What are the four main types of open wounds. How can minor wounds be treated at home. When should you seek medical attention for an open wound. What are the potential complications of open wounds. How are serious open wounds treated medically.

Understanding Open Wounds: Definition and Causes

An open wound is a break in the skin or underlying tissues that exposes internal structures to the external environment. These injuries can range from minor scrapes to severe lacerations and are often caused by accidents, falls, or encounters with sharp objects. Understanding the nature of open wounds is crucial for proper treatment and prevention of complications.

Common causes of open wounds include:

• Falls on rough surfaces
• Accidents with sharp objects like knives or broken glass
• Vehicle collisions
• Sports injuries
• Industrial or workplace accidents

The severity of an open wound can vary greatly, from superficial abrasions that barely break the skin to deep lacerations that may require immediate medical attention. Recognizing the type and extent of an open wound is essential for determining the appropriate course of treatment.

The Four Primary Types of Open Wounds

Open wounds are classified into four main categories based on their characteristics and causes. Each type requires specific care and treatment approaches.

1. Abrasions

Abrasions occur when the skin is scraped against a rough surface. These wounds are typically superficial, affecting only the outer layers of skin. While abrasions may not bleed profusely, they can be painful and prone to infection if not properly cleaned.

2. Lacerations

Lacerations are deep cuts or tears in the skin and underlying tissues. They are often caused by sharp objects or forceful impacts. Lacerations can result in significant bleeding and may require medical intervention, especially if they are deep or affect sensitive areas.

3. Punctures

Puncture wounds are characterized by a small entry point caused by a sharp, pointed object penetrating the skin. While the external appearance may be minimal, punctures can be deceptively deep and pose a risk of internal damage and infection.

4. Avulsions

Avulsions are severe wounds where a portion of skin and underlying tissue is partially or completely torn away. These injuries often result from violent accidents or explosions and can lead to extensive bleeding and tissue damage.

Home Care for Minor Open Wounds

Many minor open wounds can be effectively treated at home with proper care and attention. Following these steps can promote healing and reduce the risk of complications:

1. Clean the wound thoroughly with soap and water
2. Apply an antiseptic solution to disinfect the area
3. Control bleeding using direct pressure and elevation
4. Cover the wound with a sterile dressing or bandage
5. Change the dressing regularly and keep the wound clean and dry
6. Monitor for signs of infection or delayed healing

For pain management, over-the-counter acetaminophen can be used as directed. It’s important to avoid aspirin-containing products, as they may prolong bleeding. If swelling occurs, applying ice can help reduce inflammation.

When to Seek Medical Attention for Open Wounds

While many open wounds can be managed at home, certain situations require professional medical care. Knowing when to seek help is crucial for preventing serious complications.

You should consult a healthcare provider if:

• The wound is deeper than 1/2 inch
• Bleeding persists despite applying direct pressure for 20 minutes
• The injury resulted from a serious accident
• There are signs of infection (increased pain, redness, swelling, or discharge)
• The wound is on the face or a sensitive area
• You have not had a tetanus shot in the past 5 years (for puncture wounds)

Prompt medical attention in these cases can prevent complications and ensure proper healing.

Medical Treatments for Serious Open Wounds

When professional medical care is required, healthcare providers have several options for treating open wounds. The choice of treatment depends on the type, location, and severity of the wound.

Wound Closure Techniques

For wounds that require closure, doctors may use:

• Skin adhesives or glue for minor cuts
• Sutures (stitches) for deeper lacerations
• Staples for certain types of wounds
• Adhesive strips for small cuts

Wound Cleaning and Debridement

Thorough cleaning is essential to prevent infection. In some cases, debridement (removal of dead or contaminated tissue) may be necessary to promote healing.

Antibiotic Treatment

If there’s a risk of infection, antibiotics may be prescribed. This is particularly common for puncture wounds or contaminated injuries.

Tetanus Prevention

For certain types of wounds, especially punctures, a tetanus shot may be administered if the patient’s immunization is not up to date.

Secondary Intention Healing

In some cases, particularly with contaminated wounds, the doctor may choose to leave the wound open to heal from the inside out. This process, known as healing by secondary intention, can help prevent infection and abscess formation.

