Burn care: How to recognize severity and care for burn injuries in children

October 6, 2020
PHOTO: Getty Images

Fire and burn related injuries are the third leading cause of death in children ages 1 to 14. According to the CDC, more than 300 children are treated in emergency departments and two children die each day from burn or fire-related injuries. It is important for caregivers to know how to properly identify the severity burn and when to seek medical treatment. This post will review the different potential causes of burns, ways to recognize different types of burns, how to administer first aid, when to seek additional help, key things to avoid, and helpful tips to prevent burns in children.   

Causes

Young children most commonly suffer burns from scalding hot liquids or steam. Older children are more likely to injure themselves with flames or direct contact with fire. It is essential for caregivers to be aware of the various potential sources of burns in order recognize potential hazards and to ensure a safe environment for children. Burns can be caused by: 

  • Radiation – The most common cause of a radiation burn is the sun. Ultraviolet rays can severely damage unprotected skin. It is essential for children to wear minimum SPF30 sunscreen during the day whenever they may be exposed to sunlight. Other sources of radiation include: X-ray imaging or cancer radiation treatments.  
  • Thermal – A thermal burn occurs when something hot makes contact with the skin and raises the temperature of the tissue underneath. Thermal burns can occur from hot bath water, scalding hot liquids such as coffee or cooking liquids, hot foods such as spaghetti or steam.  
  • Chemical – Chemical burns can occur internally or externally. It is important for caregivers to secure all toxic substances including household cleaners and automotive liquids out of reach. Internal burns may occur from swallowing strong acids, such as bleach or button batteries. External chemical burns can occur when certain chemicals are spilled onto the skin or eyes. If a chemical burn occurs, call poison control and seek medical care immediately. Poison Control: (800) 222-1222. 
  • Electrical – Electrical burns occur from coming in contact with an electrical current. Children can sustain electrical burns from biting on cords or wires. They can also occur from sticking fingers or objects into electrical sockets. While these burns may appear small on the outside, the electrical current also travels through the body and burns all tissues along its path. If you believe your child may have sustained an electrical burn, seek medical attention immediately.  

Types of burns

  • First-degree burn – A simple sunburn is an example of a first-degree burn. The skin will appear very red and painful. These burns are superficial and only affect the very top layer of skin called the epidermis. They do not disrupt the integrity of the skin. 
  • Second-degree burn – A severe sunburn can become a second-degree burn. These burns are also described as “partial thickness” as they extend through the top layer of skin called the epidermis and involve the layer beneath it known as the dermis. When the top layer of skin is destroyed and the layer beneath it is affected, the skin will blister. These burns are severely painful and can be recognized by their blistered appearance.
  • Third-degree burn – A third-degree burn is the most severe type of burn and it is always a medical emergency. These burns are also described as “full thickness” as they extend through and injure all of the layers of the skin. The dermis is the deepest layer of skin and it contains all of our nerve endings, blood vessels, hair follicles, sweat and oil glands. A third-degree burn goes through this deep layer, injuring all of the structures that lie within it. As a result, these burns will appear dry, white, leathery, charred and painless.  

First aid

  1. Stop the burning process. Run the burned area under cool water for 20 minutes. Do NOT use refrigerated or ice water. Extremely cold water will constrict the blood vessels around the injury and can lead to even more damage. If the burn is very large, do not rinse with cold water as this can cause the child’s body temperature to drop. In the case of large burns, please seek medical treatment immediately. 
  2. Remove all jewelry. Burns cause significant swelling. If the victim is wearing jewelry on any of the areas that are burned, carefully remove it immediately. Swelling around jewelry can cut off circulation to surrounding tissues. This can lead to more damage that may not be reversible.  
  3. Carefully remove clothing. Use caution when removing clothing over burned areas. If the clothing is stuck to the skin and cannot be gently removed, leave it in place. Use scissors to cut around it and remove the clothing that is not adhered to the skin.  
  4. Cover the burned area with a clean, dry bandage. If a first aid kit is available, use a piece of dry gauze and paper tape to cover the burned area. Other supplies that may be utilized include: abdominal pads, nonadherent dressings, and large bandages. Use caution when applying tape. If a gauze bandage or ACE wrap is used to hold the dressing in place, ensure it is not wrapped tightly. The area should be gently and loosely covered so that the burn is not compressed.   
  5. Change bandages daily. Remove the bandage every day. Gently clean the area with soap and water. Do not scrub. Simply apply soap over the burn and rinse with cool water. Dry the area. Apply any prescribed topical ointment or Vaseline and cover the burn again with a new dry dressing. Burns can easily get infected. It is important to keep the injury clean and perform dressing changes every day.  
  6. Apply topical ointment or Vaseline daily. It is important to keep the burn moisturized to promote healing and prevent the bandage from sticking. Apply a generous amount of triple antibiotic ointment or Vaseline to the burn with each dressing change. Antibiotic ointments such as Neosporin should only be used for the first 5-7 days after injury. Prolonged use of antibiotic ointments may cause a skin reaction and a rash. After 5-7 days have passed, discontinue the antibiotic ointment use and use Vaseline daily.

