How should I approach the management of a child with Epidermolysis Bullosa, particularly regarding wound care and pain management?

Management of a child with Epidermolysis Bullosa (EB) should focus on careful wound care and effective pain management.

For wound care, maintain a warm, moist healing environment using appropriate dressings that minimise trauma and pain during changes. Avoid routine use of topical antiseptics or antimicrobials unless there is clinical evidence of infection, and systemic antibiotics should only be used if infection is confirmed and guided by microbiology advice. Dressings should be selected considering pain, tolerance, exudate amount, and frequency of changes to reduce discomfort. Pressure redistribution and offloading are important to prevent further skin damage, using specialist support surfaces tailored to the child's size and ulcer location. Nutritional assessment and ensuring adequate hydration are essential to support wound healing and overall growth.

For pain management, regular assessment of pain is critical, and analgesia should be tailored to the child's needs, including both pharmacological and non-pharmacological methods. Minimising trauma during dressing changes and handling is important to reduce pain. Multidisciplinary involvement, including dermatology, paediatrics, dietetics, and pain specialists, is recommended to optimise care.