Potential Complications of Open Wounds

While proper treatment significantly reduces risks, open wounds can lead to complications if not managed correctly. Understanding these potential issues is crucial for early detection and intervention.

Infection

The most common complication of open wounds is infection. Signs of wound infection include:

• Increased pain, redness, or swelling around the wound
• Unusual discharge or pus
• Foul odor from the wound
• Fever or chills
• Delayed healing

If you notice these symptoms, seek medical attention promptly. Early treatment of infections can prevent more serious complications.

Scarring

While some scarring is normal in the healing process, excessive scarring can occur, especially with deep or poorly managed wounds. Proper wound care and following medical advice can help minimize scarring.

Tetanus

Tetanus is a serious bacterial infection that can occur in deep puncture wounds. Keeping tetanus vaccinations up to date is crucial for prevention.

Chronic Wounds

In some cases, particularly in individuals with underlying health conditions like diabetes, wounds may fail to heal properly, leading to chronic open wounds that require ongoing medical management.

Prevention and Long-Term Care for Open Wounds

Preventing open wounds and ensuring proper long-term care are essential aspects of wound management. By following these guidelines, you can reduce the risk of injury and promote optimal healing:

Safety Measures

• Wear appropriate protective gear during potentially hazardous activities
• Keep your environment free of sharp objects and potential trip hazards
• Use caution when handling tools and machinery

Proper Wound Care

For wounds that are healing:

• Keep the wound clean and dry
• Change dressings as recommended by your healthcare provider
• Avoid picking at scabs or disturbing the healing process
• Protect healing wounds from sun exposure

Nutrition and Hydration

Proper nutrition plays a crucial role in wound healing. Ensure a balanced diet rich in:

• Protein for tissue repair
• Vitamin C for collagen production
• Zinc for immune function
• Adequate hydration to support circulation and tissue health

Follow-Up Care

Attend all follow-up appointments with your healthcare provider. These visits allow for monitoring of the healing process and early detection of any complications.

Innovations in Open Wound Treatment

The field of wound care is constantly evolving, with new technologies and treatments emerging to improve healing outcomes. Some recent innovations include:

Advanced Dressings

Modern wound dressings are designed to maintain optimal moisture levels, protect against infection, and promote faster healing. Examples include:

• Hydrocolloid dressings
• Foam dressings
• Antimicrobial dressings

Negative Pressure Wound Therapy

This technique uses controlled suction to remove excess fluid from wounds, promote blood flow, and accelerate healing, particularly for large or chronic wounds.

Bioengineered Skin Substitutes

For severe wounds or burns, artificial skin products can be used to promote healing and reduce scarring.

Hyperbaric Oxygen Therapy

In some cases, exposure to high-pressure oxygen environments can accelerate wound healing, particularly for diabetic ulcers or radiation injuries.

As research continues, new treatments and technologies are likely to emerge, offering improved outcomes for patients with open wounds.

Special Considerations for Different Populations

Certain groups may require special attention when it comes to open wound care and prevention. Understanding these unique needs can lead to better outcomes and reduced complications.

Elderly Individuals

Older adults may face challenges with wound healing due to:

• Reduced skin elasticity and thickness
• Decreased blood circulation
• Higher likelihood of chronic conditions affecting healing

For this population, extra care in prevention and meticulous wound management are crucial.

Diabetic Patients

People with diabetes are at higher risk for wound complications due to:

• Impaired circulation, especially in extremities
• Reduced sensation (neuropathy) leading to unnoticed injuries
• Compromised immune function

Regular foot checks, proper glucose control, and prompt attention to any skin breaks are essential for diabetic individuals.

Immunocompromised Individuals

Those with weakened immune systems, whether due to illness or medication, require extra vigilance in wound care to prevent infections. Strict adherence to hygiene protocols and early medical intervention for any signs of complication are crucial.

Pediatric Patients

Children’s wound care needs can differ from adults due to:

• Faster healing rates
• Increased risk of scarring
• Challenges in keeping dressings in place

Age-appropriate wound care education and close monitoring are important for pediatric patients.

By recognizing and addressing the unique needs of different populations, healthcare providers and caregivers can ensure optimal wound healing outcomes across all patient groups.