When to seek medical treatment

Depending on the location and severity of the burn, your child may need to seek additional medical treatment. Call 911 or take your child to the nearest emergency room if he or she has suffered any of the following injuries: 

  • Second-degree burn  
  • Third-degree burn 
  • More than 10% of the child’s total body surface area is burned. For a general estimate, if the area burned is equal to or larger than the child’s arm, it is considered a large burn. Do not use a wet compress on large burns because they can cause the child’s body temperature to drop.  
  • Burns involving the face, hands, feet, genitals or a moving joint. Burns or soot on the face may signal an airway burn. Airway burns are a true emergency. Burns within the airway can cause significant swelling which can ultimately block off the airway. Burns around a moving joint, extremities or the genitals can cause significant swelling that can ultimately block off blood supply to the area. When the blood supply to an area is cut off, the tissue can die and the damage is irreversible. 
  • Burns resulting from fire, electrical sources, or chemicals. During a fire, many toxic gases are released into the air. It is difficult to know the extent of a child’s injuries following a fire and they should be further evaluated by a medical provider. When electricity contacts the skin, it travels through the body. As the electricity travels through the body, it can injure all of the tissues and organs along its path. If a small burn is visualized on the outside of the skin from an electrical source, the child needs to be further evaluated for additional injuries that cannot be seen. Chemicals can continue to burn and injure the child after initial contact with the skin. It is essential to seek medical care and contact poison control to neutralize the burning process.  
  • Any burn that appears to be infected. Burns are at a very high risk for infection. Suspect an infection if there is more swelling, increased redness or streaking around the injury or drainage from the wound. If the child has a fever or becomes lethargic, they be seen by a medical provider immediately for appropriate antibiotics.   

Where to seek medical treatment

Children with burn injuries may be cared for by a local pediatric emergency department, including Texas Children’s Hospital. In some cases, a higher level of care might be warranted from a recognized pediatric burn center. If your child requires a higher level of care, the emergency department will safely arrange for your child to be transferred to the closest facility. 

What not to do

  • Do NOT apply ice or cold water to a burn. Ice and cold water will constrict the blood vessels around the injury and lead to further damage.  
  • Do NOT apply butter, grease, or powdered home remedies to a burn. Butter and grease are thick, non-breathable liquids. These substances hold in heat and can cause the skin to burn even more. Additionally, butter and grease are filled with bacteria. A burn breaks down the skins natural barrier which prevents the body from infection. Applying these liquids over a burn can introduce an infection directly into the body. Powders may also retain heat and introduce infection.  
  • Do NOT break blisters. Breaking open a blister causes an opening in the skin where bacteria may be introduced to cause an infection. If a blister breaks open on its own, gently remove the top layer of skin to prevent bacteria from being trapped underneath. Clean the area and perform dressing changes daily.  
  • Do NOT remove clothing that is adhered to the skin. If clothing has melted onto the skin it will not come off easily. Do not attempt to remove this clothing. The victim will be at an increased risk for bleeding, infection, and hypothermia. Seek medical attention immediately.  

Tips to prevent burns

  • Food handling safety 
    • Never leave children unattended in the kitchen.
    • When cooking on the stove, turn all handles to face inward. Ensure handles are not extending over the stove where a child can easily reach up to grab them. 
    • Never serve children scalding hot foods or beverages.  
    • Use caution when heating food in the microwave. Foods may heat unevenly resulting in a temperature difference between the food and the container.  Stir foods to disperse the heat evenly after microwaving. Always test food for temperature before serving to young children.
  • Water temperature 
    • Always test the water temperature with your elbow before allowing a child to enter the water. 
    • If a thermometer is available, ensure the water temperature is less than 120 degrees Fahrenheit.  
  • Appliance safety 
    • Always unplug hair dryers, straighteners and curling irons after use. Ensure they are secured, supervised and out of a child’s reach while in use. 
    • Never leave children unattended near cooking appliances such as grills, stoves, and ovens. Teach young children the dangers of touching hot appliances.  
    • Never allow children to operate appliances without proper supervision. 
  • Electrical safety 
    • Secure all electrical cords and wires out of reach. 
    • Place safety covers over all electrical outlets.  
  • Firework safety 
    • Educate children on the dangers of fireworks and empower them to observe from a distance.  
    • Do not store fireworks anywhere within the home or garage.  
    • Secure all lighters and matches within the home. 

 Additional resources

Post by:

Kasey A. Keane, MPA, PA-C, Pediatric Surgery Physician Assistant Fellow