Nasal Cannula Skin Breakdown in Children: Prevention and Care
Skin breakdown from a nasal cannula usually starts as persistent redness where the prongs, tubing or straps touch your child’s face, and it is easiest to stop at that stage. The most useful habits are a correctly sized cannula, gentle securing with no tight straps, dry skin, and a look under and around the device every time you do care. If you see redness that does not fade, a sore, or any open skin, tell your child’s care team the same day.
This guide explains what breakdown looks like, why children are prone to it, what you can do at home, and who to call. It is written for parents and family caregivers of children on home oxygen or high-flow nasal cannula, and for families who are new to in-home nursing.
TL;DR
Children’s skin is thin and has an immature barrier, so device-related pressure injuries are common in pediatrics.
The nasal bridge, the columella (the tissue between the nostrils) and the skin behind the ears are the places to check.
Look at the skin under and around the device at least every 4 hours or with cares, as clinical guidelines advise for hospital settings.
Dressings and barrier films can protect skin but do not remove pressure, and they never replace a hands-on skin check.
Report new redness, sores or sizing problems to your child’s physician or respiratory therapist promptly.
Table of Contents
What skin breakdown from a nasal cannula looks like
Breakdown is a spectrum. Researchers who classify nasal pressure injuries in children describe it in stages: Stage 1 is persistent redness on intact skin, Stage 2 is a shallow sore or erosion with partial skin loss, and Stage 3 is dead tissue with full-thickness skin loss. Parents will almost always meet Stage 1 first, which is why a quick daily look matters so much.
In practical terms, watch for:
Redness that is still there after the device has been off the skin for a short while
A shiny, tight or dented patch of skin
Dry, flaky or cracked skin at the nostril rim
A small blister, scrape or weeping spot
A child who suddenly fights the cannula, rubs their nose or cries when it is touched
The location tells you a lot. Nasal injuries related to respiratory support appear on the nasal bridge and the columella, while lesions from face masks can occur around the nose and mouth. Children’s Minnesota’s high-flow guideline also points to the back of the ears, the bridge of the nose and the nares as the spots to focus on during inspection.
Why children’s skin breaks down so easily
A child is not a small adult when it comes to pressure. The Royal Children’s Hospital Melbourne notes that pediatric pressure injuries are most often linked to medical devices, because of an immature skin barrier and lower tissue tolerance than adults have.
A nursing study from South Korea lists the usual contributors: wrong device size, excessive strap tension, friction from the child’s movement, moisture trapped under the interface, and thin, immature skin. Each of these is something a caregiver can influence.
Size and fit
Prongs that are too large press on the septum and nostril walls. Prongs that are too small can slip and rub. The 2025 French review of nasal injuries advises that, for pediatric patients, you consider the child’s size and weight and use commercially available pediatric products rather than adapting standard equipment. Size also matters for breathing: the Canadian Paediatric Society cautions that overly large cannulae can raise pressure in the chest in children who cannot release it by opening the mouth, so high-flow cannulae must be properly sized.
Tension and friction
A cannula held tightly against the face is the classic cause of a pressure mark. A child who squirms, sleeps on one side or pulls at tubing adds friction. Neither problem is anyone’s fault, but both call for a secure, loose fit and a routine of repositioning.
Moisture
Drool, nasal secretions, sweat and humidified gas all collect under tape and straps. Wet skin is weaker skin. Drying the area gently at each check is one of the simplest protections you have.
Time on the device
The longer a child needs support, the greater the exposure. In infants, known risk factors for nasal injury include birth before 30 weeks, birth weight under 1,500 g, and a long duration of respiratory support. Many medically complex children at home fall into this group, which makes a steady prevention routine part of daily care rather than an occasional task.
How to check your child’s skin: a routine you can keep
How often should you look? In clinical settings, guidance for high-flow therapy says to inspect skin beneath and around oxygen devices at least every 4 hours or during routine cares. That is written for healthcare providers, so at home use it as a benchmark: tie the check to things you already do, such as diaper changes, feeds, repositioning, and tubing checks.
A simple check takes under a minute:
Wash and dry your hands, then look at the face in good light.
Lift the prongs gently and check the inside of the nostrils, the rim, and the columella.
Look at the nasal bridge and cheeks where tubing and tape sit.
Check behind the ears and along any strap path.
Feel for dampness and pat dry with a soft cloth.
Reposition the tubing so it does not rest on the same spot as last time.
Note what you saw, even if it was nothing, so the next caregiver can compare.
Written notes are especially useful when several people share a child’s care, because a mark that was “a little pink” yesterday and “darker” today is easy to miss without a record. If your family uses a nursing log, add a skin line to it. Our guide to atraumatic care in pediatric nursing covers the same gentle-handling mindset for other procedures.
Prevention that works at home
Choose and secure the cannula carefully
The American Thoracic Society’s guideline on home oxygen for children says that cannulae should be appropriately secured to the face and replaced as often as weekly, or as needed, to maintain skin integrity. Ask your home equipment provider or respiratory therapist to show you the right size and a secure but not tight method for your child specifically. Do not cut or modify tubing or prongs yourself.
Consider a protective layer, but keep checking
Barrier films, silicone dressings and thin foams are sometimes used under devices. The Minnesota Hospital Association’s guidance notes that these dressings do not reduce pressure and must not replace routine, hands-on skin inspection. Ask your child’s physician or respiratory therapist which product, if any, suits your child before you place anything on the skin, and ask how often to change it.
Relieve pressure, not just cover it
Repositioning tubing, rotating where tape sits (as your care team allows), and making sure heavy tubing is supported by the bed or clothing rather than hanging from the face all lower pressure at the source. For a broader look at how families can build safe routines around repositioning and pressure, the resource on preventing device-related pressure injuries in children is a helpful companion.
