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Four-year-old Caroline has a deep gash at the top of her nose.
“I heard you got an ‘owee!’… and that’s just no fun!” says Dr. Mike Ziegler, an emergency pediatrician at Children’s Healthcare of Atlanta, comforting Caroline.
Her mom was in another room and didn’t see it happen but she knew her daughter needed help.
“This is definitely going to require some repair,” says Ziegler, “and it may actually take a couple of layers. In other words, what we would do is use some sutures that are absorbable to go in and close the deeper structures.”
One of the challenges in treating small children who are injured is how to lessen the pain enough so doctors and nurses can do their work. Often, the best solution lies in a kind of twilight between being fully awake and being fast asleep.
They use a type of anesthesia called “conscious sedation.” It provides both pain relief and sedation, but not enough to lose consciousness.
“It allows her body to stay here, while her mind goes on vacation,” says Ziegler.
Still, conscious sedation is not without risk.
“Any time I do a sedation,” he says, “we set up the room with monitors, suction, oxygen bag and mask to be able to help children if they have any problems.”
Caroline gets six stitches before the anesthesia wears off. Dr. Ziegler says her parents will need to keep the wound clean and protected from the sun.
“And it’s very important that any type of wound that’s healing –especially in the first six to 12 months – has sunscreen placed on it whenever the child is going to be out in the sun and can potentially get significant ultraviolet exposure,” says Zeigler. “ And this is important because you need to minimize the risk of subsequent tumors that can occur even from a single episode of sunburn.”
He says with proper care, the prognosis is good.
“The wound fit together very nicely,” says Zeigler, “and so we were able to bring the deep tissues together and the superficial tissues together in hopes that she will have as small a scar as possible. We’ll give it about six to 12 months and see what it looks like.”
Dr. Ziegler adds that the reason Caroline is at such a high risk from sunburn is that the scarring tissue doesn’t have pigment tissue in it the way normal a skin cell does, which increases the risk of a tumor.
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