10. Bruising, abrasions and lacerations: minor injuries in children I

Simon J Young, Peter L J Barnett and Ed A Oakley
Med J Aust 2005; 182 (11): 588-592.


  • Minor injuries in children (those that could reasonably be expected to heal with minimal medical intervention) are extremely common. The possibility of more serious injuries should be considered and excluded early.

  • Successful examination requires gaining the child’s trust, relieving pain early, and using a flexible and creative examination technique.

  • Bruising may suggest a more serious underlying injury, or the bruising pattern may indicate non-accidental injury or a bleeding disorder.

  • Superficial abrasions and lacerations can be safely cleaned with good quality water, and all foreign material should be removed. Deeper wounds with suspected damage to nerves, tendons or circulation need formal exploration under a general anaesthetic.

  • Good local anaesthesia can be produced by topical preparations, and many wounds can be closed with tissue adhesives with an excellent cosmetic result.

  • Antibiotics should be prescribed for specific circumstances, such as wounds with extensive contamination or tissue damage, and all children with injuries should be checked for adequate tetanus cover for prophylaxis.

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  • Simon J Young1
  • Peter L J Barnett2
  • Ed A Oakley3

  • Department of Emergency Medicine, Royal Children’s Hospital, Parkville, VIC.



This article is based on the clinical practice guidelines of the Royal Children’s Hospital, Melbourne. These are readily available on the internet at . We would like to acknowledge all the past and present staff of this hospital who have contributed to these guidelines, and thus assisted with this article.

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  • 3. McKenzie I, Gaukroger PB, Ragg P, Brown TCK. Manual of acute pain management in children. New York: Churchill Livingston, 1997.
  • 4. Luhmann JD, Kennedy RM, Porter FL, et al. A randomized clinical trial of continuous-flow nitrous oxide and midazolam for sedation of young children during laceration repair. Ann Emerg Med 2001; 37: 20-27.
  • 5. Ferguson C. Topical anaesthetic versus lidocaine infiltration to allow skin closure in children. Available at: (accessed Mar 2005).
  • 6. Zempsky WT, Karasic RB. EMLA versus TAC for topical anesthesia of extremity wounds in children. Ann Emerg Med 1997; 30: 163-166.
  • 7. Bush S. Topical anaesthesia use in the management of children’s lacerations, a postal survey. J Accid Emerg Med 2000; 17: 310-311.
  • 8. Thompson S. Tap water is an adequate cleansant for minor wounds. Available at: (accessed Mar 2005).
  • 9. Farion K, Osmond MH, Hartling L, et al. Tissue adhesives for traumatic lacerations in children and adults. Cochrane Database Syst Rev 2001; (4): CD003326.
  • 10. Therapeutic guidelines: antibiotic. Version 12. Melbourne: Therapeutic Guidelines, 2003.
  • 11. The Australian immunisation handbook. 8th ed. Canberra: Australian Government Department of Health and Ageing, 2003. Available at: (accessed May 2005).
  • 12. National Health and Medical Research Council. How to use the evidence: assessment and application of scientific evidence. Handbook series on preparing clinical practice guidelines. Table 1.3: Designation of levels of evidence. Canberra: NHMRC, February 2000: 8. Available at: (accessed Mar 2005).


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