Pressure ulcers: Helping to prevent pressure ulcers for children

What is a pressure ulcer?

A pressure ulcer is an area of damaged skin caused by pressure or shearing: it may also be known as a ‘bedsore’.

Pressure ulcers can develop by sitting or lying in one position for too long without moving, or from any medical devices you/your child may be using. There are a few examples on the images in this leaflet.

If there is pressure to an area, blood cannot circulate causing a lack of oxygen and nutrition to the skin. If the pressure continues, then damage can occur very quickly.

If the skin changes colour, feels hard, if a warm area develops or if there is a loss of feeling or pain in an area, this may be a sign that a pressure ulcer is developing.

If you / your child don’t move, or are unable to move, or have reduced sensation you / your family member may develop changes to  skin such as a red or purple area which can become sore, patches that have become very hard, patches that are soft or boggy or patches that are darker than they may usually be.

Early signs of a pressure ulcer

Redness, discomfort, pain, patches of hard skin, blue/purple patches, blisters or visible skin damage or areas that are cool or hot. 

Report any skin changes immediately to your carer or health care professional who can advise on pressure area care.  

Where are pressure ulcers most likely to develop?

Usually on the parts of the body which take your weight and where the bone is close to the surface, for example your heels, bottom, or in very young babies the back of the head. They can take a long time to heal and are painful. Sometimes they get infected. It is much better to stop this from happening. 

A pressure ulcer can develop in only a few hours. If a pressure ulcer isnt treated quickly it can develop into an open blister and over a period of time; into a deep hole in the flesh. 

Please record any questions or concerns in the space below to discuss with your health or care professional

Patient/Carer comments

If you only have a one off healthcare professional visit you will be provided with the information you need, in the form of this leaflet and a discussion about how you can help yourself / your child to prevent pressure ulcers. It would be beneficial to share this leaflet with your family members or anyone who has any input into your care, to raise awareness of how to prevent pressure ulcers occurring.

Equipment that can help prevent pressure ulcers

Your plan of care may include specialist equipment such as:

• An special bed – Do not use your heels to push yourself up to the bed. It is advised that you lift your heels before changing the position of the bed. If you don’t it can cause skin damage.
• Special mattress – This may be filled with air or made of a special foam to relieve or redistribute pressure.
• Cushions – These would redistribute pressure while you are sitting in a chair.
• Slide sheets – These will be used to help change your position.

Your healthcare professional / carer may also use things to keep the pressure off your / your child's heels to stop them from getting sore. This is referred to as offloading. It can be done with equipment such as specially designed boots or simply with pillows. These will be discussed with you / your child and you will be shown what to do with them.

Some of the areas most at risk are shown below. 

Be aware that some essential devices can cause pressure damage. Check clothing i.e rivets, seams, zips and buttons as these can also cause skin damage.              

Implications of having a pressure ulcer:

People who have had a pressure ulcer describe them as something that;

• Was “embarrassing and smelly, got infected and stopped me doing what I wanted to do”
• “Made me feel like a burden, really unwell and stopped me going to out or having a social life”
• Was “painful, caused broken sleep and even stopped me sleeping at all”

Pressure ulcers can take a long time to heal and could mean you have to stay in bed for a very long time.

Ways to prevent a pressure ulcer

A good way to remember this is aSSKINg. This stands for;

• A risk assessment – will be completed. If you are at risk a care plan appropriate to your / your relative’s needs will be made with you.
• Skin Inspection – Check your / your relative’s skin as often as you can. Tell someone if you / your relative feels sore or uncomfortable, particularly if this is on a bony area. If you are unable to feel if you are getting sore, try to move more often. If you have any contracted limbs it’s important that they are checked. Do not rub skin as this can remove the top layer causing damage.
• Surface – If you / your relative are being assessed as being at risk of developing pressure ulcers special equipment may be offered which can help to prevent a pressure ulcer occurring. It is also very important that your chair is the right height and width for you, to prevent you sliding as this can damage your skin.
• Keep moving – This is very important. Stand or walk as much as possible, of if in bed try to roll onto alternate sides as often as you can or as discussed with your health professional. Keep moving as much as you can. If you can walk around please ensure that your footwear fits correctly to prevent skin damage. If you / your relative are assessed as being at high risk of developing a pressure ulcer and choose not keep moving, this can lead to the development of very severe damage that can put you at risk of very serious infections.
• Incontinence – It is important to deal with any continence concerns as these can damage your / your relative’s skin and increase the risk of pressure ulcers. If you/ your relative develop sore or chapped skin, let your health professional or carer know. A barrier cream to protect skin and washing with a mild non-perfumed cleanser may be recommended by your healthcare professional.
• Nutrition – Plays a very important role in preventing pressure ulcers. Nutritional needs will be discussed with you/ your relative and advice given on how to help ensure that you / your relative are eating and drinking adequately.
• Give information – It is important that you/ your relative understand the information given to you. If you/ your relative are unclear please speak to your health care professional or carer.

Your healthcare professional or carer will

Look at your child's skin in line with the plan of care agreed with you. They may need to ask if they can look at intimate body parts of your body i.e. your bottom. They will ask your child to change your position, or if you are unable to, advise carers to assist you. This will be planned with you and your child.

Advice might include

• How to adjust your child's  sitting and lying position
• How often you need to move or be moved
• How to support your feet and elevate your heels
• Which equipment you should use and how to use it

Your care givers will be advised of the best way to assist your child to reposition. This will be discussed with you at each contact.

This information  has been adapted from a regional leaflet produced by the Cheshire and Merseyside Pressure Ulcer Steering Group. It only gives general information. Do not rely on this leaflet alone for information- please seek advice from a healthcare professional if you have any concerns about your skin.

This leaflet only gives general information. You must always discuss the individual treatment of your child with the appropriate member of staff. Do not rely on this leaflet alone for information about your child’s treatment. 

Confidentiality

‘The Trust’s vision is to keep your information safe in our hands.’ We promise to use your information fairly and legally, and in-line with local and national policies. You have a right to understand how your information is used and you can request a copy of the information we hold about you at any time.

For further information on confidentiality contact the Information Governance Team:

Information.Governance@ncic.nhs.uk | 01228 603961

Feedback

We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:

pals@ncic.nhs.uk | 01228 814008 or 01946 523818

If you would like to raise a complaint regarding your care, please contact the Complaints Department:

complaints@ncic.nhs.uk | 01228 936302