Topical applications in pediatrics refer to medications or treatments applied directly to the skin to treat localized conditions without systemic effects. These are commonly used for inflammatory skin conditions, infections, wounds, and pain relief, and must be tailored to the child’s age, skin sensitivity, and diagnosis.
Indications
- To treat inflammatory conditions
- To protect the intact skin
- To clean the skin of infected weeping lesions
- To prevent and manage pruritus
- To maintain moisture
- To anesthetize the area
Common Forms of Topical application Medications
| Form | Description | Examples |
|---|---|---|
| Creams | Water-based, easily absorbed | Hydrocortisone, antifungals |
| Ointments | Oil-based, occlusive, better for dry lesions | Bacitracin, petroleum jelly |
| Lotions | Liquid, good for hairy areas | Calamine, corticosteroid lotions |
| Gels | Alcohol-based, fast drying | Benzoyl peroxide, lidocaine |
| Pastes | Thick, protective barrier | Zinc oxide for diaper rash |
| Powders | Absorb moisture, reduce friction | Antifungal powders |
| Sprays | Even application over large or painful areas | Antiseptics, anesthetics |
| Patches | Transdermal delivery of systemic medication | Lidocaine-tetracaine patch |
Equipment Needed
A clean tray containing:
- Prescribed medication
- A bowl with warm water
- Washcloth
- A small bowl with gauze pieces
- Tongue blade/spatula/pair of gloves
- Kidney tray
Preparation
- Explain the procedure to the child and parent as appropriate.
- Inspect the skin for cleanliness.
- Assess the skin integrity.
Procedure
- Perform hand hygiene.
- Clean the area with warm water and washcloth. If open wound is present, clean the area with sterile gauze pieces and solution prescribed.
- Dry skin well after washing.
- Apply topical medication to the site.
Nurse’s Responsibility in Topical Application
- Administer gels, lotions, pastes, ointments, and creams using cotton swabs, tongue blades, or gloves.
- Gloves help to reduce the transmission of microorganisms and protect the nurse from absorbing the medication through her hand.
- If a powder is ordered, sprinkle it over the site; ensure that the child’s head is turned away so that none is inhaled.
- If a spray is ordered, check with reference source or the manufacturer’s recommendations; most sprays must be shaken before administration.
- Spray over the site and ensure that the child’s head is turned away to reduce the potential of inhalation.
- Apply dressing over the site if indicated to prevent the medication from being rubbed off, and to protect the clothing at that site.
- Do not use dressing in case of topical steroids.
- Apply transdermal and topical systemic medication patches to a flat area of the skin; they are self-adhesive.
- Do not cut medication patches to fit area or reduce dose.
- Skin thickness, sensitivity, and condition should be taken into account when applying topical treatments.
- Apply in downward strokes following hair growth to prevent folliculitis.
- Rubbing should be avoided as this creates heat and irritation and can cause damage to delicate skin cells.
Topical Steroids
- Treatment of inflammatory conditions, for example, eczema.
- Apply no more than twice a day.
- Ointments provide better absorption and often less irritation; apply thinly following fingertip units.
- 1% hydrocortisone is safe for infants under 1 year and on face for all ages.
- Occlusive dressing increases the potency up to 10-fold.
- Use the least potent preparation that is effective for severity of condition.
- Avoid prolonged use, especially on the face and around the eyes.
Special Considerations
- Infant skin is thinner—increased absorption risk.
- Avoid prolonged use of topical steroids, especially on the face.
- Do not apply to broken or infected skin unless prescribed.
- Use age-appropriate formulations and avoid alcohol-based products in neonates.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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