Turns out I sometimes suffer from what I’ve dubbed: Child-Just-Bumped-Their-Head-Or-Fell-Again Deafness. It started with my second child. As a toddler, he fell or bumped into something about every other minute and I unwittingly started to sometimes not even notice he was crying. I wasn’t aware of my disorder until my husband would give me a little nudge or exasperated look. What? I feel bad, it’s just that it happened so often I sometimes forgot to react. Don’t get me wrong though. Everyone mom knows THAT cry. The one that REALLY means their li’l one is hurt and it’s time to drop the laundry basket or get off Facebook (or both), ignore that the coffee is ready and dive Superwoman style to get a big hug in. Well, THAT cry recently came from my 6 year old, accompanied by a whole lot of blood and a trip to the Emergency Room.
It was a Sunday like any other: the kids are circling our bed waiting for us to get up, while the hubby’s trying to read just one more page of his novel and I’m seeing how much more of my People Magazine I can get caught up on (poor Sandra Bullock!), when finally we decide we should probably feed the kids. Just as the hubby was firing up a second round of pancakes and I was perfecting a home-made mocha, our daughter ran out of the kitchen, bumped into the wall which then made her fall onto the corner of the staircase banister and put a big ‘ol gash in her tiny head.
Naturally, I learned a whole lot that day and also turned to Pediatrician Shakha Gillan to find out where I went wrong.
First, the advice I got from the ER doctor was that it was the smart thing to do to bring my daughter to the local hospital versus the Children’s Hospital (about 40 minutes further away). Had the gash actually been on her face, it still would have been fine to go to the local hospital as ours, I learned, has Plastic Surgeons on call (you want the Plastic Surgeon or your child may unnecessarily have a large scar for life). However, if a child breaks a bone, all bets are off and you head straight to the nearest Children’s Hospital. Talk to your pediatrician to find out what works best in your area and what your hospital can and cannot accommodate. BUT FIRST find out what your pediatrician can take care of –do they have a Plastic Surgeon on call if a wound is on the face, do they have office hours on the weekend if something happens– if so, HEAD THERE! The ER bill will cost you — depending on your insurance — likely at least $1000 — vs. a simple office co-pay. I also was told Urgent Care would have saved us loads of money (my daughter’s cut did not require a Plastic Surgeon). It’s an expensive lesson to learn, but all that blood was alarming!
I also learned that staples are the new stitches. However, if you have a squeamish kid, you can request that their hair be braided, which has the same effect.
My questions for Dr. Gillin:
When my 6 year old gashed her head, I was given the option of stitches, staples and braids (in the event she was too squeamish), which would you have recommended and why?
Since the scar will not typically be visible, there are more options available.
The options for closure of a scalp gash basically involve what will bring the gash back together the best, with causing the least discomfort to the child. So staples are very easy to do since it is very quick. I tend to do stitches if I think it will bring the gash back together better, but it involves the cooperation of a child (so if I have a child who is moving all over, then I may use staples because they are quick).
I do not do braids.
For the removal of the staples or stitches, can a parent do this at home or do you recommend a pediatrician doing so? If you recommend a pediatrician, why?
You really want to have the doctor do this- although it seems easy to do, you want to be under the care of a physician if the wound hasn’t closed properly, or looks infected. There are times that I take out one suture, and the wound seems to be opening up, so I leave the suture in for another day and have the patient return the next day.
You have to be crazy to try and remove a staple by yourself. Even your child will probably not allow it.
I was told to keep the staples in for 5-7 days and to watch if it got red, painful or swollen and head back to the pediatrician or hospital – anything else to look out for?
That really is it- if there are any signs of infection- redness, bleeding, or pus.
With any type of injury involving stitches or staples, how long should a child refrain from any physical activity like soccer, gymnastics, etc?
This is one of those common sense questions- if your child will likely “pop” their stitches out, then refrain from that activity. So anything that would involve them having contact with the head [or injured area].
Also remember to keep the wound clean- so going to the beach, or the barn, or the county fair may not be the best until the wound has healed.
With a head injury, outside of the obvious big gash, what other concerns should a parent keep an eye out for?
Parents should watch for internal bleeding- so altered mental status, vomiting. They should discuss this with their physician. I usually recommend close monitoring, and give patients handouts to review what specific signs to look for in the first 24 hours.
I went to the local hospital and felt it was a pleasant experience. Should I have gone to Children’s Hospital instead? Or what protocol in general would you recommend to moms all over the United States (Call ped first? Head to local hospital first? Urgent Care?)
I think it really depends on your local hospital. I would agree that Scripps Encinitas, and Scripps La Jolla, are fantastic with gashes for children. Now if a parent was extremely worried about the scar, or insisted on having a Plastic Surgeon- then they are not able to provide that at many local hospitals (for that matter, it may not be possible at a specific Children’s Hospitals either).
One thing that emergency departments/ hospitals often have that I do not have in my office is topical anesthesia- a liquid anesthesia that is put on a cotton ball, and placed on the wound so that even the needle anesthesia is easier for a child. Although all children may not need this, it is very helpful for many kids.
With a broken bone, I was told to go directly to Children’s Hospital – do you agree with this?
For the most part, yes. If there needs to be any management involving an orthopedic surgeon, most children need to go to the Children’s Hospital. So while some families will go to the local hospital to save time, or the drive, they eventually have to drive and wait at Children’s due to a broken bone.
Anything else you’d like to share?
Don’t forget that your child will have a small scar, it is OK. We all have them!! But, keep the wound out of the sun for many many weeks to minimize the scar they will have.
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Shakha Gillin, M.D., F.A.A.P. attended UCSD for her undergraduate education and medical school (and if she looks familiar that’s because she’s the twin sister of Breezy go-to dermatoligist Dr. Vi). She practiced pediatrics in La Jolla for 5 years before joining El Camino Pediatrics. She has also worked in private practice in Newport Beach and in the Rady Children’s Hospital Emergency Department. Dr. Shakha Gillin has a special interest in preventative care, particularly healthy and active lifestyles for children. She was recognized by San Diego Magazine as a “Top Doctor” in 2006, 2007, 2008 and 2009. She also organizes the North County Pediatric Journal Club, an every other month meeting where local pediatricians discuss the latest pediatric medical topics.
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