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Cuts, grazes and bruises

cut; blood; scrape; graze; bleeding; bacteria; bruise; antiseptic; injury; abrasion; contusion; laceration; tetanus; infection; rule; R.I.C.E.; scrape; gravel; rash; wound; scab; first; aid; RICE; groups; transfusion; type; rhesus; blood group ;

Children often injure themselves during play, and older children can be injured during sporting activities. While the body is very good at healing itself, cuts and grazes usually heal more quickly if simple first aid steps are followed.

Contents

Many people are concerned about the risks of infection if they help someone who is bleeding, but simple steps can be followed to minimise the risk.

We recommend that all parents, and all people who care for children, do a First Aid course provided by a recognised training organisation.

Grazes

  • Grazes (also called scrapes, abrasions, 'carpet burns' or 'gravel rash') are some of the most common injuries to skin, especially for children. They are very painful as they damage many nerve endings in the skin.
  • The top layers of the skin are scraped off and the broken skin surface is covered by many small bleeding spots where tiny blood vessels are broken.
  • Bleeding is not usually severe, since only small blood vessels are damaged.

What to do for grazes

  • Grazes hurt, so the child will need comforting.
  • Wash your hands before starting to treat the wound, as the damage has broken the body's first defence against infection (the skin), and grazes can become infected.
    washing hands
  • If there may be a risk to you of catching a blood borne infection, follow the steps in the section below on Blood risks.
  • Stopping bleeding is not usually a problem with grazes, but if there is ongoing bleeding, apply pressure with a clean dressing - either a sterile dressing from a first aid kit, or a clean cloth (an ironed one is good as ironing kills germs). If these are not available, clean paper tissues can be used.
  • Many grazes will contain dirt, small stones or other 'foreign' matter which can lead to infection if left.
    • Wash the injured area with soap and clean water.
    • An antiseptic is usually not needed, but could be useful if clean water is not available. Check the label for how to use the antiseptic, as many types should be diluted (mixed with water).
  • If the dirt cannot be removed by gentle washing of the wound:
    • Cover the wound with a clean non-adherent (non-stick) dressing. Ones made for burns are very good.
    • Seek treatment from a doctor or health worker.
  • If the wound seems clean, it can be left to heal without any other treatment, but many grazes will hurt less if they are covered for at least the first 24 hours.
  • Some people prefer to apply an antiseptic cream or lotion (do not use one containing alcohol) and cover the wound with a sterile non-adherent dressing.
  • If the wound is small an adhesive dressing strip often works well, and many different dressings are available for larger ones.
    • Dressings made for burns are often very good.
    • Avoid dressings that might stick to the wound, as getting them off is painful.
  • Young children often need an adhesive dressing strip even if the wound is tiny. They seem to find uncovered sores upsetting, and an adhesive dressing strip may reassure them.
  • After a few hours a pinkish, yellow crust forms on the surface as the first stage of the healing process.
    • Do not remove the crust as it is a sterile (germ free) protective layer which helps healing. 
  • After the crust forms and hardens, the graze will usually heal most quickly if left open to the air and kept dry. But leave a dressing on if the child is likely to pick at the crust, or if another injury is likely (knees can easily be scraped again).
  • How long the crusts (or 'scabs') take to fall off depends on how deep the graze is. It is best to leave them alone, to fall off by themselves.

Healing sores are itchy, and most young children (and many older ones) will find scratching hard to resist. Cover the sore if needed, but also make sure hands are washed thoroughly and often, so that if they do touch the scab it will be with clean hands. Cutting finger nails short can also help.

Infected wounds

  • Any wound breaks the skin barrier against infection, and germs can get in.
  • A wound that has not started to heal within 2 days could be infected. Infections may spread to the area around the wound, and sometimes to the whole body.
  • Signs that the wound may be infected include:
    • increasing pain and tenderness
    • swelling and redness around the wound
    • increasing heat in the wound and surrounding tissues
    • pus seeping out of the wound
    • a streak of redness spreading up from the wound (if it is on an arm or leg)
    • tenderness in the groin or armpit from infected lymph glands
    • fever and feeling unwell.
  • While many infected wounds can heal without treatment (the body's immune system may be able to fight the infection), usually by the time the person starts to feel unwell and have a fever, antibiotics would be advisable. See your doctor or health worker for advice.

Cuts

  • Because cuts go through deeper tissues, larger blood vessels can be damaged, causing a lot more bleeding than grazes. Cuts on the head are likely to bleed a lot.
  • To control bleeding, apply pressure to the cut area with a clean cloth.
    • If a cloth is not available, use fingers to press onto the wound. If possible, get the person who is bleeding to apply this pressure or use a barriers such as latex gloves (or plastic bag) to protect your hands, because of the risk of getting a blood-borne infection (see 'Blood risks' below). 
    • Raising the injured part will slow down blood flow and help control the bleeding.
      cover cuts or scratches    wear disposable latex gloves
  • Do not use a tourniquet (a tight bandage which stops blood flow to an area) because a tourniquet can lead to a lot of damage to the rest of the limb.
  • If the bleeding does not stop within a couple of minutes, or if the blood is spurting out (which usually means a large blood vessel has been cut), seek medical treatment urgently, but go on applying pressure while waiting for help to arrive.
  • For a cut to heal well it needs to be clean (no dirt, glass etc in it) and the two sides need to be close together. Some cuts gape open if they are large or if they are on a part of the body where the skin is tight, such as the knee or the scalp. Large cuts and cuts that gape open usually heal more quickly if the edges are held together by special dressings, special glue or stitches.
  • Seek medical help if:
    • the wound is not clean
    • the cut is large (more than about a centimetre long)
    • the cut gapes open
    • bleeding does not stop quickly
    • the cut might leave an unsightly scar (eg on the face, especially around the eye)
    • you are not sure what is the best thing to do.
  • Small clean cuts (such as paper cuts on the fingers) usually heal well without special treatment if they are kept clean and dry.
  • A waterproof dressing could be applied if the cut area may get damp, or if the cut was acquired during sport, when 'The Blood Rule' may be applied (see the The blood rule below).

