Management

General measures

• Children with terminal illnesses have skin that is susceptible to breakdown and has poor healing abilities
• Prevention is better than cure
• Good nursing care is required to foresee and prevent problems
• Frequent and appropriate turning is essential to avoid pressure areas breaking down
• Suitable mattresses and mobility aids should be employed

Medication

At risk areas

• Protect with OpSite, Tegaderm or Cutifilm

Broken areas

• Use DuoDerm, Spyrosorb.

Infection

• Send swab for growth. Use IntraSite gel, Iodosorb paste covered with OpSite, or Tegaderm ± antibiotics.

Cavities

• Pack with Kaltostat or Sorbsan.

Fungating tumours and odour

• Use topical metronidazole gel, charcoal dressings or honey and sugar.

Painful ulcers

• Consider anaesthetic preparations e.g. Emla cream or a topical morphine gel such as Lutrol gel. (Lutrol gel is available on request from St. Thomas’ Hospital, London and other hospital pharmacies may make this up specially).