Introduction

A Pressure Mapping System is a medical device that measures and shows how pressure is distributed across a surface in contact with the human body. In simple terms, it tells exactly where pressure is highest and lowest on the body at any given moment.

In pediatric settings, this device plays an important role in preventing pressure injuries (sores), assessing how a child sits or walks, and making sure support surfaces and equipment are safe and comfortable. Children are not small adults - their skin is more delicate, their bodies are still growing, and they may not be able to communicate discomfort the way adults do. Pressure mapping helps fill that communication gap with real data.

Purpose and Where It Is Used

The primary purpose of a pressure mapping system is to measure interface pressure - the force between the body and any surface it rests on (mattress, wheelchair cushion, shoe insole, etc.).

What It Helps With

• Detecting dangerous high-pressure zones on the skin before a sore or injury develops
• Assessing how evenly a child's weight is distributed while sitting or lying
• Evaluating foot pressure and walking patterns (gait analysis)
• Selecting the right mattress, cushion, or seating system for a child
• Checking how well orthotic devices (splints, insoles) are redistributing pressure
• Monitoring children who are immobile or have limited ability to move on their own

Where It Is Used in Pediatric Care

Types of Pressure Mapping Systems

Pressure mapping systems are classified based on where they are used (the application site) and the type of sensor technology they use.

By Application

By Sensor Technology

How a Pressure Mapping System Works

The system consists of three main parts working together:

1. Sensor Mat or Pad - A thin, flexible mat filled with hundreds to thousands of tiny pressure sensors arranged in a grid. This is placed between the body and the surface (mattress, seat, shoe).
2. Data Processor / Interface Unit - Collects electrical signals from all the sensors and converts them into pressure values (measured in mmHg or kPa).
3. Software and Display - Shows the pressure data as a colour-coded map on a computer or tablet screen in real time.

How to Use a Pressure Mapping System: Step-by-Step

The steps below apply generally to most pressure mapping systems. Always follow the specific instructions provided with the device being used.

Step 1: Preparation

1. Check that the sensor mat, cables, and software are in working order before the session.
2. Turn on the connected computer or display device and open the pressure mapping software.
3. Allow the system to warm up as per the manufacturer's instructions (some systems need a few minutes to stabilise).
4. Clean the sensor mat according to the manufacturer's guidelines. Most mats have a wipeable cover that can be cleaned with a mild disinfectant between uses.

Step 2: Calibration

1. Calibrate the system before each session or as required by the device manual. Calibration ensures accurate readings.
2. For seat mapping systems, place the mat on the cushion or seat without the child first and zero the baseline on the software.
3. For mattress systems, lay the mat flat on the mattress and confirm the display shows no pressure before the child lies down.
4. For foot pressure platforms, follow the software's calibration wizard before the child steps on.

Step 3: Positioning the Sensor

1. Place the sensor mat correctly on the surface to be assessed (seat cushion, mattress, floor platform).
2. For in-shoe insoles, select the correct insole size for the child's foot. Insoles that are too large or small will give inaccurate readings.
3. Ensure the sensor mat is flat with no folds or air bubbles trapped underneath.
4. Connect the mat to the data processor unit securely.

Step 4: Positioning the Child

1. Help the child move onto the sensor mat gently and safely.
2. For seating assessment: the child should be seated upright in the usual position they would maintain during wheelchair or seat use.
3. For mattress assessment: the child should lie in the position they normally rest or sleep in.
4. For foot/gait assessment: ask the child to stand naturally on the platform, or walk across it at a comfortable pace.
5. Wait a few seconds for the reading to settle before recording data.

Step 5: Reading and Recording Data

1. Observe the colour-coded map on the screen. Note areas showing orange or red (high pressure).
2. Use the software tools to identify peak pressure values, pressure distribution percentage, and contact area.
3. Take a snapshot or recording as required. Most software allows saving images, short recordings, or full session data.
4. For gait analysis, record the child walking across the platform at least 3 times for consistent data.

Step 6: Interpretation

1. Review the pressure values. Areas with sustained pressure above 30 mmHg over bony prominences (tailbone, heels, back of head) are considered clinically significant and need intervention.
2. Compare the data before and after adjusting the cushion, mattress, or position to see if the change improved pressure distribution.
3. For gait and foot mapping, the data is reviewed against age-appropriate normative data to identify deviations.
4. Document findings as part of the clinical record.

Step 7: After the Session

1. Help the child off the sensor mat carefully.
2. Save and back up all session data in the software.
3. Clean the sensor mat as per the manufacturer's cleaning protocol.
4. Store the mat flat or rolled (not folded sharply) to protect the sensors.
5. Turn off the system and disconnect cables properly.

