Whether a tetanus shot is required after an injury has to be one of the most frequently asked questions to me. My child has been injured (the urgency becomes more significant if the offending object was a rusty piece of metal)! Doctor, please give him a tetanus shot!

Well, the guidelines on the management of injuries (bruises, cuts, and scrapes)  are quite clear:

1. Clean the wound or scrape: Simple water and any soft soap (does not have to be antibacterial) and try and remove as much grit, dirt or pieces of glass or any foreign material as possible.
2. Stop the bleeding! Pressure controls all bleeding (even major vessels). Use direct pressure using a pad of cotton or gauze pieces over the bleeding point directly.
3. Watch for signs of infection (listed below).
4. Contact your doctor as to whether you need a tetanus shot (in general, if one is fully immunized as per schedule, one does not need tetanus shot unless the wound is severely contaminated and especially if the last shot has been given more than five years before the injury.

Seek urgent medical aid if:

1. Any wound over body cavities or near natural orifices.
2. The wound is deeper than the skin since it will require stitches. (There are wonderful new inventions that may eliminate the need for stitching using glues, staplers or even old fashioned sutures painlessly).
3. Even after cleaning there is the presence of dirt, glass or other foreign bodies in the wound.
4. It is a puncture wound (like a bite) where the external injury may seem trivial, and there may be a serious injury to vessels or nerves underneath or the possibility of a bad infection.
5. Signs of infection:
   • The child develops a fever.
   • Redness, swelling, warmth, or increased pain around the cut or scrape
   • Pus draining from the wound or abrasion
   • Red streaks on the skin around the cut or scrape

So parents, please do not rush to your doctor and demand for a tetanus shot to be given immediately to your injured children. If you have been immunizing your child as per the schedule with periodic boosters, for most injuries, a tetanus shot is superfluous.