Kids can’t help but get into just about anything, whether that means climbing trees, jumping from the top step of a staircase, or flinging themselves off of furniture. 


Of course, with all of this activity comes the risk of injury. Here at Carolina Kids Pediatrics in Raleigh, NC, we know that bumps and bruises are a part of life, but our pediatricians also want parents to be able to avoid those scary emergency room visits. There are over 8 million pediatric ER visits annually for accidents and injuries – the good news is, most of these can be treated without ever needing to go to an ER. 


Here at Carolina Kids Pediatrics, our team of pediatricians provides both acute injury care and suturing, so you usually don’t have to rush your child to the nearest ER.


Most wounds can be treated by holding pressure to stop bleeding, properly washing with soap and water, and then bandaging at home. However, it’s important to know when a cut might require the attention in our Raleigh office.


You should bring your child in for care right away if a cut:
·Looks deep or very wide
·Has debris in it
·Is becoming increasingly red and swollen
·Is more than a half-inch long
·Bleeds through a bandage
·Still bleeds after 5-10 minutes of applying pressure


If you decide that your child’s cut needs to be looked at, our pediatric docs can usually take care of this problem and provide wound care and suturing. If in doubt, you can always give us a call and find out whether your child’s injury warrants a trip to our office for care.


Bruises are most common in children once they start standing and walking. Wrap ice in a towel, and apply briefly (a minute on, a minute off). While bruises may be tender to the touch, it’s important to see your pediatricians if the bruise is causing serious pain.


What are the options available nowadays for closing a small cut?

• Skin glue was approved for use in 1998 and has become popular. It is applied by rubbing it over the cut while the cut is being held closed. It’s a good choice for straight cuts and is quick and painless. However, it cannot be used to close a wound that has any tension on it from muscle usage. This is because skin glue is not as strong as stitches and, when used in areas of tension, the risk of the cut reopening is high. It also should not be used on wounds that are likely to ooze or bleed – this will cause a bubble under the glue and can disrupt the wound closure. 
• Steri-strips (or "butterfly" bandage closures) are narrow adhesive strips placed over a cut, with a bit of tension to keep it closed. They are used for small cuts that are not very deep or over a joint or areas of tension. If they stay in place for at least three days, the outcome can be just as good as stitches. However, they are not as strong as stitches and do not stay in place as well.
• Stitches provide more strength and less risk of being pulled off too soon. However, they can be traumatic due to the time and pain involved in putting them in. At Carolina Kids, we can utilize both numbing ointments and anesthetic injections before closing a wound with stitches. 
• Staples are most often used for cuts in the scalp behind the hair line.  They can be placed very quickly and close the cut almost as well as stitches.

How soon after an injury does your child need to see a doctor for stitches? 
 
Most cuts can generally be closed up to 18 hours after the injury. This means we might be able to stitch a minor cut that occurs in the evening during office hours the next morning – especially if it is not bleeding and has been appropriately cleaned and covered. Definitely give us a call if you think stitches might be needed, though. Some cuts, like cuts on the face or very deep cuts, should be closed sooner, but it is usually safe to wait at least 12 hours to have a cut closed. If you do decide to wait: clean the cut well, and don’t let it dry out. Wet some gauze pads and tape them over the cut. 
 
When should you be concerned about scarring from stitches?  
 
Facial cuts in children usually heal remarkably well and with very little scarring. Pediatric plastic surgeons recommend that most facial cuts be repaired using simple stitches. The suture size and needle type are specifically designed for the delicate skin of the face.
How can you make your child's scar less visible?
 
Although scars cannot be completely erased, there are some simple things you can do to help minimize them. 