Keep skin dry and the humidity right
Moisture trapped under the interface is one of the documented causes, so wipe away secretions promptly and dry the skin before re-securing. If your child is on humidified oxygen or a ventilator, humidity settings matter for comfort and airway health too; see our parent guide on home humidification for ventilated children.
Catch problems early
A Turkish study of neonates on noninvasive ventilation concludes that early detection and effective nursing care can help prevent nasal pressure injuries. That finding is about newborns, but the principle carries over to home: the person who sees the child most often is the best early-warning system.
What to do if you see redness, soreness or an open sore
Act at the first sign. Guidance for staff says to consult respiratory therapy for proper sizing and adjustment as soon as there is irritation or damage under a respiratory interface. At home, that translates to the following.
Redness that does not fade: take the pressure off that spot, dry the skin, reposition the tubing, and call your child’s respiratory therapist or home equipment provider about fit. Mention it to your pediatrician as well.
A sore, blister or broken skin: call your child’s physician the same day. The same guidance advises that physicians should be notified when new pressure injury findings appear.
Spreading redness, warmth, drainage, fever, or a dark or black area: contact the physician right away, because these can signal infection or deeper injury.
Trouble breathing, blue or gray lips, or a child who is hard to wake: call 911. Skin is secondary to breathing.
Do not stop oxygen or high-flow therapy because the skin looks sore unless your child’s physician tells you to. Your care team may change the interface, rotate between types, or add protection, but those decisions belong to them.
Why the urgency? Because the outcome gets worse with delay. The Turkish neonatal study notes that advanced injury, such as deep septum necrosis, may ultimately need surgical repair if not managed early. Most families will never see anything close to that, and a quick response to Stage 1 redness is how it stays that way.
Cannula skin care alongside other devices
Many children who use a nasal cannula also have other equipment: a tracheostomy, a ventilator, a feeding tube or a central line. Each touches skin, and each has its own checks. A skin routine that covers all of them at once is easier to keep than several separate ones. These guides can help you build it:
For a child on a trach, the question of moving from cannula to other airway support, and how skin factors in, is a conversation for your child’s pulmonologist or ENT team.
Our perspective
Skin breakdown is rarely a single dramatic event. It is a series of small things that nobody had time to notice: a strap that got a little tighter, a patch of dampness, a mark that looked fine yesterday. That is why we think the most protective feature of home care is a consistent person who knows your child’s face. When the same nurse sees your child day after day, a new pink spot stands out. When faces rotate, the change is easy to miss. This is the reason we built our approach around continuity. We do not start care until the family, the nurse and our team all agree it is a good fit, which we call our 3 Thumbs Up Rule, and we publish measures such as shift fill and nurse retention so families can see how reliable we are. Our nurses care for children with tracheostomy, ventilator, feeding tube, seizure, cardiac and neurological needs across Georgia, and a skin check belongs in every shift alongside those tasks. We also believe parents should not have to carry the paperwork alone. We handle GAPP and Medicaid paperwork on a family’s behalf so that your energy goes to your child. Opulent
In-home pediatric nursing in Georgia
If your child is eligible for Medicaid or the Georgia Pediatric Program (GAPP) and needs skilled nursing at home, Opulent Private Care provides in-home pediatric nursing across Georgia, including care for children with tracheostomy, ventilator and feeding tube needs. We match nurses on clinical and family fit, and we complete GAPP and Medicaid paperwork for you. Learn more about in-home skilled nursing under GAPP or our trach, vent and G-tube nursing.
Already have an agency but want steadier staffing? See how a GAPP agency transfer works, or ask about our family caregiver option.
Questions to bring to your child’s care team
Appointments move fast, so it helps to arrive with specifics. Consider asking:
Is my child’s cannula the right size, and how will we know when they outgrow it?
How often should we replace the cannula and tubing at home?
Is a barrier film or dressing appropriate for my child’s skin, and which one?
Which spots should we rotate or protect, and how?
What counts as a problem we should call about the same day?
Who do we call after hours about skin or fit problems?
Take photos of any mark, with the date, to show the physician. A picture often communicates more than a description over the phone.
FAQ
How quickly can a nasal cannula cause skin breakdown in a child?
It varies with the child’s skin, the fit and the amount of moisture and friction, so there is no safe “grace period.” Stage 1 redness can appear while a child is still on the same cannula that seemed fine last week. That is why routine checks and prompt sizing advice matter more than any timetable.
Can I put a bandage or barrier film under the cannula?
Possibly, but ask your child’s physician or respiratory therapist first. Barrier films, silicone dressings and thin foams are used in pediatric care, yet they do not reduce pressure and cannot replace skin inspection. Choosing the right product and changing it on schedule is part of the plan your care team gives you.
How often should the cannula be replaced at home?
The American Thoracic Society’s home oxygen guideline says cannulae can be replaced as often as weekly, or as needed to keep skin intact. Your child’s care team will set the schedule that fits your child and your equipment.
Does a nurse at home help with skin checks?
Yes. A skilled pediatric nurse looks at skin as part of routine care and tells the physician about new findings. If your child qualifies for GAPP, ask Opulent Private Care how in-home nursing can support your child’s daily routine.
Sources
Facial skin breakdown in patients with non-invasive ventilation (PMC)
Nasal Injuries Related to Respiratory Support Interfaces (PMC, 2025)
Royal Children’s Hospital Melbourne: Pressure injury prevention and management
Minnesota Hospital Association: Pressure injury and respiratory devices (2020)
Home Oxygen Therapy for Children: An Official American Thoracic Society Clinical Practice Guideline
Canadian Paediatric Society: Use of high-flow nasal cannula oxygen therapy in infants
Nasal pressure injury in neonates on noninvasive ventilation (Ergün & Aktaş, 2023)
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