Tetanus

  • Any cut, or even a small wound, such as a prick from a rose thorn, can become infected with the bacteria (germs) that cause tetanus.
  • Make sure that tetanus immunisation is up to date. If the person has not had the full number of tetanus injections, or if it is longer than 5 years since the last one, extra treatment may be needed. (See Immunisation and Tetanus for more information).

Blood risks

Some infections can be passed from one person to another if blood from the first person:

  • contains live germs (eg it is fresh blood and contains germs, such as the viruses causing hepatitis B, hepatitis C, or AIDS (Human Immunodeficiency Virus))
  • gets onto skin or mucosa (the lining inside parts of the body such as the mouth, vagina or rectum) of another person
  • and the skin or mucosa of the other person is damaged (eg with a cut or graze), allowing the germs to pass into the blood.

Some ways to reduce the likelihood of germs being passed on:

  • Get the person who is wounded to manage the wound treatment if possible (eg if it is a cut on a finger, get the person to apply pressure to stop the bleeding and wash the blood off).
  • If another person needs to help, use a barrier, such as latex gloves, to stop blood getting onto their own skin. Plastic cling film or plastic bags are not ideal, but are better than nothing if gloves are not available.
  • Apply a waterproof dressing.
  • Wash off all blood from the skin with soap and water as soon as possible and wash your hands even if you used gloves.
  • Wash blood out of clothing (using cold water).
  • Dispose of blood stained cloths, dressings etc into a plastic bag which can then be placed into a bin which has a lid.
    put blood-stained laundry in sealed plastic bags    discard blood-stained material

Note: dried blood has a very low risk of passing on any infection. Once the blood is dried no special precautions are usually needed. However, people generally prefer not to have to handle blood stained cloths even when dry, so wrap them up!
It is important to be careful, but not too concerned about the risk of blood-borne infections.

  • For example, if the person with the wound is your own child, who you know does not have any of these infections, precautions such as those described above do not all have to be followed.
  • But it is still important to wash off all blood and apply a waterproof dressing if your child is playing with others, as your child's skin barrier has been damaged.
  • Precautions (special care) such as using latex gloves are recommended for people providing first aid, as the health status of the person with the injury is often not known to them.

The blood rule

Most sports have adopted a 'rule' which must be followed if a player is wounded during a game, because of concerns about spread of blood-borne infections. The rule is often similar to this:

'A player who is bleeding or who has blood on himself or his uniform is required to leave the ground, at the request of the umpire and have the problem seen to.

The player will not be allowed to return until the bleeding has ceased and any blood has been completely removed. This player can be inter-changed off the ground, or the umpire can call a halt to play while the player is seen to.'
As well as removing all blood, a waterproof dressing should be applied, so that if bleeding starts again blood cannot get onto any other player.

Note: if the injury is serious, it would be best for the player not to return to the game. The health of the injured player should come first.
You could look at 'Blood rules, OK' by Sports Medicine Australia to learn more.

Bruises

  • Bruises are caused by banging against something or being hit by something (for example being hit by a ball), or being squeezed hard (for example when a finger is caught in a car door).
  • The skin, fat layer and muscles are damaged. The most obvious damage is bleeding under the skin from many small broken blood vessels, which first causes swelling at the site of the bruise, then a change in colour.
  • Pain is caused by direct damage to nerve endings, and also by the effects of the contents of damaged cells leaking into the tissue around them.
  • The blood which leaks out of blood vessels needs to be broken down into molecules (small particles) which can be carried away from the site of the injury and got rid of through the kidneys. The colour changes (red, blue, then yellow-green) occur as the haemoglobin molecules (from the red blood cells) are broken down and carried away.

What to do for bruising

As soon as the injury occurs, try to stop further bleeding and swelling by following the steps known as R.I.C.E.

R Rest the injured part.
I Ice or cold pack on the bruise. Make sure that ice does not go directly onto skin by placing a damp cloth around the ice.
C Compression bandaging - wrap a bandage firmly round the area. If the bandage causes any pain it is too tight.
E Elevate the injured part.

Depending on how bad the bruise is, rest may need to be continued for several days, and it may also be recommended that ice be applied at regular intervals for up to 3 days. Do not apply heat for at least 24 hours (often longer) as heat dilates blood vessels (makes then wider), and damaged blood vessels may start oozing blood again.
After a day or so, gentle heat and massage may help the swelling go away, but do not do anything which is painful.

More about blood

  • There is a topic on the Kid's Health part of this site which has more information about what blood does, blood groups and blood transfusions: Blood.
  • There is much more information about what blood does and diseases of blood in the Nemour's Foundation Kidshealth site topic Blood.
  • The Better Health Channel (Victoria) has a topic  Blood groups.

Resources

Australia

St John Ambulance Australia

  • for training and first aid courses
  • first aid quick reference sheets
  • St John Book: 'Australian First Aid - 4th Edition 2009' - listed on Publications page 
    http://www.stjohn.org.au/

Red Cross Australia

Reference

Sports Medicine Australia 'Blood rules, OK' 
http://sma.org.au/wp-content/uploads/2009/10/Blood_rulesOK-pamphlet.pdf 

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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