Open Wound: Types, Treatments, and Complications

What is an open wound?

An open wound is an injury involving an external or internal break in body tissue, usually involving the skin. Nearly everyone will experience an open wound at some point in their life. Most open wounds are minor and can be treated at home.

Falls, accidents with sharp objects, and car accidents are the most common causes of open wounds. In the case of a serious accident, you should seek immediate medical care. This is especially true if there’s a lot of bleeding or if bleeding lasts for more than 20 minutes.

There are four types of open wounds, which are classified depending on their cause.

Abrasion

An abrasion occurs when your skin rubs or scrapes against a rough or hard surface. Road rash is an example of an abrasion. There’s usually not a lot of bleeding, but the wound needs to be scrubbed and cleaned to avoid infection.

Laceration

A laceration is a deep cut or tearing of your skin. Accidents with knives, tools, and machinery are frequent causes of lacerations. In the case of deep lacerations, bleeding can be rapid and extensive.

Puncture

A puncture is a small hole caused by a long, pointy object, such as a nail or needle. Sometimes, a bullet can cause a puncture wound.

Punctures may not bleed much, but these wounds can be deep enough to damage internal organs. If you have even a small puncture wound, visit your doctor to get a tetanus shot and prevent infection.

Avulsion

An avulsion is a partial or complete tearing away of skin and the tissue beneath. Avulsions usually occur during violent accidents, such as body-crushing accidents, explosions, and gunshots. They bleed heavily and rapidly.

Some wounds may be treated at home and others may require a trip to your doctor for a medical approach.

Home care for minor wounds

Minor wounds can be treated at home. First, wash and disinfect the wound to remove all dirt and debris. Use direct pressure and elevation to control bleeding and swelling.

When wrapping the wound, always use a sterile dressing or bandage. Very minor wounds may heal without a bandage. You’ll need to keep the wound clean and dry for five days. You should also make sure you get plenty of rest.

Pain typically accompanies a wound. You can take acetaminophen (Tylenol) as directed on the package. Avoid products with aspirin since they can cause or prolong bleeding.

Apply ice if you have bruising or swelling, and avoid picking at scabs. If you’re spending time outdoors, use a sunscreen that’s sun protection factor (SPF) 30 on the area until it’s completely healed.

When to see a doctor

Although you can treat some wounds at home, you should see a doctor if:

• an open wound is deeper than 1/2 inch
• bleeding doesn’t stop with direct pressure
• bleeding lasts longer than 20 minutes
• bleeding is the result of a serious accident

Medical treatments

Your doctor may use different techniques to treat your open wound. After cleaning and possibly numbing the area, your doctor may close the wound using skin glue, sutures, or stitches. You may receive a tetanus shot if you have a puncture wound.

Depending on the location of your wound and the potential for infection, your doctor may not close the wound and let it heal naturally. This is known as healing by secondary intention, meaning from the base of the wound to the superficial epidermis.

This process may require you to pack your wound with gauze. Although the healing may not look pretty, it prevents infection and the formation of abscesses.

Another treatment for an open wound includes pain medication. Your doctor may also prescribe penicillin or another antibiotic if there’s an infection or high risk for developing an infection. In some cases, you may need surgery.

If a body part is severed, it should be brought to the hospital for possible reattachment. Wrap the body part in moist gauze and pack it in ice.

When you leave the doctor’s office, you might have bandages and dressings. It’s important to wash your hands and work on a clean surface when changing bandages and dressings.

Disinfect and dry the wound thoroughly before dressing it again. Dispose of old dressings and bandages in plastic bags.

The main complication of an open wound is the risk for infection. Call your doctor immediately if you’ve had a puncture, deep laceration, or serious accident and you’re showing signs of significant bleeding or infection.

Signs of hemorrhage include continuous bleeding that doesn’t respond to direct pressure. You may have an infection if the wound shows:

• an increase in drainage
• thick green, yellow, or brown pus
• pus with a foul odor

Other signs of infection include:

• a fever of over 100.4°F (38°C) for more than four hours
• a tender lump in your groin or armpit
• a wound that isn’t healing

Your doctor will drain or debride the wound and often prescribe an antibiotic if bacterial infection develops. In serious cases, you may need surgery to remove infected tissue and sometimes the surrounding tissue as well.

