Pressure injuries occur in bed-bound individuals due to the constant force of the mattress surface against the skin. Patients with loss of feeling are at particular risk, since they are unable to detect any pain and alert a healthcare worker. Similarly, very young patients may be unable to adequately communicate their discomfort, due to limited speech and descriptive abilities.

Although pressure injuries may appear on any area of the body, bonier regions such as the head, heels, and lower spine may be more prone. Furthermore, the areas affected may vary in adults and children due to their differing size, weight, and bodily proportions. There is plenty of accessible research regarding the causes and treatment of pressure sores in adults; however, the same cannot be said for younger patients. Research assessing the prevalence and incidence of pressure injuries in children is scarce, and there is little evidence to indicate how many children develop pressure sores during their hospital stay, or how they can be prevented.

Interventions including repositioning patients every 2 to 4 hours and using pressure distribution mattresses to avoid pressure sores developing in adults. However, there is little research regarding the optimal repositioning interval for infants and children. Similar tailor-made mattresses for use in cribs and baby warmers have not yet been widely introduced.

Additional considerations include the tolerance of young skin to pressure, and the requirement for diapers, which may further irritate the skin and alter bodily contact with the mattress. Nurses caring for newborn babies currently use modified versions of adult risk assessment tools when determining how likely they are to develop pressure injuries. Moreover, in an effort to improve comfort levels, nurses will often resort to using rolled up blankets or other soft objects as pressure distribution devices, even though these are actually repositioning aids.

To address this disparity, Dr. Ivy Razmus and her colleagues explored the specific issues around pressure sores affecting children who are admitted to hospital in the medium to long term, and who may require ongoing care at home.

In a recent study, Dr. Razmus and her colleagues investigated the differences in pressure distributions on mattresses between children and adults, and how these differences might inform optimal clinical practice. The study participants were allocated a standard coil mattress of a size appropriate to their height to mimic typical hospital conditions. A pressure sensor mat was placed on top of the mattress to record the differences in load at different bodily regions.

The research team took readings over a set time while the patient lay as still as possible, recording the average pressure at the head, shoulders, lower spine, and heels. They discovered that the heels were high-pressure regions in both children and adults. For children, the area of highest pressure was at the head. In contrast, the head represented the least pressure bearing region for adults. This is unsurprising given that children’s heads are heavier than adults’ heads in proportion to the rest of the body. Additionally, the back of the head is the most prominent bony protrusion throughout infancy and early childhood.

This finding further highlights the need for age-specific equipment designs for use in healthcare settings. Not only will this ensure increased patient comfort, but it will also minimize the occurrence of pressure injuries in children confined to bed for extended periods.

Advanced practice nurses hold additional professional credentials and have exceptional expertise in specific fields of medicine. The contribution of specialist nurses in the management of hospital-acquired wounds has traditionally been undervalued, although this has improved during the last decade or so. However, recognition of the role of specialist nurses in the context of caring for children and babies has been virtually non-existent.

This has presented research opportunities for dedicated advanced practice nurses such as Dr. Razmus, who has worked tirelessly to investigate the unique considerations of young people at risk of developing pressure sores during hospital stays. Her research has shed new light on the ways in which injuries can be minimized and clinical practices refined, whilst highlighting the indispensable role of the specialist nurse in a range of pediatric settings, including acute care and community health centers.

Awareness of other friction injuries in babies and young children, such as those associated with feeding tubes or diaper wearing, may also be boosted in response to these essential insights. Crucially, the importance of family engagement and support in the ongoing prevention and management of pressure injuries in chronically ill children must not be underestimated.

Together, these vital yet overlooked aspects of care will enhance the healthcare experiences of minors across the globe, and assist in equalizing the level of care for adults and children.