Your 5-year-old falls at the park again after attempting something insane, like jumping from the top of one picnic table to the other. He runs to you sobbing with his hand holding the side of his head, and all you can think is, “He knows better!” You interrupt your first adult conversation of the day to give him a hug only to see blood gushing out from between his fingers. After suppressing the urge to laugh hysterically, you switch to emergency mode, apply pressure, snag a piece of ice from another mom’s cooler, all the while making soothing sounds and saying, “You’re OK,” over and over.
Many parents have been there before, except for those rare creatures whose kids always make ‘good choices.’ For the rest of us, the next big question, after making sure he’ll live, is, “Do I really have to take him and my four other kids to the hospital and pay a $100 co-pay?”
This was me last Friday. Plus, my 3-month-old baby woke up because of all the shrieking and wanted to nurse. And my three other kids, 8 and under, were playing at the park and didn’t want to leave, “RIGHT NOW!”, and get in the car.
TIP : Find the closest urgent care clinics covered by your insurance before the next emergency. The co-pay is usually half what the ER costs. There’s no time to do this when the blood is gushing – I know! Make sure to give them a call and ask specifics: do they place stitches, have an x-ray machine, cast broken bones, and have a nebulizer or ‘breathing treatment’ machine? You don’t want to arrive, only to find out it’s a geriatric urgent care.
So, I’ll share my hard-won knowledge with this quick and practical ‘How-to’ guide on wounds and stitches:
- How many layers deep is the cut?
- How long is the cut and does it gape open?
- Are the edges clean or ragged?
- Are there possible serious complications?
- Where is the wound? (ie. Do you want a scar or not?)
If the cut goes through multiple layers of skin, it usually needs stitches to keep the wound edges in the right place while it is healing. Not to be gross, but if you can see something besides skin, like bone or yellow bits of fat, deep in the cut, then you should get stitches. In general, a cut more than a ¼ in. deep should get stitches.
The longer the cut, the more the wound edges can move around and heal ‘crooked’ or with bunched up areas of skin. Also, if it gapes open it will likely heal that way with a wider area of scar tissue. A good rule of thumb is to get stitches if it is over ¾ of an inch long.
A small cut by a kitchen knife is a great example of a cut that doesn’t need stitches. The straight edges of the wound will heal with almost no scar. An impact wound that has pulled the skin apart leaving ragged edges will have a hard time healing well. The ragged edges need to be trimmed smooth before stitching so they don’t bunch up while healing or die off providing a nice spot for an infection to take hold.
This may seem like a no-brainer, but if the wound is near anything important, you should get medical treatment. This would be anywhere with important nerves, like cuts to the face, hands and feet. Also cuts deep and close to joints should be stitched for two reasons: One, they are a pain to keep from opening up every time you bend the joint, and two, an infection that gets into a joint can be very serious. Plus, make sure you have an updated tetanus shot if there are any suspicious objects involved in causing the wound.
Ok, if you really don’t care what it’s going to look like afterwards, or you enjoy using the occasional scar as a conversation starter, then you really don’t need to get stitches for minor injuries. Your body will just fill in the area with scar tissue. Your main goal, in this case, is to clean the wound and keep it from getting infected.
If you decide to stay home (and save the copay)
- Start by cleaning the wound out well. Irrigate gently with lots of water and make sure to get any particles, rocks, slivers, etc., out of the wound.
- Put on an initial antibiotic treatment – ointment, first aid wash, etc.
- Apply any herbal wound remedies you like.
- Use a bandage to hold the wound closed in the way you want it to heal.
If you’re using a bandaid:
- Get a good quality one that will stay on well – the fabric ones seem to work best on my kids.
- Attach the bandaid to one side of the wound, pull the skin and wound closed, as straight as possible, and stick down on the other side.
- Start at one edge of the wound and work your way to the other (or the middle and work your way to the edges). Don’t be afraid to use plenty of bandaids. If you leave any of the wound gaping, it will heal that way. Try to keep the bandages protected and dry so they keep the wound edges together for at least the first 3 days or so. The less you disturb the wound, the less it will scar, and the more likely it will heal the way you bandaged it.
If you’re using ‘closure tape’ or ’steri-strips’, which you can order from medical supply stores:
(For those who have lots of crazy, ‘no-fear’ little boys, and want to plan ahead)
- Paint a bit of Benzoin Tincture on either side of the wound without getting it in the wound – think ‘glue stick’. You can buy this at the ‘old school’ pharmacies in most areas – call around. It really helps the closure tape stay stuck for days instead of hours, but you can do without it in a pinch.
- Ditto above: Apply the tape to one side and pull the wound closed as straight as possible and stick it to the other side. Continue until the entire wound is pulled together as straight as possible.
Good luck and if you’re curious to see how our picnic table adventure ended, see my next post on how to remove stitches.
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Great, thank for sharing your post, I learned alot from it.
I’m glad you liked it!