Conditions that can develop from an open wound include:

• Lockjaw. This condition is caused by an infection from the bacteria that cause tetanus. It can cause muscle contractions in your jaw and neck.
• Necrotizing fasciitis. This is a severe soft tissue infection caused by a variety of bacteria including Clostridium and Streptococcus that can lead to tissue loss and sepsis.
• Cellulitis. This is an infection of your skin that’s not in immediate contact with the wound.

Whether you have a minor or a more serious open wound, it’s important to take quick action. Some open wounds can be treated at home, but this isn’t always the case.

You need medical attention if you have a deep cut or if you’re bleeding a lot. This ensures you receive the most appropriate treatment and reduces your risk for complications and infection.

Cuts and puncture wounds: MedlinePlus Medical Encyclopedia

A cut is a break or opening in the skin. It is also called a laceration. A cut may be deep, smooth, or jagged. It may be near the surface of the skin, or deeper. A deep cut can affect tendons, muscles, ligaments, nerves, blood vessels, or bone.

A puncture is a wound made by a pointed object such as a nail, knife, or sharp tooth. Puncture wounds often appear to be on the surface, but may extend into the deeper tissue layers.

Symptoms include:

• 
  Bleeding
• Problems with function (movement) or feeling (numbness, tingling) below the wound site
• Pain

Infection may occur with some cuts and puncture wounds. The following are more likely to become infected:

• Bites
• Punctures
• Crush injuries
• Dirty wounds
• Wounds on the feet
• Wounds that are not promptly treated

If the wound is bleeding severely, call your local emergency number, such as 911.

Minor cuts and puncture wounds can be treated at home. Prompt first aid can help prevent infection and thereby speed healing and reduce the amount of scarring.

Take the following steps:

FOR MINOR CUTS

• Wash your hands with soap or antibacterial cleanser to prevent infection.
• Then, wash the cut thoroughly with mild soap and water.
• Use direct pressure to stop the bleeding.
• Apply antibacterial ointment and a clean bandage that will not stick to the wound.

FOR MINOR PUNCTURES

• Wash your hands with soap or antibacterial cleanser to prevent infection.
• Rinse the puncture for 5 minutes under running water. Then wash with soap.
• Look (but do not poke around) for objects inside the wound. If found, don’t remove them. Go to your emergency or urgent care center.
• If you can’t see anything inside the wound, but a piece of the object that caused the injury is missing, also seek medical attention.
• Apply antibacterial ointment and a clean bandage that will not stick to the wound.

• DO NOT assume that a minor wound is clean because you can’t see dirt or debris inside. Always wash it.
• DO NOT breathe on an open wound.
• DO NOT try to clean a major wound, especially after the bleeding is under control.
• DO NOT remove a long or deeply stuck object. Seek medical attention.
• DO NOT push or pick debris from a wound. Seek medical attention.
• DO NOT push body parts back in. Cover them with clean material until medical help arrives.

Call 911 or your local emergency number if:

• The bleeding is severe or cannot be stopped (for example, after 10 minutes of pressure).
• The person cannot feel the injured area, or it doesn’t work right.
• The person is otherwise seriously injured.

Call your health care provider right away if:

• The wound is large or deep, even if the bleeding is not severe.
• The wound is more than a quarter inch (.64 centimeter) deep, on the face, or reaching the bone. Stitches may be needed.
• The person has been bitten by a human or animal.
• A cut or puncture is caused by a fishhook or rusty object.
• You step on a nail or other similar object.
• An object or debris is stuck. Do not remove it yourself.
• The wound shows signs of infection such as warmth and redness in the area, a painful or throbbing sensation, fever, swelling, a red streak extending from the wound, or pus-like drainage.
• You have not had a tetanus shot within the last 10 years.

Keep knives, scissors, sharp objects, firearms, and fragile items out of the reach of children. When children are old enough, teach them to how to use knives, scissors, and other tools safely.

Make sure you and your child are up to date on vaccinations. A tetanus vaccine is generally recommended every 10 years.

