Deep cut in index finger of 19 months old baby - how to re-bandage?

Question

My 19-month-old baby while playing had a deep cut in her left hand index finger. Her pediatrician dressed her finger now and didn't administer any tetanus injection, as she had already been given Diphtheria-Pertussis-Tetanus vaccine some months back.

Now, the problem is that she doesn't allow us to re-bandage her finger. If we try to do it forcefully, she cries and shouts so much that she finds hard to breathe.

Answer 1

When my son was about 15 mos old he had an incident with a treadmill (on my in-law's watch, a still sore subject presently) where his hand got stuck in it and a good portion of his palm's skin was burned off. It was grotesque, and VERY painful. My in laws did not seek treatment right away, and didn't clean the wound (there were bits of treadmill still stuck in it two days later when I came back from my business trip.) So, when I brought him to the ER, they had to remove the layer of infected skin, remove dirt & debris, and then apply a burn treatment. It was horrific, and as @Marc experienced, he had to be restrained.

I had to change the dressing once a week, or, as often as it got dirty, wet, or removed by a baby who doesn't want a bandage getting in the way of putting Legos in his mouth ( ;-p ) which ended up being every day. He had NO SKIN on his entire hand. Here's our method:

• Get a helper. Someone with nerves of steel.
• Prepare your bandage/dressing and have ALL necessary objects within reach. Here are the two essential objects that you haven't been using: a baby sized stretchy knit winter glove with all but the index finger cut off, and a baby crew sock (long enough to go to AT LEAST her elbow) with. 5 little slits cut in the toe for her fingers to slip through. This will cover your sterile gauze bandage and prevent it from getting ripped off and keeps it somewhat cleaner/thereby reducing how often you have to do this.
• Have a really, really, super-awesome reward ready, and visible, but out of reach.
• Begin a "countdown to all done" count as slowly as you need to, but not too slow that she loses you between numbers. Count to ten beginning the moment she will first feel something, and ten should come the exact second you let her up. This is a GREAT method to use now, and any time she'll experience something painful.
• To clean the finger use just soap and water. It's mild and doesn't hurt so much. (Maybe she'll even play in the sink in soapy water? Mine had to keep his dry, but I've used this trick on other occasions.) If she fights, have your helper hold her arm over the sink and use a squirt bottle to shoot a steady stream of saline on her finger. Use clean gauze to dry. (Soapy water would need a rinse, with saline you can skip it) She might already be screaming. Sorry dear, that's life. Speak softly and soothingly.
• Slather that finger with ointment. Whatever the doctor recommends. I use A&D, or bacitracin. Neither one hurts. I do mean slather!
• Get your sterile gauze on there. I used the roll kind. It's thin so you can wrap around the tiny finger. Those squares they sell are no good for baby hands. Wrap it around MANY times, going all the way down the finger and back up until the finger is like a Q-tip. Secure with a piece of water proof tape. If you want it to stay dry, wrap the whole thing in tape. It doesn't have to look good!
• Get the glove on. It's kinda tricky to not rip the glove since it's been cut. Have backups ready.
• Put the sock over the glove and all the way down the arm. This, paired with long sleeves, keeps the kid from getting it off.
• IMMEDIATELY ADMINISTER THE SUPER-AWESOME REWARD, and lots and lots of praise. Just don't coddle too much. You want her to learn that she was not in danger, and "it's no big deal."

If you can keep your cool, she will eventually take your cues and will relax, somewhat. Kids trust their parents, if you trust in yourself.

I did this on my kitchen table, baby laying on a towel, helper using appropriate amount of body weight to hold down torso, legs, and unaffected arm. Helper usually held baby's hand between his chest and helper's, to give him something to squeeze. We made sure his face was not covered, and he could see what was happening. I think it's better for them to see what's being done. It teaches them to deal with pain in a healthy way, and to trust you.

In between dressings, try to gently, nonchalantly touch and handle the injured hand. This desensitizes her so she won't associate you touching her hand with pain. Encourage her to use her hand (now that she's all bandaged up and well protected!) This was especially important for us, since our baby's mobility was at risk, but it's good advice anyway-to help her forget the trauma. If you get to a point where she doesn't fight so much, try touching her palm and talking to her while you are bandaging to get her to realize you aren't hurting her. She may calm down. Practice getting closer and closer to the cut.

Above all: Don't worry. She won't remember this on her wedding day.

(FYI: my boy's palm is totally, 100% recovered and fully functional, and now sits calmly for immunizations as a result of the trust we now have, and the "countdown to all done")

Answer 2

It hurts and she's scared, both by the impending pain and the memory of the injury. At eighteen months, my youngest fell against a brick planter and cut her face just across her eyebrow. In order to stitch her, the pediatrician had to wrap her to a board to hold her still and keep her hands down. That was a traumatic event - for years she was claustrophobic, and she remembers it today, thirteen years later. But what could we have done differently? It was traumatic for me, but looking back, it had to be done.

I think you're in a similar position. An index finger on a toddler or baby is so important, so easy to get infected, that you have to know it's healing. You have to do what needs to be done. You can try to distract her, but she's a baby, a learning machine, and that won't work twice if it works once.

Parenting isn't about the fun stuff. It's about handling the problems, and I feel for you. It's gut-wrenching for me to remember. I wish I has something good and helpful to say.

Answer 3

We have to do some pretty painful things to my nine year-old daughter with cerebral palsy fairly regularly. It's just part of being a parent, and unfortunately, there isn't a good way to make it pleasant for your child. The best you can do is get it over with as fast as possible. Some things to keep in mind:

• You need to remain calm yourself. If parents flip out when their kids flip out, it just makes it worse. Speak in calm, soothing tones, even if your child is screaming. It won't make her stop screaming during, but it might help her not scream so loud, and it will usually help her calm herself faster afterward. It also helps keep you calm so you can get it done faster, and it speeds communication and makes the job of nurses or other helpers easier when they don't have to calm you down in addition to soothing the child.
• Have one person hold her down while the other changes the dressing. It's really hard to do both at the same time.
• Don't be hesitant. If you try five times to remove a bandage, but flinch when the baby flinches, you're just prolonging her agony. Make sure and steady movements, and finish what you start.
• These next two are more for children who can talk well, but don't lie to her about it. Tell her it will hurt, but you will be done as soon as you can. If you lie to her, she won't trust what you say about similar procedures in the future.
• Try to accommodate her requests as much as possible, but not if it will unduly prolong the procedure. For example, my daughter asks doctors and nurses to sit down. I don't know exactly why, but it helps her feel more comfortable.