Table 2.
Integument (skin) guidelines with relevant citations as evidence
| Age group | Guidelines | Evidence | |
|---|---|---|---|
| 0–11 months | 1. | Discuss insensate skin with parents and caregivers. | [9] |
| 2. | Discuss the risk factors that may contribute to impaired skin integrity. | [3, 7, 9–15] | |
| 3. | Teach parents and caregivers to inspect the skin (especially weight bearing or insensate areas) for changes in color, texture, and temperature. | [4, 7, 9–15] | |
| 4. | Discuss the need to check water temperature and encourage the use of a bath water thermometer. | [7, 9–12] | |
| 5. | Suggest that parents and caregivers check for hot surfaces that have been exposed to the sun such as car seats and playground equipment. | [7, 9–11] | |
| 6. | Recommend the use of barrier creams to protect the skin from damage as a result of bowel and bladder incontinence. | [7, 11, 12, 16] | |
| 1–2 years,11 months | 1. | Teach parents and caregivers to inspect the skin (especially weight bearing or insensate areas) for changes in color, texture, and temperature. | [3, 4, 7, 9–16] |
| 2. | Recommend the use of barrier creams to protect the skin from damage as a result of bowel and bladder incontinence. | [7, 11, 12, 16] | |
| 3. | Discuss the need to check water temperature and encourage the use of a bath water thermometer. | [7, 9–12] | |
| 4. | Suggest that parents and caregivers check for hot surfaces that have been exposed to the sun such as car seats and playground equipment. | [7, 15,16] | |
| 5. | Teach parents and caregivers how to inspect for well-fitting orthoses. | [3, 7, 16] | |
| 6. | Teach parents and caregivers that the child should wear protective clothing and footwear over insensate areas. | [7, 15, 16] | |
| 7. | Suggest that parents and caregivers seek treatment if the child’s skin is compromised. | [7, 16] | |
| 3–5 years,11 months | 1. | Teach parents and caregivers to inspect the skin daily (especially weight bearing or insensate areas) for changes in color, texture, and temperature. | [3, 4, 7, 9–16] |
| 2. | Encourage the child’s involvement in skin inspection. | [7, 10–16] | |
| 3. | Teach child to develop awareness of insensate areas. | [7, 10–16] | |
| 4. | Review with parents and caregivers the consequences of heat, moisture, or pressure to insensate areas. | [7, 10–16] | |
| 5. | Recommend the use of barrier creams to protect the skin from damage as a result of bowel and bladder incontinence. | [7, 10–16] | |
| 6. | Discuss the need to check water temperature and encourage the use of a bath water thermometer. | [7, 10–17] | |
| 7. | Suggest that parents and caregivers check for hot surfaces that have been exposed to the sun such as car seats and playground equipment. | [7, 10–17] | |
| 8. | Teach parents and caregivers how to inspect for well-fitting orthoses. | [7, 9–12] | |
| 9. | Teach parents and caregivers that the child should wear protective clothing and footwear (including water shoes in a pool or on pool deck) over insensate areas. | [7, 15, 16] | |
| 10. | Suggest that parents and caregivers seek treatment if the child’s skin is compromised. | [7, 16] | |
| 6–12 years,11 months | 1. | Teach parents and caregivers to inspect the skin daily (especially weight bearing or insensate areas) for changes in color, texture, and temperature. | [3, 4, 7, 9–16] |
| 2. | Encourage the child’s involvement in skin inspection. | [7, 9–16] | |
| 3. | Teach child to develop awareness of insensate areas. | [7, 10–16] | |
| 4. | Review with parents and caregivers the consequences of heat, moisture, or pressure to insensate areas. | [7, 10–16] | |
| 5. | Teach parents and caregivers how to look for well-fitting orthoses and other equipment that may cause injury to skin. | [7, 15, 16] | |
| 6. | Teach parents and caregivers that the child should wear protective clothing and footwear over insensate areas. | [7, 10, 16] | |
| 7. | Discuss the need to check water temperature and encourage the use of a bath water thermometer. | [7, 10–16] | |
| 8. | Suggest that parents and caregivers check for hot surfaces that have been exposed to the sun such as car seats and playground equipment. | [7, 10–16] | |
| 9. | Promote adequate hydration and proper nutrition for healthy skin. | [7, 14, 18, 19], Nutrition, Metabolic Syndrome, and Obesity Guidelines | |
| 10. | Encourage parents, caregivers, and the child to keep skin clean and dry. | [7, 9–14] | |
| 11. | Suggest wearing seamless socks that are clean and dry. | [7, 12, 14] | |
| 12. | Suggest the use of antiperspirant on areas with perspiration, such as the feet and intertriginous areas. | [7, 16] | |
| 13. | Encourage parents and caregivers seek treatment if the child’s skin is compromised. | [7, 12] | |
| 14. | Advise parents and caregivers to engage non-ambulatory children in pressure relieving activities every 15 minutes. | [7, 10–11, 16–17] | |