Wound – cut or puncture; Open wound; Laceration; Puncture wound

• First aid kit
• Laceration versus puncture wound
• Stitches
• Snake bite
• Minor cut – first aid

Ball JW, Dains JE, Flynn JA, Solomom BS, Stewart RW. Skin, hair, and nails. In: Ball JW, Dains JE, Flynn JA, Solomom BS, Stewart RW, eds. Seidel’s Guide to Physical Examination. 9th ed. . St Louis, MO: Elsevier; 2019:chap 9.

Lammers RL, Aldy KN. Principles of wound management. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 34.

Simon BC, Hern HG. Wound management principles. In: Walls RM, Hockberger RS, Gausche-Hill M, eds, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 52.

Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

First aid for abrasions, cuts and scratches

1. Types of wounds
2. First aid for abrasions
3. First aid for scratches
4. First aid for cuts
5. When to See a Doctor

Image by prostooleh on Freepik

Abrasions, scratches and cuts – violations of the skin – are varieties of superficial wounds. The cut has smooth edges, a linear or linear-arc shape, it can be deep and shallow. If the skin has irregularities, the wound takes on a zigzag or angular shape. Abrasions and scratches are characterized by a larger area and a smaller depth of damage.

The cause of such injuries is accidents at home and at work, careless handling of cutting tools. Given the prevalence of cut wounds, everyone should know the rules for first aid for cuts and other superficial wounds.

Types of wounds

Depending on the degree of tissue damage, incised wounds are divided into deep and shallow. With shallow injuries, mucous membranes, skin and subcutaneous fat are damaged. Examples of superficial wounds are scratches and abrasions. An abrasion differs from a scratch and a cut by incomplete damage to the skin or mucosa. After healing, no traces remain on the affected area.

Injuries in deep wounds affect muscles, large vessels, internal organs.

Compared to other varieties, cuts bleed more. First aid for a cut is required immediately, since even with a small injury, blood loss can be significant if the vessel is damaged. Deep incised wounds pose a threat to health and life. Such injuries cause intense bleeding, which, if not promptly treated, leads to hypovolemic shock, an acute condition characterized by a sharp reduction in blood supply as a result of severe loss of water and electrolytes. If a nerve is affected as a result of an injury, this leads to a violation of the sensitivity of the affected area, possible paralysis or paresis – impaired mobility. When internal organs are injured, internal bleeding can develop, which leads to traumatic shock or peritonitis – inflammation in the peritoneum.

First aid for abrasions

Mechanical damage to the mucous or skin can be obtained at home, at work, during outdoor activities. Abrasions occur as a result of a bruise, when struck by a hard object or falling on the pavement.

Compared to other incised wounds, abrasions are characterized by a minimal degree of damage, so a person can provide first aid to himself on his own:

1. Wash hands thoroughly and treat them with an antiseptic.
2. Wash affected area with running water.
3. Make sure that the wound is free of sand, earth, and other foreign bodies that may have been introduced as a result of a fall.
4. Treat the edges of the wound with an antiseptic solution, preventing it from getting inside. For these purposes, hydrogen peroxide, iodine or brilliant green is suitable. If they are not in the first aid kit, you can use a weak solution of potassium permanganate or furacilin.

When providing first aid for abrasions, the use of plasters and multi-layer dressings should be avoided. In the first hours after the injury, the abrasion “gets wet”, that is, fluid is constantly released on the surface of the wound. Dressings stick to the skin and injure it when removed. Extensive abrasions can be temporarily covered with a bandage while a crust forms, but tissue healing is faster with air access. To restore the skin, creams and ointments with an antiseptic and regenerating effect are used.

Under the crust, new skin is formed. The edges of the wound gradually begin to peel off, but you should not tear it off or comb it, as this will lead to re-injury and may cause infection.

First aid for scratches

Knowing what first aid is for abrasions, the same recommendations can be applied when scratches appear:

1. The damaged area is washed with water and treated with an antiseptic solution.
2. If the scratch is deep, apply a bandage or band-aid.
3. To accelerate healing, anti-inflammatory and regenerating agents are used. Ointments and creams with essential oils of tea tree, rosemary, chamomile extract, aloe, panthenol have such properties.

