constant anabolic state, actively building their bodies. They need more calories, protein, and water per unit of body weight than adults. Often, they are powerless over food choice; parents, caregivers, or teachers decide when and what they eat. Their communication of needs and desires is still developing. Diets, often consisting of unpopular foods restricted by region, ethnicity, and financial or social status, as well as small appetites, are frequently inadequate. Additionally, a child’s adventurous nature spawns risk-taking behavior. Threat of gastrointestinal infection is higher due to exploration and hands-to-mouth gestures. Needs change as rapidly as growth occurs, necessitating flexibility and constant adjustment in plan of care. Nutritional screening, problem prevention, and early intervention are imperative.

  Attention to unique childhood nutritional needs and requirements is critical to the success of any care plan. Focusing on the provision of optimal nutritional care for support of wound healing is vital to its success.

Incidence of Skin Breakdown in Children

  Although the prevalence, prevention, and treatment of skin breakdown in adults have been widely studied, the research in the pediatric population is limited. In 1998, the National Institutes of Health (NIH) mandated that any human research supported by the NIH include attention to children under the age of 21. This elicited study of wound incidence in children, and the literature now indicates that prevalence of wounds in children is high enough to warrant interest.¹

  Although the exact incidence is currently unknown, skin breakdown and pressure ulcers exist in the pediatric population. Wounds occur in both the hospital and home environments. Wounds may develop in children with chronic illness such as myelomenigocele (spina bifida), cerebral palsy, paraplegia, myelodysplasia, scoliosis, and clubfeet.² Children who are critically ill with extended hospital stays in the pediatric intensive care unit have higher risk of skin breakdown, which leads to higher risk of mortality.³ Pressure ulcers also develop due to frequent accidental injury, which occurs in children due to their developing physical abilities and poor recognition of dangerous situations. Common types of minor wounds are soft tissue bruising, abrasions, lacerations, puncture wounds, and diaper dermatitis in infants.⁴ Major sites of skin breakdown in pediatrics differ from those of adults. The most common sites are the occipital region in children <36 months old and the sacral region in older children. In orthopedic injury, skin breakdown occurs more in lower extremities, mostly in the feet. Of additional concern is childhood propensity for developing keloid or hypertrophic scaring due to anabolic state and abundant collagen formation.² From a positive prospective, children have a great capacity for healing, wounds included. Children suffer from fewer comorbidities such as diabetes or heart disease; thus, they heal at a more rapid rate with fewer complications.

Nutritional Status as Part of Wound Risk Assessment

  Risk factors for pressure ulcer development have been well defined in the adult population, but not in the pediatric population. The standard factors of risk assessment used in adults can be applied to children. These include immobility, neurologic impairment, impaired perfusion, decreased oxygenation, poor nutritional status, presence of infection, moisture, acidemia, and weight status.⁴ Again, it is a mistake to treat children as adults because physical and metabolic differences create other risks.