Pressure areas/ulcers

Pressure areas or ulcers are areas of damage to the skin and underlying tissue, usually occurring over bony prominences. They are caused by:

  • Pressure: when skin and tissue are directly compressed between bone and a support surface such as a bed.
  • Shear: when skin and tissue are pulled in different directions, for example when a child slips down in a wheelchair.
  • Friction: when the skin rubs against a surface, for example the heels rubbing against a sheet.

Both children at risk and their parents/carers need to be aware of the importance of pressure ulcer prevention. Pressure ulcers can be painful, difficult to treat and even life threatening in extreme circumstances.

Several factors may increase a child's risk of developing pressure ulcers:

Decreased mobility
Children with decreased mobility may have difficulty relieving pressure when lying or sitting. They may be unable to reposition themselves and may slip down in the bed or chair, producing a shearing effect. When parents or carers assist children to reposition or transfer, inappropriate manual handling techniques may also cause shearing or friction.

Neurological impairment or decreased sensation
Children with neurological impairments or decreased sensation may not feel the uncomfortable sensation of pressure building up and therefore may not reposition themselves to relieve pressure. They may not even feel when a pressure ulcer has developed.

The inability to control the bladder and/or bowel increases dampness in the buttock and thigh area, making the skin more prone to damage. Urine and faeces also contain substances that can increase the chance of skin breakdown. Advice can and should be sought from a continence nurse or other specialist.

Temperature and humidity
Increased heat and humidity increase sweating which can add to the risk of skin breakdown. Skin cell function is also impaired if the skin becomes too warm or too cold, increasing the skin's susceptibility to damage.

Decreased nutrition and circulation
Children with low body fat may have decreased subcutaneous fat and muscle bulk, providing little padding over bony prominences. Children with high body fat have increased padding over bony prominences, but this tissue is poorly vascularised and may be more prone to shear forces. Good nutrition is also required to repair tissue and prevent ulcer occurrence. Good hydration is required to maintain the resistance and elasticity of the tissues.

Good pressure care needs to be practiced across all activities of daily living: in bed, in the wheelchair or other chair (e.g. activity chairs), in the bath and on the toilet or commode. Prevention of pressure ulcers may include: correct positioning; changing position or lifting the body; regular inspection of the skin; wearing suitable clothing; using suitable bedding; taking care when lifting and transferring and using pressure relieving equipment. Whilst correct pressure care equipment is an important component of prevention, it should not be seen as a complete solution.

Read further information by the NHS on the prevention and treatment of pressure ulcers.

All advice is either supported by references (cited in the text) or is based upon peer reviewed professional opinion. Our advice is impartial and not influenced by sponsors or product suppliers listed on the site.
Conflict of interest statement