Can my child get stitches at urgent care?

The short answer is “Yes.” Still, there’s far more to know: Does your child really need stitches? Will every urgent care center suture children? Can your pediatrician suture your child in their office? And, how much will it cost? Here’s all the information you need.

How do I know if my child needs stitches?

Several aspects of a laceration justify stitches or other methods of closing a wound, like adhesives or surgical tape. Generally, a cut requires professional attention if it:

  • Continues to bleed or does not close
  • Is longer than 0.5 inches (1.2 centimeters)
  • Is on the face and longer than 0.25 inches (0.6 centimeters)
  • Is deep enough to expose underlying tissues
  • Resulted from a bite
  • Was caused by deep penetration of a foreign object (Do not attempt to remove any foreign objects)
  • Is on or near the genitalia

If you plan to bring your child to urgent care or an emergency department for stitches, avoid giving them food or drink beforehand, in case sedation is necessary. If a wound continues to bleed, apply direct pressure to the area and elevate it.

What’s the Purpose of Stitches?

Stitches stop bleeding, reduce the potential for infection, and minimize scarring.

Known as sutures in the medical community, stitches are a regular procedure at pediatric urgent care and emergency departments. According to one study, skin lacerations account for as many as 11% of all emergency department visits. Most cuts measure less than 0.80 inches (2 centimeters) in length, and only a small fraction require the attention of a surgeon.

The tissue layers of the human body are, from exterior to interior, the epidermis, dermis, subcutaneous tissue, and deep fascia. The epidermis and dermis comprise the skin, and the two layers are bound closely together. With the exception of very deep lacerations, sutures most often hold together layers of the epidermis and dermis.

When suturing, physicians use as few stitches as possible—but as many as necessary—to close the skin and approximate its previous line, while minimizing skin tension. Minimizing skin tension plays an important role in the final cosmetic outcome. In some cases, absorbable or subcutaneous sutures may be placed below the outer layer to limit strain on the epidermis and further reduce scarring.

The optimal time interval from injury to laceration repair is somewhat vague. Non-contaminated wounds may be successfully closed up to 8–12 hours post-injury. Clean lacerations on the face and scalp can often be successfully closed 12–18 hours post-injury. After that time, the risk of infection outweighs the cosmetic benefit of stitches. The time limit does not apply to wounds that remain open.

Typically, stitches are removed within 4–21 days:

Face 4–5 days Scalp 7–10 days Neck 7 days
Chest/Abodmen/Back 10–14 days Arms 7–10 days Hands/Feet 10–14 days
Legs 10–14 days Palms/Soles 14–21 days Overlaying a Joint 14–21 days

The process of removal varies based on the type of sutures used; some stitches dissolve on their own.
(There is no additional fee to have the stitches or skin staples removed at KidMed.)

Wounds continue to heal for 6–12 months before taking their final appearance. Children under 15 have been shown to have lower infection rates and improved cosmetic outcomes, although the common locations of pediatric injuries may be a factor.

Head and neck wounds account for an estimated 60–81% of all pediatric lacerations. Some 30% occur on the scalp, while 51% of lacerations are to the face, mostly the forehead and chin—predictable spots of injury during a fall. Finger lacerations are another common pediatric injury, typically the result of a hand getting caught in a door.

While bite wounds require additional monitoring due to risk of infection, medical literature does not suggest antibiotic prophylaxis unless a child is known to have a compromised immune system.

Factors that Influence the Success of Stitches for Children

So what leads to a successful outcome? It’s far more than the person administering the stitches, especially in pediatrics.

Type of Injury

Not all wounds heal equally. Clean cuts from sharp objects leave less noticeable scars and are less likely to cause infection. Sutures to repair tension injuries caused by blunt objects, including crushing injuries, are more complex because of additional damage to underlying tissue and a higher rate of infection.

Location of Injury

Vertical lacerations on the forehead or cheek are known to cause more obvious scars, as are cuts to the edge of the lip. The difference in tissue type between lip and facial skin often leaves a small “step-off” shape at the transition point, called the vermillion border. Still, everyone heals differently.

Pediatric Experience

Most parents assume the primary determinant of successful suturing is the ability of the physician. While this plays a role, there are other critical factors, especially in pediatric care, when a patient’s calm and comfort are paramount.