Wow it’s great to see you’re still applying your skills! Doesn’t mothering count as an honorary residency? I think of you often and wish we were still close by so we could harvest and cook things. I am ready for a wheat grinder and couldn’t remember which one you liked better for bulk work vs. every day milling…
My brother-in-law did something similar to using bandaids on my niece’s head injury. She’d fallen and hit the back of her head. Everything looked okay and scarring isn’t a huge issue since her hair would cover it up. Anyways, they took a bit of hair from above and below the cut and pulled it together with a smally ponytail holder. Then they did the same with the hair on either side of the cut. Then just pulled the rest of her hair up in a big ponytail around it. Worked great:)
Wow, Darrell – I’ll have to add hair to my list of ways to close a wound. Talk about some quick thinking! Especially since a head full of hair is impossible to place a bandage – which is why doctors usually shave the area. I bet very few have thought about leaving the hair unshaven and using it to pull the wound together. Tell your BIL he’s very clever. Thanks for the comment!
Thank you so much for your help…!!!! My mom fell this morning and hit her head on a sharp table edge.
The cut is a bit longer than two inches long and about 1 millimeter deep and two wide. It’s right on her hailine and goes up from there….now we kow that she definetly needs stiches!!!! On theway to Doc’s office.
thanks again!!! God Bless
Pierre,
Glad I could help – it’s why I enjoy sharing what I know.
I hope all goes well with the stitches!
Misty
Copay ??? We should be so lucky! (Can’t afford insurance…)
When my son needed four stitches after a playground fall, the hospital charged us $850 (!) Almost a month’s rent, after waiting an interminable time in ER. Without insurance, patients actually pay (a lot) more, because they’re paying “Retail” instead of the discounted rate given to the insurance companies. Yes, I think some (big) changes to the health care system are long overdue.
Don,
You’re right, the ER is outrageously expensive, especially if you don’t have insurance.
One idea: Urgent cares have tried to meet the need for minor emergencies without the cost of a fully equipped ER, but aren’t always available in every area. Many urgent cares can do stitches and/or X-rays for breaks, and they usually cost much less than the ER.
Take care,
Misty
My grandma to a tumble and cut the back of her head the bleeding was easy to stop and I also thought about stitches but she did not want to do that. So after cleaning it and apply antibiotic I pinned hair on each side of the wound to close it. I was just wondering if I had done the right thing when I found this blog. Seems some else also had the idea. I am going to watch the wound and see if this will work.
Jen
Since you’re usually not worried about a scar on the head under the hair, you would only need stitches for a serious wound that is bleeding a lot.
Using the hair is a great method. Remember that scalp stitches usually stay in 7-10 days, so try to keep the wound dry the first 2 days, and then be careful not to pull it open for the first week or so.
Your main concern would be infection. Watch for redness, puffiness, heated skin, and/or oozing puss. If you use an antibiotic cream/ointment, it’s generally a good idea to only use it for a few days when the wound is new, since overuse can also irritate and inflame a wound.
I hope she is doing better!
Misty
Thanks. I just did something stupid, and this helps me feel better about the decision I already made :0
dumb guy
LOL – Glad I could help – hope it turns out well!
Thanks! I just took a big cut on my finger, but after reading your blog, I have decided to tape it closed and continue with my day! Thanks for sharing
Glad I could help! I hope the finger gets better quickly – Been there, done that
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Thank you! I’m glad you enjoyed it.
Misty
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THank you so much for this. My 5 yr old hit the corner of the wall and has a small gash on his head. Now i know I can rest easily for not taking him to get stitches.
Glad to help – I hope he’s doing better soon. If it’s in the hair, you’ll probably never see the scar. Just keep an eye on it for redness, heat, and swelling, which would indicate an infection and don’t hesitate to bug your doctor if you get worried. I always recommend calling and talking to a nurse if you’re on the fence, because that’s usually free and can help you decide how serious something is. Good luck!
my son just hit his head on our fireplace, he has a pretty nasty cut on his forehead. i got it to stop bleeding after like 5 minutes. i have a bandaid on it now i am just wondering if i should get him stitches or not. he is only 18 months old. any ideas?
Hi Tom,
Sorry to hear about your son. My 2-year-old is also always climbing and into everything.
If the cut is really long or really deep you should consider stitches. If it’s no longer bleeding, your main consideration will be scarring.
If you decide not to have stitches, then remember that you want to get the edges of the wound fit together as best as you can to make the scar as small as possible.
Then make sure to keep it held together like that and keep it dry for 7 – 10 days. If it pops back open or gets wet, which can also soften and re-open the wound, you’ll likely increase the size of the scar and open it to infection. If you don’t have steri-strips or butterfly bandages, you can try taking a fabric bandage and cut the sticky part on either side of the pad into thin strips. Use these across the wound to hold the wound edges in place. Leave them on for the full week if possible. The less you disturb the sealing of the wound edges, the better. I would also put a small amount of antibiotic ointment on AFTER closing the wound with the small bandage strips so you don’t interfere with the strips adhering well. The ointment should be able to penetrate fine in the spaces between the bandage strips.
It’s always a good idea to consult your family doc if you’re at all worried.
Good luck,
Misty
i had a gaping laceration in my left hand that needed 10 stitches, it was horrible! i wasnt gonna go to the er but after reading your post, i’m glad i went!
Hi Sandra,
I’m glad the info helped you out. Hand injuries are really difficult. You want to make sure you don’t have any permanent damage. Plus, it’s no fun having to do everything one-handed for a while. I hope it all heals up well!!
Misty