Paediatric Pressure Ulcer Prevention
Date issued: January 2024
Review date: January 2026
Ref: C-557/AB/Child Health/Paediatric Pressure Ulcer Prevention
PDF: Paediatric Pressure ulcer prevention and management final January 2024.pdf [pdf] 429KB
What is a pressure ulcer?
A pressure ulcer happens when pressure and/or shear and friction is placed constantly over an area of your body for a long-time causing damage to the skin and/or deeper layers of tissue under the skin. This usually happens over a bony area of your body or where medical equipment has been placed. This is because the blood flowing to the affected area is stopped, causing the tissue to be starved of oxygen and nutrients. Pressure ulcers can be shallow or very deep. They can be very painful and lead to further problems such as infection and longer hospital stays.
It is important for you and your parents/carers, to understand what can be done to stop pressure ulcers from happening as well as what the warning signs are.
Places of biggest risk:
When lying down
When sitting down
Who is at risk?
Anyone can develop a pressure ulcer; however, some children are at higher risk of pressure ulcers than others. This could be due to disability, pain, medicines, or ill health. For example:
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Not being able to move as much means you are less likely to change position or may require help to do so.
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Being underweight or overweight.
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Having a poor diet and not drinking enough.
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Having dry, swollen, moist, sore or thin skin.
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Regularly wetting or soiling your clothes, nappy or pad with wee/ poo or having moist skin due to sweat, which causes moisture damage or ‘nappy rash’.
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Having a damaged spinal cord or being unable to feel pain over part or all of your body.
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Having medical equipment can cause pressure/friction damage, e.g., oxygen tubing, oxygen masks, urinary catheters, wheelchairs, plaster casts, gastrostomy tubes and saturation probes.
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Having circulatory or respiratory conditions that affect blood flow.
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Currently having a pressure ulcer or having had previous pressure ulcers.
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Taking strong pain medicine as these may hide early warning signs of pressure ulcers and may also make you feel sleepy and therefore less likely to change your position.
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Being very poorly or having surgery.
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Having a high temperature for a long time.
What are the warning signs?
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Pain or soreness over bony areas or under or by medical equipment/tubes.
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Red patches on fair-skinned children.
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Purple / bluish patches on dark-skinned children.
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Your skin in one area may feel hotter or cooler, firm, or soft and /or look shiny.
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Blisters or cracks or what look like grazes may form.
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Areas may become hard or swollen which may be painful.
Pressure ulcers can vary from an area of unbroken skin with a change of skin tone/colour through to a wound that goes through all the skin layers to the bone. They can form quickly in a few hours but some may take longer to show.
What can I do to stop getting a pressure ulcer?
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Check your skin or ask someone else to look for the early warning signs and tell us if you notice any changes.
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Keep moving, moving to a new position at least every 2 to 4 hours will mean the pressure from the bed/ chair will not keep pressing in the same place on your body. Try not to drag yourself up the bed/ chair as this can cause friction on your skin. Avoid lying on any tubing or wires.
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Use the special mattresses/ cushions we give you, if your nurse thinks that you are at risk of a pressure ulcer, they will get you a special mattress and /or cushion for your chair.
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Keep your skin dry and clean, moist skin is more at risk of pressure, so if you are not able to get to the toilet to wee or poo, it is important to tell your nurse so that they can support you to keep your skin clean and dry.
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Eat healthily and drink lots, eating a range of foods including vegetables, fruits and food rich in protein (eggs, cheese, meat, fish, milk, lentils, beans) and drinking lots of fluids, especially water, will help to keep your body and skin healthy.
What if I get a pressure ulcer?
Sometimes, despite doing everything we can, pressure damage can still happen. Your nurse may help your pressure ulcer to heal by:
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Asking you to sleep on a different mattress and sit on an air/ foam cushion to lessen the pressure on your body. You will be asked to try not to lie or sit on the ulcer.
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Using a barrier cream or film which is rubbed over the ulcer as well as the rest of your skin in this area to prevent further damage.
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Changing your nappy or pad more often, if you wear one, especially if you have diarrhoea.
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Use dressings which are placed over your pressure ulcer to help you to heal your ulcer and stop it from getting an infection. It is important to leave the dressings in place so they can protect your ulcer.
Further help
If your nurse thinks that other people may be able to help you, they may refer you to:
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A dietitian.
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A physiotherapist or an occupational therapist.
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Wheelchair services if you use a wheelchair.
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Your GP practice nurse, once you go home, to carry on the dressing changes or you may have a visit from the community nurses.
If you have an ulcer and have not seen a practice nurse or a district nurse for your dressing changes, please ask your parent or carer to phone your doctors’ surgery and make an appointment for you to be seen.
If you would like more information, please ask your nurse or visit these helpful websites:
https://www.publichealth.hscni.net/publications/pressure-ulcer-prevention-children
Public Health Agency pressure ulcer advice booklets in different languages.
https://www.gosh.nhs.uk/conditions-and-treatments/procedures-and-treatments/treating-and-reducing-risk-pressure-ulcers-after-leaving-hospital/ Great Ormond Street Hospital advice on pressure ulcer prevention at home.
A range of videos based around the topic of pressure ulcers including top 10 tips for prevention, the importance of healthy eating, the importance of movement and how to prevent pressure ulcers when you have a cast.
Pressure Ulcer | National Wound Care Strategy Programme
The national website supported by NHS England offering advice on pressure ulcers, prevention and wound care for patients and carers.