First aid for cuts

Incised wounds most often occur with careless handling of sharp objects. First aid for cuts and abrasions has a lot in common:

1. Treat the cut with an antiseptic or antibiotic ointment (prescribed by a doctor).
2. If the cut is not deep and involves only the skin, wash the wound profusely and cover with a bandage, gauze, or clean cloth.
3. The bandage on the cut should be changed 1-2 times a day, avoiding contamination of the wound.

When to see a doctor

As a rule, small scratches and abrasions do not cause serious health problems and allow you to do without contacting a specialist. With regard to cuts, it is important for the patient to objectively assess the degree of tissue damage. If the wound strongly diverges to the sides, the fat layer and muscles are noticeable, there is severe bleeding, it is necessary to call an ambulance or take the person to the emergency room. Before a visit to the traumatologist, the wound should be washed and a pressure bandage applied to slow down the loss of blood. If an object that caused damage remains in the wound, it cannot be removed on its own, as this will increase bleeding.

For large deep cuts, surgical treatment of the wound is required, followed by suturing.

In some cases, medical attention may be required for minor injuries. If the scratch was received by a rusty nail or particles of glass or earth got inside, you need to see a doctor. You should find out if the person is vaccinated against tetanus. In the absence of preventive vaccination, in case of deep contamination of the wound, the doctor will give an injection.

Appeals to a medical institution require any wounds with signs of infection, which is manifested by suppuration, swelling of tissues, fever.

How to properly treat wounds and abrasions of a child “Persona Childhood”

All small children are fidgety, they always want to run, jump and play pranks. But sometimes games end in frustration in the form of various kinds of injuries; such as abrasions or cuts.

In this article, we will look at how to distinguish an abrasion from a cut, and what assistance should be provided.

It should be noted that a wound is a generalized term for all mechanical damage that is accompanied by damage to the skin and mucous membranes, and is characterized by pain, bleeding and gaping.

The simplest example of a wound is an abrasion and a cut.

Abrasion is a mechanical superficial injury with a blunt object to a section of the skin. Superficial damage to the skin, when only the upper layers of the skin are damaged, is called excoriation (from Latin excorio – “to peel off the skin”). Most often, excoriations occur with minor mechanical damage.

In most cases, abrasions are accompanied by slight bleeding, dirt and other foreign bodies getting into the wound.

Cut is a common name for a not deep and not large incised wound: damage to the skin and (sometimes) subcutaneous tissue resulting from exposure to a sharp object (sharp stone, piece of glass, nail and other dangerous objects). Cuts are superficial and deep.

Before proceeding with first aid, it is necessary to assess whether the injury is dangerous and whether specialist assistance is required.

No medical attention required if wound:

1. Less than 2 centimeters in length.
2. Only affects the top layer of skin and subcutaneous tissue.
3. Has smooth edges.
4. Accompanied by minimal bleeding.

!!! Seek immediate medical attention if:

1. Scarlet blood flows from the wound.
2. The edges of the wound are uneven.
3. Eyes, mouth, nose damaged.

After you have assessed the damage received by the baby, you can start treating the wound:

1. We wash the wound. While the blood is flowing, most microbes will leave the damaged area on their own. With a dry cotton swab or paper towel, we remove particles of dirt from the abrasion. Move carefully from the center of the wound to its edges. Make sure all dirt is removed. Then rinse the wound with warm water and pour hydrogen peroxide over it. This will disinfect the wound and help stop the bleeding. Some experts advise diluting the peroxide with water so as not to burn the healthy skin around the wound.
2. Stop the bleeding. After treating the cut with peroxide, apply a dry gauze bandage for 10 minutes. Try not to overtighten the injured area (except in cases of severe and prolonged bleeding).
3. After the bleeding has stopped, the dressing can be removed and an antiseptic applied.
1. A. Brilliant green solution . It is used from infancy to heal the umbilical wound. Zelenka perfectly fights pathogenic microbes, dries up abrasions and promotes its faster healing.
2. B. Iodine – 5% solution is recommended for children. More allergenic, moreover, causes burning and itching. Not recommended for babies. Iodine cannot be poured into the wound itself, the skin around the abrasion or cut is treated.
3. C. Weak solution of potassium permanganate – has a disinfecting and wound healing effect.
4. D. Levomekol – Excellent wound healing ointment. Suitable also for the smallest children.