Scar Management for Children

Energetic, curious, and uncoordinated, children are often an amusing joy to watch as they play and explore the world around them. Unfortunately, this combination, mixed with their lack of hazard awareness, means that they are frequently having falls and touching things they shouldn’t, resulting in injuries.

These injuries are usually always unexpected accidents that happen during normal day-to-day activities. Whether it be tripping over a toy, bumping into a hot beverage, or falling off a piece of furniture, scratches, burns, and other skin abrasions can vary from minor to severe.

As caregivers, we are constantly seeking to protect our little ones. Although we can’t always keep them safe against unforeseen injuries, we can take precautions to manage the repercussions and scarring.

Scars can have lasting effects on people, especially children, so it is important to understand what we can do to minimise our child’s scarring. Although some adults may perceive scars as a badge of honour, children often struggle if they feel different to other kids, which can be damaging to their self-esteem. Physiological scarring can also limit a child’s mobility and can cause extreme discomfort and sometimes pain. Additionally, scars may even become a visual daily reminder of a hardship that was suffered, which can be deeply distressing.

So, how can we best treat our children’s injuries and prevent long-term harm? This article will explore some insights into scar management for kids and will share some helpful treatment options that can be used on any scar.

The Risk of Pathological Scars in Children

Normotrophic scars are often considered the ideal type of scar as they are thin, elastic, painless and lie flat against the skin. Pathological scars are the opposite. Pathological scars form if there is a disturbance in the healing process or if incorrect treatment is used, causing an overgrowth of cells, proteins, and cytokines. 

This overdevelopment of cells can result in raised, inflamed, tight and uncomfortable skin tissue, known as keloid, contracture or hypertrophic scars¹. Unfortunately, these types of scars are very common in children. Why? 

The simple answer: Adults and children heal differently.

Although the physiological healing process is generally the same in all humans, the activity of enzymes needed to produce collagen for the formation of scars is higher in children than in adults². This overactivity of enzymes can contribute to an overdevelopment of scar tissue in our children, resulting in a pathological scar.

Although the physiological healing process is generally the same in all humans, the activity of enzymes needed to produce collagen for the formation of scars is higher in children than in adults². This overactivity of enzymes can contribute to an overdevelopment of scar tissue in our children, resulting in a pathological scar.

Overdeveloped scarring can cause major issues in children. Thick, tight scar tissue known as contractures can pull and cause tension on their delicate skin, making it uncomfortable and difficult for them to move and function normally.

This can hinder a child’s ability to enjoy activities such as playing with friends and participating in sports. Tightness can also suppress the skin’s ability to stretch and may even disrupt a child’s growth.

Scars can also be extremely itchy and sometimes even painful. Scars can present issues with nerves, including complete numbness within the scarred area or heightened sensitivity.

As it can be difficult to hide pathological scars, their distinct appearance can also impact children’s emotional health. They can serve as a daily visual reminder of the injury and, depending on the child’s experience, can trigger post-traumatic stress. Bullying and stigmatisation can also deeply damage a child’s well-being and self-esteem.

The danger of these issues is that they can quickly accumulate and create larger problems that can carry through into the child’s future, such as sleep disturbances, emotional disorders, and ongoing physical ailments.

Therefore, when treating wounds in children, it’s vital to be aware of these risks and to use specific therapies to guide the healing process and manage the scarring.

How to Defend Your Child Against Scarring

To prevent pathological scarring, treatment is most effective if it is applied as soon as the wound is closed and healed during the inflammatory phase. To promote the best outcomes, each of the following treatment strategies can be incorporated together and used simultaneously in support of one another’s healing elements.

Monitoring

During treatment, consistent inspections of the wound and healing progress is needed to keep track of whether the child is growing adequately with the scar. If the scar is too fibrous and is not corrected, it can cause tension, discomfort, and asymmetric growth.

As scars can have an impact on a child’s psychological development, the child’s emotional well-being should also be monitored and followed even after the physiological treatment has finished. Scar surgery may present as a requirement for the child down the line, whether it be for a functional purpose or aesthetic, needed to alleviate emotional distress or self-esteem issues.

