Does your child need sutures? A Step-By-Step Guide
As a pediatrician who has seen countless cuts, scrapes, and tears, I understand the anxiety that sets in when your child has a bleeding wound. That moment of "Do we need to go to the ER or Urgent Care?" can be overwhelming, especially when your little one is upset and bleeding. Today, I want to walk you through when stitches might be necessary and what to expect during the treatment process.
When to Consider Stitches
Not every cut requires medical attention, but certain signs indicate your child may need stitches:
Deep wounds that expose fat, muscle, or bone
Cuts longer than 1-2 centimeters (about ½ to ¾ inch)
Wounds on areas with constant movement (like joints)
Cuts on the face, lips, or other cosmetically sensitive areas
Wounds that continue bleeding after 15 minutes of direct pressure
Jagged, gaping edges that don't stay together when relaxed
Injuries from dirty or rusty objects that increase infection risk
First Steps at Home
Before heading to medical care, take these immediate steps:
Apply direct pressure with a clean cloth for 15 minutes
Rinse the wound gently with cool, clean water (no soap directly in the wound)
If bleeding continues after pressure, elevate the area above heart level
Do not apply alcohol, hydrogen peroxide, or antibiotic ointment before seeing a doctor
What to Expect at the Doctor's Office or ER
Initial Assessment
When you arrive, medical staff will evaluate:
How the injury occurred
The wound's location, depth, and size
How much time has passed since the injury
Your child's tetanus vaccination status
Any allergies or medical conditions
Pain Management Options
Your child's comfort is a priority, and several options may be used:
Topical Anesthetics (LET) LET (Lidocaine-Epinephrine-Tetracaine) gel is often the first step. This numbing gel is applied directly to the wound and covered with a dressing for about 30 minutes. It dramatically reduces the pain of later injections and procedures.
Injectable Local Anesthesia After the LET gel has taken effect, your doctor may inject a local anesthetic around the wound. While the thought of a needle sounds scary, remember that the area is already numbed from the gel, making this much more comfortable than you might expect.
Distraction Techniques Medical staff often use age-appropriate distraction—tablets, videos, or conversation—to help your child cope with anxiety and discomfort.
Wound Cleaning
Thorough cleaning is essential to prevent infection. The doctor will:
Irrigate the wound with sterile saline solution
Remove any debris or foreign material
Possibly use a surgical scrub solution around (not in) the wound
Imaging (If Needed)
Sometimes additional tests are necessary:
X-rays if there's concern about foreign bodies like glass or metal
Ultrasound may be used for soft tissue evaluation
These are typically done only when there's suspicion of embedded objects or underlying damage
Closure Options
Depending on the wound characteristics, your doctor may use:
Traditional Sutures (Stitches) These are strong threads that hold the edges of the skin together. The number of stitches depends on the wound size.
Staples Sometimes used for straight lacerations on the scalp or other areas where cosmetic outcome is less critical.
Dermal Adhesive (Skin Glue) For smaller, clean cuts with straight edges. This glue seals the wound without needles and dissolves on its own.
Steri-Strips These thin adhesive strips can close minor cuts and may be used alone or to reinforce other closure methods.
Specialist Referral
In certain situations, your child may be referred to a specialist:
Wounds involving tendons, nerves, or deeper structures
Complex facial lacerations (especially around eyes, ears, or lips)
Hand injuries that may affect function
Animal bites with significant tissue damage
After-Care Instructions
Proper wound care at home is crucial for healing:
Keep the wound clean and dry for 24-48 hours
Gently wash around the wound with mild soap and water after this period
Apply antibiotic ointment if recommended by your doctor
Cover with a clean bandage and change daily
Watch for signs of infection:
Increasing redness or warmth
Swelling that gets worse after 48 hours
Yellow or green discharge
Fever
Increasing pain
Return for suture removal as directed (usually 5-10 days depending on location)
A Note on Scarring
All wounds leave some mark, but proper care minimizes scarring:
Protect healing wounds from sun exposure for at least 6 months
Consider silicone-based scar sheets for larger wounds after complete healing
Be patient—scars fade significantly over the first year
When to Call the Doctor
Contact your healthcare provider if you notice:
Signs of infection (as listed above)
Wound edges separating
Continued pain despite over-the-counter pain relief
Any concerns about healing progress
and just remember…
Remember, seeking proper medical care for significant cuts not only prevents infection but also promotes optimal healing and minimizes scarring. While the experience might be stressful, modern pain management techniques make the process much more comfortable than many parents expect.
As always, I'm here to support you through these bumps and scrapes along the parenting journey!
Sending you a big hug,
Anjuli
Disclaimer: This blog post is for informational purposes only and should not replace the specific instructions provided by your child's surgeon or healthcare provider. Always follow the post-operative care instructions given by your medical team.