Precautions and Potential Risks

General Precautions

• Always ensure the device has been properly calibrated before recording data. Uncalibrated readings are unreliable and can lead to incorrect clinical decisions.
• The sensor mat should never be folded sharply or placed under excessive weight when not in use, as this can permanently damage the sensors.
• Check that cables are not running across walking paths during gait assessments to prevent tripping.
• Children with open wounds, active skin infections, or fragile skin conditions (such as epidermolysis bullosa) should not have a standard sensor mat placed directly on the affected skin without specific clinical direction.
• The device itself does not treat or prevent pressure injuries on its own. It is a diagnostic and monitoring tool. Actual repositioning, cushion changes, and skin care remain essential alongside its use.

Device-Related Risks

• False sense of security: A green or blue reading does not automatically mean a child is safe from pressure injury. Sensor placement errors, poor calibration, or unusual body shapes can affect readings.
• Sensor mat slipping: If the mat shifts during assessment, data becomes inaccurate. Ensure the mat is secured or held in place for the duration of the reading.
• Electrical safety: All devices must be used with the appropriate power supply and should be checked for electrical safety (cords, connectors) before each use in a clinical environment.
• Latex or material sensitivity: Some sensor mat covers contain latex or other materials. Check whether the child has any known material allergies before contact.

Precautions Specific to Neonates and Infants

• Sensor mats used with premature infants or neonates should be specifically validated for low-pressure ranges, as infant body weight generates far less pressure than older children or adults. Standard adult-calibrated mats may not accurately detect low pressures relevant to neonatal care.
• Sensor mats should be soft, thin, and non-constricting. Bulky or stiff mats are not appropriate for neonatal use.
• All equipment placed near neonates in a NICU must be compatible with the neonatal care environment and cleared for use by the clinical team in charge.

How to Keep the Device Safe and Well-Maintained

• Cleaning: Use only the cleaning solutions and methods recommended by the manufacturer. Harsh chemicals can damage sensor coatings. Most mat covers are designed for mild disinfectant wipes.
• Storage: Store the sensor mat flat or gently rolled. Never fold it or place heavy objects on top. Keep it in its protective case when not in use.
• Cables and Connectors: Handle cables gently. Do not pull on cables to disconnect - always grip and release from the connector itself. Inspect cables regularly for signs of wear or damage.
• Software and Calibration Files: Keep the software up to date as per the manufacturer's guidance. Back up calibration data and session records regularly.
• Sensor Mat Lifespan: Sensor mats have a finite lifespan depending on use. Follow the manufacturer's guidance on how many sessions the mat is rated for, and replace it when performance degrades or it reaches its limit.
• Environment: Avoid storing the device in very hot, cold, or humid conditions. Extreme temperatures can affect sensor accuracy and shorten the device's working life.
• Regular Servicing: Have the device checked and serviced by a qualified technician at the intervals specified by the manufacturer. This is particularly important in clinical settings where the device is used frequently.

Additional Information Worth Knowing

Pressure Mapping and Cerebral Palsy

Children with cerebral palsy often spend long hours in wheelchairs and may have difficulty changing position independently. Pressure mapping is particularly valuable in this group because it helps select the most appropriate seat cushion and identifies high-pressure zones that need to be addressed through seating adjustments or pressure-relief schedules.

Pressure Mapping for Flat Feet and Foot Deformities

Plantar pressure mapping (pedobarography) is a well-established method for evaluating foot problems in children. It can detect abnormal pressure distribution associated with flat feet (pes planus), high-arched feet (pes cavus), clubfoot follow-up, and in-toeing or out-toeing gait patterns. It also helps assess the effectiveness of orthotic insoles before and after fitting.

Pressure Mapping vs. Visual Skin Inspection

Visual inspection of the skin is essential and should always be done routinely. However, pressure damage can begin in deep tissue before it is visible on the skin surface. Pressure mapping provides an added layer of information by identifying high-risk zones before visible changes appear, allowing earlier intervention.

Availability Across Settings

High-quality commercial pressure mapping systems (such as those made by XSENSOR, Tekscan, Novel, Vista Medical, and others) are available internationally and are used in clinical settings across many countries. Some research from lower-resource settings has developed lower-cost alternatives using force sensing resistors, demonstrating that the principle of pressure mapping can be applied even where commercial devices are not accessible.

Who Uses This Device in a Clinical Team

Pressure mapping is used by a range of healthcare professionals including pediatricians, occupational therapists, physiotherapists, orthotists, rehabilitation engineers, and nursing staff. Interpretation of data is always done within the context of the child's overall clinical picture and should involve the relevant members of the care team.

Frequently Asked Questions