Babies can develop bed sores, formally known as pressure injuries or pressure ulcers. This condition involves damage to the skin and underlying tissue caused by prolonged pressure, which restricts blood flow to the affected area. While often associated with adults, infants—especially those who are ill, premature, or have limited mobility—are at risk for developing these injuries. A pressure injury can develop quickly, sometimes in only a few hours, ranging from minor skin discoloration to a deep open wound.
Understanding Infant Skin Susceptibility
A baby’s skin is structurally and functionally different from an adult’s, making it more susceptible to damage from external forces. The epidermis, the outermost layer, is significantly thinner in infants, and premature neonates have an underdeveloped epidermal barrier. This thinner layer offers less protection against pressure and friction.
The dermis contains less resilient collagen and elastin, meaning the tissue lacks the mechanical strength to withstand external forces. Subcutaneous fat, which provides padding, is also thinner in newborns, reducing cushioning over bony areas. These combined factors mean that a baby’s skin is less resilient and slower to heal when subjected to constant pressure or rubbing.
Primary Causes and High-Risk Areas
Pressure injuries occur when sustained force compresses soft tissue between a bony prominence and an external surface, starving the area of oxygen and nutrients. The primary causes involve three mechanical forces: sustained pressure, friction, and shear. Friction is the rubbing of skin against a surface, such as when a baby is dragged across a sheet. Shear occurs when the skin remains stationary but the underlying tissue shifts, which happens when an infant slides down in a crib.
Infants with limited mobility, such as those in the Neonatal Intensive Care Unit (NICU), are at the highest risk. The most common location for injury is the back of the head (occiput) due to their large head size and prolonged time spent lying down. Other high-risk anatomical areas include:
- The tailbone (sacrum/coccyx)
- Heels
- Ears
- Elbows
- Shoulder blades
Medical equipment is a frequent cause of injury in hospitalized infants, as devices like nasal tubes, masks, splints, and monitoring equipment create focused pressure points. Moisture from wet diapers or sweat can soften the skin, a process called maceration, making it vulnerable to friction and breakdown.
Recognizing and Addressing Early Signs
Identifying a pressure injury in its earliest stage is fundamental for effective intervention. A Stage 1 pressure injury involves intact skin with a noticeable change in color, temperature, or firmness. For lighter skin tones, the earliest sign is persistent redness that does not blanch when light pressure is applied.
On darker skin tones, redness may not be apparent; instead, the area might appear darker than the surrounding skin, such as blue, purple, or brown discoloration. The affected area might also feel warmer or cooler, firmer or softer, or be tender compared to the surrounding tissue. A Stage 2 injury is more developed, showing partial-thickness skin loss that looks like a shallow open ulcer or an intact or ruptured blister filled with serum.
If these early signs are observed, the immediate action is to reposition the infant to relieve pressure on the affected area. Contacting a pediatrician or medical professional immediately is crucial to prevent the injury from worsening.
Essential Prevention Strategies for Caregivers
Caregivers can significantly reduce the risk of pressure injuries through attentive, routine care focused on skin and position management. A comprehensive skin inspection should be performed daily, or more frequently, paying close attention to high-risk areas and any areas under medical equipment. Look for changes in skin color, temperature, or texture during these checks.
Frequent repositioning is the most direct way to relieve sustained pressure on a single area. If an infant cannot move independently, a caregiver should change the baby’s position at least every two to four hours, or as advised by a healthcare provider. When moving a baby, avoid dragging the skin against the bed surface, which can cause friction and shear forces.
Managing moisture is equally important, involving keeping the skin clean and dry, especially in the diaper area. Diapers should be checked and changed promptly when wet or soiled to prevent skin maceration. Applying a barrier cream lightly can help protect the skin from urine and feces. Proper nutrition and hydration also support overall skin integrity and the body’s ability to heal.