This can be as simple as applying a topical anesthetic before injecting a more potent one or cleaning a wound. Yet the value of pediatric experience in suturing extends further. For older children, it may be taking the time to explain the process to lower fear and stress. Keeping a child calm is critical for effective suturing.

In the absence of expert pediatric care, medical staff may resort to less-reliable means of closing wounds—such as skin closure tape (Steri-Strips) or skin glue—because they cannot effectively manage the pre-procedure needs of pediatric patients. (Tape or glue can be effective and painless ways to close certain superficial wounds but should not replace sutures due to patient age or behavior.)

We work with parents to decide which technique is best for repairing their child’s laceration.  We discuss options for minimizing pain and discomfort during the procedure while doing everything possible to ensure the best outcome.

– Dr. Mark Flanzenbaum, KidMed

A Rhode Island Medical Journal study of general urgent care physicians revealed that many were uncomfortable or understaffed to perform procedures on uncooperative children. Successful pediatric suturing requires extensive bedside experience, access to a variety of soothing and restraining methods, and a range of sedation techniques.

Because one or all often are not present at general urgent care, some general urgent care physicians will send pediatric patients from their facility to a pediatric urgent care center or pediatric emergency department for stitches.

Suturing Experience

Experience treating a specific patient and wound type is the most valuable asset for any medical professional suturing a wound. For non-complex wounds, suturing techniques do not vary from urgent care to emergency departments to plastic surgery centers—but experience suturing children does.

While surgeons are accustomed to patients under general anesthesia, urgent care and emergency department medical staff typically have far more experience suturing conscious patients.

If you have concerns about who will suture your child, ask about their specific experience suturing conscious children. A facility type or medical specialty does not guarantee experience. A study of pediatric physicians found that during their three-year residency, they performed a median of just 14 laceration repairs in the emergency department, as few as one per year.

We have years of expertise managing a wide range of pediatric lacerations. Understanding the full set of parental and patient needs decreases stress and plays an important role in successful wound treatment and healing.

– Dr. Mark Flanzenbaum, KidMed

The only wounds likely to require surgical consultation are exceptionally deep wounds affecting nerves, arteries, bones, or joints, and certain wounds to the eyelid, lip, or ear. Most primary care pediatricians do not suture children—or perform any invasive procedures—in their office.

The Cost of Stitches

A 2013 report by The New York Times estimated that each stitch at an emergency department costs roughly $500. The article included profiles of a man billed $3,355.96 for five stiches on his finger, and a woman whose bill for three stitches reached $2,229.11. In comparison, the total cost of stitches at urgent care typically ranges from $150 to $350, depending on the seriousness of the laceration.

Why are stitches so expensive in emergency departments? The answer is less about stitches and more about broader issues with medical inflation in hospital settings. Every hospital has a chargemaster, an a-la-carte price list for every procedure, pill, and person involved in care. (While those documents typically are not public record, California requires their disclosure and publication online.)

Chargemaster prices vary widely—and arbitrarily—from hospital to hospital, even within the same city. Facility fees, a primary factor in high emergency department costs, add a significant portion of the expense.

There are other causes, too. Basic components are priced far higher than their equivalent outside the hospital. Among several examples, The New York Times cited a $529 line item for “supplies and devices,” which consisted only of a gauze head wrap, available online for $1.

What to Do after Your Child Gets Stitches

All wounds should be monitored for infection, although infections occur in just 1.2–3% of all sutured wounds. Infection rates are slightly higher for bite wounds or long, complex lacerations.

Common signs of an infected wound include:

  • Patchy or streaking redness
  • Yellow or green pus
  • Increased swelling, tenderness, or pain
  • Fever

If sutures come out early and the wound has not closed, the wound should be reevaluated.

Common post-suture applications by parents include aloe vera gel, cocoa butter and topical or oral Vitamin E. None of these has been shown to have a long-term impact on healing or wound appearance, although none have a negative impact.

There has been shown to be some benefit to the application of silicone based scar gels plus sunblock when used regularly for 6-12 months following wound repair.

 

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Comments

  1. Wow that was odd. I just wrote an very long comment but after I clicked submit my comment didn’t appear. Grrrr… well I’m not writing all that over again. Anyhow, just wanted to say fantastic blog!

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