Wounds and young children: Is there anything parents can do to minimize scarring?

October 16, 11:31 AMEarly Childhood Parenting ExaminerAngele Sionna

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Children get banged up during everyday play, it's a fact of life. But sometimes play turns too rough and kids get a wound that needs the care of a doctor - and stitches or Dermabond surgical glue.

Once it heals, a scar often remains. Is there anything you can do to try to erase the scar from their skin like the incident has left their memories?

"The younger the child, the more likely the scar will heal very nicely," says Dr. Louis DeLuca, a board-certified plastic surgeon who has extensive experience in caring for children who have sustained soft tissue injuries.
"As you may or may not know, fetal scar healing is a virtually scarless process suggesting some mechanism of young, immature cells to repair themselves without the degree of untoward scarring seen in teens and adults," Dr DeLuca added.

Dr Steven J. Pearlman, Past President of American Academy of Facial Plastic & Reconstructive Surgery, says that age and location of the scar can play a role in its complete healing:

Scars that are the least visible are along what are called resting skin tension lines (RSTL), these are the lines that become wrinkles when people get older. They are also very perpendicular to the minimal skin tension lines (MSTL), these are opposite the way that muscles pull. That way, as the muscle moves, it pulls along favorable scars and not across them that make them widen.
Also children have more active hormones that are stimulating growth. Many of these same principles work in wound healing. So wounds and subsequent scars have a more active process in children (faster new tiny blood vessel in-growth called neo-vasularization) making it look redder but actually heal faster.

Dr DeLuca adds, "An area such as the face has wonderful healing potential due to its excellent blood supply (a very important physiologic factor in wound healing) as well as the minimal tension in this area (a very important mechanical factor). An active child may place significant tension on a healing wound that can lead to a widened scar or possibly a thickened scar. Minimizing a child’s activity level is a fruitless endeavor. I find that modifying their activities is much more realistic. Keeping the wound clean and encouraging the child not to pull on the sutures is also important."
Here are some recommendations of things parents can do to minimize scaring:

• Massage the scar. "Massaging the scar is a modality thought to ‘break-up’ the scar tissue to allow the collagen fibers to heal in a more aligned fashion and minimize the chance of thickened scarring," Dr DeLuca says.
• Choose products with silicone. Dr DeLuca recommends any product applied to the scar contain some form of silicone. He says "silicone has been extensively studied in burn victims (who are at the highest risk for abnormal healing and thus poor scars) and has been show to decrease the risk of hypertrophic/keloid scars (very thick scars)." Dr Pearlman agrees. "The best products that make scars fade are topical silicone gel products such as Kelokote, ScarGuard and ScarFace (all name brand products), these do more than topical vitamins. They create a barrier and keep gentle pressure on new scars that reduce their size and enhance healing."
• Vitamin E: another option. Dr DeLuca says it "plays some role in wound healing and can also be beneficial in a scar treatment product."
• Use sunscreen. "It is imperative that a healing scar be covered with sunscreen to minimize exposure to UV light. Healing scars are prone to hyperpigmentation (becoming darker than the surrounding skin) for up to one year following the injury," Dr DeLuca says.

So how soon do you need to apply these products for them to be affective? Can they be skipped altogether? "In reality for most well sutured or healing scars and wounds, these aren’t really necessary and the eventual result in a year will be the same," says Dr Pearlman. "If the patient has a history of poor scarring or keloid scars then these should be started as soon as the wound is clean and all scabbing is gone. Starting later can still help. But scars heal and re-model for 6 months to a year so to be really effective these products need to be used for a minimum of 6 months."