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Pressure ulcers (also known as a ‘pressure sores’ or ‘bedsore’) are when the skin or the tissues underneath it are damaged. This usually happens to bony parts of the body, such as the heels, elbows, hips and base of the spine. They can also be related to medical or other devices.
Pressure ulcers can happen to anyone, but usually affect people who are spend a lot of time in a bed or who sit in a chair or wheelchair for long periods of time. They often develop gradually, but can sometimes form in a few hours.
A pressure ulcer can look like aggravated skin or as an open wound. These injuries can be painful.
Pressure ulcers are categorised depending on how serious they are.
A doctor or nurse may call a pressure ulcer at this stage a category 1 pressure ulcer.
The skin may not be broken at first, but if the pressure ulcer gets worse, it can form:
There are 2 ways pressure ulcers can happen.
Firstly, from direct pressure and secondly by a combination of pressure and shear or friction. In both cases the most vulnerable parts of the body are bony areas.
A pressure ulcer will usually develop when there is direct pressure from a firm surface to a bony area of your child’s body for a long time. This is because a bony area presses down through the tissue layers against the hard surface, pinching the blood vessels and restricting blood flow, oxygen and nutrients getting to that area.
If the pressure is not relieved regularly the tissues start to break down causing a pressure ulcer to develop.
When ‘shear’ occurs, the surface of the skin and underlying bone moves in opposite directions. This ‘shear’ movement stretches and tears the internal tissues causing damage. A typical example would be if your child regularly slouches or slips down in bed, so their skin stays in one place, but the bones and tissues underneath move a lot more.
Friction damage occurs when the skin rubs against a surface, such as a splint. The rubbing action of skin against a surface causes skin stripping where the top layers of your child’s skin are damaged. This leaves damage on the surface of the skin and when coupled with prolonged pressure this can easily turn into a pressure injury.
Pressure ulcers are usually associated with old people however, anyone can develop a pressure ulcer. Children’s skin is particularly vulnerable to skin damage as it is thinner than adults and still developing.
Consider the following risk factors when caring for your child:
If your child cannot tell pressure damage is happening, let you know something is wrong or that they are in pain.
Other areas at risk of pressure damage are those with medical equipment is attached to the skin, such as:
In hospital, we use risk assessment tools to measure your child’s risk of pressure damage. This helps us identify children at risk and plan some ways to care for your child that will prevent pressure injuries. When your child is at home, you should think about these risk factors:
You can look at your child’s skin inspection whilst you are giving personal care to your child. Look at your child’s skin whilst they are in the bath, shower, during a nappy change or whilst changing their clothing. It is important to check your child’s skin every day as pressure damage can develop quickly.
The first signs of skin damage you may find is usually a red mark. If you find a red mark there is a simple test, called the ‘blanch test’, to see if this mark is the first signs of pressure damage and how serious it is.
Press your finger lightly on the red area and hold for 5 seconds. Then lift your finger away.
If your child’s skin has gone pale (blanched) and then returned to red then this is currently not pressure damage. You should still check if there is moisture there as the redness may be from moisture damage and need treatment to stop it getting worse.
If your child’s skin stays red and does not change colour then this is pressure damage. This is a category 1 pressure ulcer.
You can check for other signs of pressure damage which include :
We can provide special equipment to reduce your child’s risk of pressure damage which includes:
There is a risk that some equipment your child needs when they are unwell could cause pressure damage.
Common equipment that causes pressure damage:
To help prevent equipment-related pressure damage:
We know prolonged pressure over bony and vulnerable areas of your child’s body can cause a pressure ulcer to develop. Regularly changing your child’s position or getting them to move around, if they are able, will relieve pressure and return blood flow to any areas affected by pressure.
Ideally you should aim to change your child’s position every 2 to 4 hours to relieve pressure areas.
Moisture associated skin damage, also known as moisture lesions, is caused by the skin being exposed to a source of moisture for a long time. This can cause the skin to become red and sore and can lead to the skin becoming broken down.
The most common form of moisture damage is linked with incontinence (when a child pees or poos themselves). The damage is caused by constant exposure to pee and poo and this can be very painful for the child and distressing for you as a parent.
Other sources of moisture damage:
A good skin care regime is important to keep skin healthy and will help prevent moisture damage. You should avoid soap products as these can irritate fragile skin. Water-based barrier creams prevent damage to the skin from too much moisture.
Your child needs a good variety of nutritious foods to stay as healthy as possible. Children need to have enough vitamins, calcium and protein to give them energy to grow, and play. Vitamins from a healthy diet are also important to help children heal, fight infection, illnesses and diseases. They help with brain development, encourage wound healing, and keep skin healthy. If your child has a wound, then getting protein in their diet helps to repair and maintain healthy skin.
What are the risks of your child developing pressure damage?
If you feel that your child is affected by one or more of the issues discussed in this resource in particular:
Contact your specialist healthcare team or the Tissue Viability Specialist Nurse via switchboard on 0114 271 7000
Email Tissue Viability: email@example.com
Your general practitioner (GP) or specialist healthcare team can refer your child to Tissue Viability at Sheffield Children’s Hospital if you and your child need further support.
Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.
Switchboard: 0114 271 7000
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