Scar Massage Therapy

Although there is a lack of consistent research, the overall findings suggest that scar massage therapy can have benefits, including reducing pain, increasing movement, and improving scar characteristics³

Scar massage therapy can reduce inflammation and swelling caused by fluid build-up and can break down overdeveloped scar cells⁴. A gentle moisturiser can be incorporated to help increase the soothing and comforting sensation of the massage for your child.

Pressure Garment Therapy

Pressure garment therapy (PGT) for preventing and treating hypertrophic scarring has become the standard of care in almost all burn centres globally⁵. Garments are custom-made for your child and are worn to create compression, which is reported to inhibit and reduce the growth of hypertrophic scars. It is theorised to restrict blood supply, oxygen, and nutrients to the scar, which all contribute to an overdevelopment of collagen and scar tissue.

Silicone Gel Treatments

Topical silicone gel treatments (SGT) appear to remain the first point of clinical recommendation in scar management and are used anecdotally by many scar experts⁶

The treatment can be used as both a preventative method against keloid and hypertrophic scars; However, they can also be used as a treatment method for keloid and hypertrophic scars⁷

Silicone gel sheeting (SGS) is suspected to suppress the over-activity of scar cell development and can regulate the healing process for the ideal scar⁸. Fortune Medical’s Rystora® range has a variety of silicone gel treatment options designed to support the needs and specificities of your child’s scarring.

So, how do these silicone sheets work?

Protection

Rystora’s silicone sheeting acts as a barrier that can help protect the skin against further damage, irritation and even bacteria while still allowing the scarred area to breathe.

Hydration

The medical-grade silicone sheeting’s hydrophobic characteristics are designed to keep moisture against the skin, helping to reduce vaporisation and preserve the humidity required to create a hydrated environment ideal for wound healing. 

Compression

The silicone can also create an occluded environment, which may provide a gentle amount of compression to the area, helping to flatten any raised areas and soften the scar over time.

Specific benefits of SGT for Children:

*3 months of consistent use of Rystora® Silicone Scar Tape

Easy Application Process: Sheeting is specifically recommended for children as an at-home, painless treatment that can be applied and removed easily, which protects children from further stress and discomfort. 

Non-Restrictive: Silicone gel sheeting is designed to be lightweight, promoting great functionality and mobility for children to participate in their daily activities. 

No Harsh Chemicals or Fragrances: Silicone gel treatments are ideal for children as they are designed to be used on various skin types, including sensitive and delicate skin common in children.

Soothing: The soothing effects of silicone gel may reduce itching, helping to prevent children from scratching and aggravating the scar⁹, which can cause further damage and inflammation.

Non-invasive: Silicone sheeting can be applied directly to the skin without surgery or other invasive procedures. They may also reduce the need for surgical intervention to remove thickened, tight, and painful scar tissue, protecting children from further distress and a longer recovery.

Diverse: Allowing parents and caregivers to remain flexible, Silicone Gel dressings can be used alongside other types of scar treatments to enhance the results of therapies that work for the child, such as massage and pressure garment therapy.

Learn more about Silicone Gel Treatments here!

Treatments for More Severe Scarring

Although gentle therapies like massage and silicone gel are suitable for all scars ranging from mild to severe, there is another approach you can also include when treating stubborn scarring, which is thicker, tougher, and more severe. These medical interventions generally need to be conducted by medical professionals.

Negative pressure wound therapy (NPWT) has been increasingly used as an innovative and constantly improving technology for scar revision, reducing inflammation, and minimising the tension caused by pathological scars. NPWT can help improve the circulation of micro-vessels and lymphatic flow and stimulate the growth of granulation tissue, supporting the wound healing process.

Steroid injections can help break the bonds between collagen fibres, which helps reduce the amount of scar tissue beneath the skin. Corticosteroid solutions also have powerful anti-inflammatory properties and can be injected directly into a hypertrophic scar or keloid, promoting reduced swelling, redness, itching, or tenderness. 

