Burn Care

Burns are common injuries in children. A burn happens when any part of a child’s body comes into contact with something that is hot. The seriousness of the burn depends on the temperature of the material and on how long the child was in contact with it. Younger children and infants have thinner skin, and they can burn much more easily than most adults would believe. The most common kind of serious burn injury is a scald burn, from hot liquid. Children also get burned from contact with hot parts of stoves, ovens, and fireplaces, and from electrical wiring. Children can also get burns from chemicals (such as drain cleaners or acids) or from radiation. Almost every child has experienced a mild burn from the sun, which is the mildest form of radiation burn.

What all burns have in common is that there is some damage to the skin. When the damage is limited to the top layers of skin only, we call it a "first degree" or "superficial" burn. These heal well and don’t require much treatment. A "second degree or "partial-thickness" burn goes through the top layers and into the middle layers of skin. Because fluid builds up in the damaged areas, partial-thickness burns always have blisters in at least some parts. Partial thickness burns can heal well when they get the right kind of treatment. Without it they can get infected and cause serious scars. When a burn goes all the way through the skin down to the fat, muscle, or bone underneath, it is called a "full-thickness" burn. Full-thickness burns always produce scars and often permanent damage to the tissue underneath.

Our two biggest immediate concerns in children with burns are pain control and loss of fluid. Partial-thickness burns are the most painful because some of the skin has literally been split in half, exposing many nerve endings. First-degree burns can be quite painful, but they don’t hurt too badly if they don’t touch anything. Full-thickness burns do not hurt at all because the tissue is already dead. The edges of full-thickness burns often include areas of painful partial-thickness burns as well.

The skin is the body’s first defense against infection, and also controls the amount of water in our bodies. When large areas of skin get burned, there’s nothing there to keep the water and minerals inside where they belong. Children with large surface area burns can lose large amounts of water very quickly (within half an hour) and can go into shock if they don’t get the right treatment. Later on, burns can become infected, which is dangerous to the child and can cause more severe scarring.

If you took your child to the doctor or hospital, they have probably already provided the beginnings of treatment. The doctors cleaned the burn and removed any tissue that was obviously destroyed. If your child had a partial- or full-thickness burn, the doctors probably applied some form of dressing with or without antibiotic in it to prevent infection. There are many different burn dressings available. Simple antibiotic ointment such as polysporin or bacitracin are among the most common and most effective. Some doctors use silver sulfadiazine (Silvadene® and others) cream, which helps the burn feel cool for a brief period. Others use iodophor gauze (Xeroform® and others) that is soaked in petroleum jelly. After applying the dressing, the doctors will have applied some kind of covering. Most doctors use simple gauze dressings. Some burn specialists use Telfa® pads or specialized "occlusive" burn dressings.

The doctors will also have given your child some strong medication for pain. This is very important, because burns hurt very badly, and children are also usually very frightened by being burned. Most pediatric experts will give a narcotic pain medicine like morphine before trying to clean or do anything painful to a burn. After the burn dressing is in place, the pain usually gets much less severe. Your doctor will have given you some form of pain medicine to use at home. Some doctors only recommend acetaminophen (Tylenol®) or ibuprofen (Advil® or Motrin®). These medications may be all your child needs, but please let your doctor know right away if they are not. Many children need some stronger medication such as codeine or hydrocodone (Lortab®); both are available in liquid forms. Do not be afraid to ask for more powerful medicine if you feel your child is in serious pain. Of course, also do not give more of the medication than the doctor prescribed without checking with the doctor first.  You can read our Aftercare Instruction on giving Oral Medications.

Your doctor will tell you how often to change the burn dressings. We usually do not change them more than once a day. For large or complicated burns, some doctors will order a visiting nurse, who can do the dressing changes and may be able to give pain medicaition during the changes.

All superficial and most partial-thickness burns heal quite well without scarring. Partial-thickness burns will cause scars if they get infected. Watch your child’s burn carfully for signs of infection, which include:

• Fever (some children with medium to large burns run a fever the day after the burn, but any fever over 101.5 ° F or 38.0 ° C is a concern)
• Pain that increases rather than decreases over time, or pain that you cannot control with medications
• Redness that continues to spread away from the burned area more than 12 hours after the burn
• Any new redness at all that was not present when you saw the doctor
• New blisters
• A foul smell from the burn
• Tense or painful swelling of the skin in the part of the body away from the burn, or swelling of fingers or toes.
• Numbness, tingling, pain, paleness, or coolness of the hands or feet on a limb that was burned.
• Changes in consciousness such as lethargy (sleepiness) or irritability.

If any of these occur, please be sure to call your doctor’s office right away. If your child or infant is difficult to awaken or seems unconscious, go directly to the emergency room.

Very often burns are more serious than they look at first. In particular, the blisters of partial-thickness burns may not develop completely until more than six hours after the burn. It is generally a very good idea to bring your child to be seen by a doctor after any burn that could be more than just a tiny one.

You may have met with a social worker or a child protective worker when you saw the doctor. This is because, unfortunately, so many children are injured each year by adults that we all want to be sure each child has a safe place to live. It is best to tell the worker everything that happened – we all make mistakes or have a moment when we are distracted and don’t pay attention. If you did not see the burn happen, or if you are suspicious that someone may have burned your child intentionally, please let your doctor know right away. This will help to protect your child and every person who cares for him or her.

Most of the time it is very clear what caused a burn, because either the child can tell or a parent can tell us. Once in a while, though, a child develops redness and blistering without any known history of a burn, and when there is no reason to suspect child abuse. Some conditions that can cause blisters are infections such as "bullous impetigo," or the much rarer "scalded skin syndrome." Both of these can be easily identified by a doctor. Occasionally an infant will develop blisters with redness on the feet. This often happens because someone with good intentions has put new shoes on the baby’s feet that don’t fit well. Those blisters can be very frightening, but they do well once we take away the shoe. A few kinds of biting spiders or insects can cause a blister at the site of the bite. The brown recluse spider can cause fairly serious tissue damage with its painless bite. If your child has a small blister that grows and turns dark red or black in the center, it could turn out to be a spider bite. Please check with your doctor if you have any concerns about any of these things.

Having a sick child at home can be tiring and frustrating. As badly as you feel for your child, you yourself may feel out of control, inadequate, or even angry – these are normal feelings. Babies and children who are sick are often fussy and irritable, and parents often feel stressed to the breaking point, especially when there are other children or adults to take care of. One of the best things you can do for your child is to be sure you take care of yourself. If possible, try to have other adults take care of your child for an hour or two each day so you can get some rest or just some quiet time. If you get so stressed that you are worried about your baby’s safety, call your local Parents’ Anonymous Hotline or visit the Parents Anonymous website to find a group near you.