“Excellent skin care is an attribute of quality care,” begins the Royal Children’s Hospital Melbourne paper on pressure injury prevention and management, cautioning that a pressure injury can develop in as short as 30 minutes if there is high pressure in a small area. Increased pressure, over short periods of time and slight pressure for long periods of time have been shown to cause equal damage.

At Action Products, where a core focus is patient skin integrity, we agree with the statement made a decade ago by Sandy Quigley, BSN, RN, CETN and Martha Curley, MSN, RN, CCRN: “Integral to the practice of pediatric nursing are the prevention and management of alterations in skin integrity.  The authors identified prominent pressure injury locations as being the occipital region of the scalp in infants and toddlers and the sacrum in children.

The prone position for surgery is associated with a variety of complications, many of which are derived from increased pressure on anterior structures. Rates of pressure sores as an intraoperative complication have been reported to be between 5% and 66%, according to a 2015 International Surgery article by Melissa M. Kwee, Yik-Hong Ho, and Warren M. Rozen. There is pressure on the face in prone position, particularly in areas such as the chin and forehead above the supraorbital ridge. “Prolonged pressure on ears, particularly on cartilaginous auricles can result in hematoma, chondritis, ischemia or necrosis,” the authors warn.

Interestingly, in “Prone Positioning can be Safely Performed in Critically Ill Infants and Children”, Authors Fineman,  LaBrecque, Shih, and Curley mention that prone positioning is occasionally used in the pediatric critical care population to optimize patient comfort, manage complex wounds, and prevent pressure ulcers. 

“Prone positioning places pressure on the forehead, chin, shoulders, thorax, pelvis, knees, and ankles,” the World Journal of Orthopedics reports. The duration of the surgical procedure is the largest risk factor for the development of ulcers, and appropriate padding and attention to bony prominences is critical to avoiding cutaneous complications, researchers point out.

“There is anecdotal evidence that critically ill children are at greater risk for pressure ulcers than the general pediatric population,” asserts Margie Rodrigues, RN, MSN, WCC.  When pressure squeezes the tissue between a patient’s bony areas and external surfaces such as table mattresses or positioning devices, ulcers can form. Our Action® table pads and positioning products, made with Akton® viscoelastic polymer, have a soft, flexible skin which can move easily as the patient is moved.

Pressure injury avoidance is particularly crucial when pediatric patients are in the prone position!