Micro-needling is another procedure that is used to try and stimulate the body’s natural healing process through the production of amino acids, including collagen and elastin. Micro-punctures are created in the scar using tiny micro-needles, with the purpose of causing a controlled superficial abrasion without actually damaging the epidermis. These micro-abrasions trigger a wound-healing cascade by releasing various growth factors, which may help soften, flatten, and reduce hyperpigmentation from scarring.

Encouragement

Based on a child’s development, it can be hard for them to understand that something painful or uncomfortable is good for them. Trying our best to aid our children in understanding what their treatments do and how they are helping can go a long way. Even if that means illustrating it as magic or superpowers, getting our children to associate the treatment with something positive can help them comprehend why they need it.

Allowing children to have a choice in some matters can help them cope if they do not have a choice in what treatments they are prescribed. This may include letting a child choose what colour pressure garment they must wear or what clothes they wear over the top. Adding some fun during treatment, such as mimicking the treatment process with their favourite toy, may also encourage children to persist with any discomfort or distress they might feel.

Recognising Your Child's Unique Healing Journey

As parents and caregivers, our primary goal is to safeguard the well-being of our children. 

Although the treatments discussed above are strong methods of attack to help promote optimal physiological and emotional healing after an injury, it is up to you and the discretion of your medical professional to implement scar management strategies best suited to your child’s individual needs. 

Of course, every child heals differently and not every scar responds to treatment the same way! Although we might be able to minimise scarring, we cannot control how scars develop. Some scars may need a more aggressive approach, such as surgical intervention

If you’d like more information about scars and how to manage them, please don’t hesitate to contact us to learn more!

References

1 Lee HJ, Jang YJ. Recent understandings of biology, prophylaxis and treatment strategies for hypertrophic scars and keloids. Int J Mol Sci. 2018;19(3):711. doi: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5877572/ 

2 Reilly, D.M. and Lozano, J. (2021). Skin collagen through the lifestages: importance for skin health and beauty. Plastic and Aesthetic Research, 8(2). doi:https://doi.org/10.20517/2347-9264.2020.15

3 Scott, H.C., Stockdale, C., Robinson, A., Robinson, L.S. and Brown, T. (2022). Is massage an effective intervention in the management of post-operative scarring? A scoping review. Journal of Hand Therapy, 35(2). doi:https://doi.org/10.1016/j.jht.2022.01.004

4 Le Touze, A. (2020). Scars in Pediatric Patients. [online] PubMed. Available at: https://www.ncbi.nlm.nih.gov/books/NBK586080/

5 Moiemen, N., Mathers, J., Jones, L., Bishop, J., Kinghorn, P., Monahan, M., Calvert, M., Slinn, G., Gardiner, F., Bamford, A., Wright, S., Litchfield, I., Andrews, N., Turner, K., Grant, M. and Deeks, J. (2018). Introduction and background. [online] www.ncbi.nlm.nih.gov. NIHR Journals Library. Available at: https://www.ncbi.nlm.nih.gov/books/NBK507759/.

6 Bleasdale, B., Finnegan, S., Murray, K., Kelly, S. and Percival, S.L. (2015). The Use of Silicone Adhesives for Scar Reduction. Advances in Wound Care, 4(7), pp.422–430. doi:https://doi.org/10.1089/wound.2015.0625

7 Monstrey, S., Middelkoop, E., Vranckx, J.J., Bassetto, F., Ziegler, U.E., Meaume, S. and Téot, L. (2014). Updated Scar Management Practical Guidelines: Non-invasive and invasive measures. Journal of Plastic, Reconstructive & Aesthetic Surgery, 67(8), pp.1017–1025. doi:https://doi.org/10.1016/j.bjps.2014.04.011

8 Bleasdale, B., Finnegan, S., Murray, K., Kelly, S. and Percival, S.L. (2015). The Use of Silicone Adhesives for Scar Reduction. Advances in Wound Care, 4(7), pp.422–430. doi:https://doi.org/10.1089/wound.2015.0625

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