• Sun protection. Damaged skin is susceptible to becoming permanently discolored by the sun for up to 6 months after an injury. It is important to minimize sun exposure to the healing cut. Keep it covered with a hat or clothing as much as possible or use a sunscreen to minimize darkening of the scar. However, do not apply sunscreen until two weeks after the cut.
• Scar massage. Scars may soften and flatten more quickly when they are massaged. Use your fingers to apply gentle pressure and massage the scar in circles – but don’t start doing this until the wound is well healed (after about 3 weeks). It’s usually helpful to use a moisturizer like Vaseline with scar massage – although there are scar-specific moisturizers available (like Mederma and Vitamin E-containing moisturizers), evidence is mixed about whether these are significantly better than just a bland lubricant like Vaseline.
• Silicone sheets or gels. Silicone products may help soften, flatten, and improve the coloration of a scar if used for at least 12 hours a day. You can get these products over the counter without a prescription – you can start using them about 3 weeks after the injury.

Concerned? Give us a call

If you are concerned about a child’s injury or fall, it’s important that you have a pediatrician who you can turn to for immediate care. Here at Carolina Kids Pediatrics in Raleigh, NC, it’s our policy to offer “work in” appointments for injuries that require urgent treatment whenever possible – so call us at (919) 881-9009 if that injury just seems like a bit more than a typical boo-boo.

If you are planning to breastfeed, the first few weeks of your baby’s life can be the most challenging.

Even if this is your first child, you’ve probably heard stories from other moms discussing the trials, tribulations and triumphs of breastfeeding. At Carolina Kids Pediatrics in Raleigh, NC, our pediatricians and our lactation consultant are here for you every step of the way to make breastfeeding more successful for you and your baby.

Latching Takes Time 

The chances of a successful latch increase if you are able to attempt nursing in the first hour or so after a baby is born. Babies tend to be alert and readier to breastfeed during this first hour – afterward, they (and their exhausted parents) often fall asleep for the better part of the next 8-12 hours. Although it’s still important to wake babies to breastfeed during this time, it tends to be more challenging than during that first hour.

Remember that your milk does not come in for about 3 to 4 days after your baby is born – so when they are breastfeeding, they are getting only small amounts of colostrum (early milk) for those first few days. 

During this time, it’s less important how much a baby gets, and more important that they develop a deep latch – with the baby’s mouth wide open, their lips flanged apart, and the nipple in the back of their mouth – not between their gums. Support your baby’s head close to the breast – I often tell new moms that if you aren’t worried that the breast will suffocate your baby (no worries, it won’t!),  then your baby probably is not close enough to your breast. If they back up, they will slip off and bite down on your nipple with their gums. Not only is this painful, it’s just not an effective way for your baby to express milk. 

Breastfeeding Happens Around the Clock 

Babies should be breastfeeding about every 2 to 2 ½ hours – or more often if they are asking for it – for the first few weeks. That time is measured from the beginning of one feeding to the beginning of the next – so, unfortunately, your break between feedings is usually even shorter than this. 

At first, they may only nurse for 5 or 10 minutes. That’s fine on the first day, but your baby should start to feed longer on the second and third day. Eventually, they may latch for 20-30 minutes on the first side, and a few minutes on the second. Once your milk comes in, your breast should soften with the feeding – and it’s always a good idea to empty the first side before switching. The last part of the milk feeding (the hindmilk) is higher in fat and calories, so it’s important to empty the first breast before offering a baby the second side. 

Babies can lose up to 7 to 10% of their birth weight before your milk comes in. Once your milk comes in, your baby should gain close to an ounce a day. They should also be more content after nursing; their stools should change from dark to light yellow and loose - sometimes 8 to 12 stools a day or more (you’ll never look at mustard the same way again!). 

Remember that at Carolina Kids we have a lactation consultant, Jerrianne Webb, working in our office. She is happy to meet with patients for in-depth lactation consults – or just answer your questions by phone.  If you are having trouble breastfeeding at any point don’t hesitate to talk to our pediatricians or our lactation consultant at Carolina Kids in Raleigh. Remember, successful breastfeeding takes all kinds of support - roadblocks can and do happen but we are here to help.

If you are looking for resources online, check out www.kellymom.com. You’ll find a wide range of information on breastfeeding, from the basics to more unique topics (like how to get through surgery or jury duty while breast feeding). 

Do you have questions about breastfeeding? Whatever you need, Carolina Kids Pediatrics in Raleigh, NC, is here to help. Call us today at (919) 881-9009 to schedule an appointment or to address your breastfeeding concerns with us.