Burns and Scalds - Burn Care Advice

Introduction

Burns are potentially serious injuries and should be managed expertly. Most children with burns can be managed as outpatients and, if superficial, should heal within 10 days without scarring. Children with burns that remain unhealed at 10 days may require consultation with a burns specialist to advise about the need for surgery and the risk of scarring.

The treatment your child needs will depend on the size of the burn, the part of the body burnt, and the depth of the burn. Special burns dressings should be used and may be left in place for up to 7 days.

If the burn is large, deep, very painful or involves certain areas of the body that make it hard to manage at home, the child will be admitted to hospital. Electrical burns may also require admission to hospital.

Appropriate use of cold running water as a first aid measure will significantly improve the outcome of the burn.

First Aid

Stop the burning as soon as possible

• Put out the fire ("stop, drop, cover (face) and roll"). Do not run
• For a scald- remove clothing as quickly as possible because hot fluid soaks into clothing and continues to burn.
• Do not remove clothing that is stuck to the burn area.
• Remove jewellery.

Dial 000 if your child is:

• Unconscious.
• Has difficulty breathing.
• Has severe pain that you cannot control.

In most cases simple first aid and pain relief are all that is needed before seeking medical attention.

First Aid:

• Apply cold running water over the surface of the burn for 20 minutes- start as soon as possible after the accident. Try to keep the rest of the child warm and avoid hypothermia.
• Warm the room (or your car) to 28 - 30°C if possible.
• Do not apply ice, iced water or any other creams or lotions (they are not helpful at this stage and may make the burn worse).
• Using cold water from a spray bottle or cold wet cloths is less effective as a first aid measure. If wet cloths are used on the burn, they need to be rinsed in cold tap water every minute as the cloth reheats quickly.
• If first aid is delayed, applying cool running water to the burn is still helpful up to three hours after the accident.

Treatment

Dressing the burn will involve:

• Appropriate pain relief for your child.
• Applying a dressing to protect and promote healing.
• Some dressings need daily checks, but most are regularly checked every 3-7 days (it may take up to 5 days to determine how deep the burn is).
• Burns that are unhealed at 10-14 days need to be discussed with a burns specialist to determine further treatment and assess the risk of scarring.
• The type of dressing may change as the burn heals.
• You will be given instructions on how to care for the dressing at home.

Pain relief

All burns are painful.

• Cold water provides excellent pain relief if used early.
• Medicine such as Panadol™, Dymadon™, or Tempra™ can give good pain relief.
• If pain persists, stronger oral pain relief may be needed. Larger burns may need pain relief by injection (if it is thought that the child will need more than one injection, admission to hospital is needed).
• Your child may cry for a number of reasons other than pain (i.e. fear, anxiety and hunger).
• Your reassurance will be comforting to them (listen to their fears and answer their questions truthfully).

What can go wrong? (Infection)

Infection is rare.

Bring your child back to the hospital any time of night or day if your child:

• Seems unwell or won't eat or drink.
• Has a temperature over 38.5 degrees Celsius.
• The wound begins to smell (some yellowish, silvery brown ooze is expected, depending on which dressing is used).
• There is pain in the burn area.
• The dressing falls off or comes loose or you notice redness spreading out from the initial injury.

It is important to avoid your child coming into contact with anyone who has or is developing cold sores on the lips, or has chicken pox (unless your child has had chicken pox or has been vaccinated against it).

Diet

It is important your child eats healthy foods so that the body has the right nutrients it needs to heal.

Activity

Keep dressings clean and dry.

Your child should engage in normal play, both with you and other children.

Accidents which cause pain and require the child to go to hospital can make them feel insecure so extra cuddles are needed. Kids often feel guilty because they have caused so much trouble. Be patient but continue to have the same important rules at home even if the details are more relaxed.

Will my child need an operation?

In the first few days following a burn, it is often not possible to tell how deep the injury is, how long it will take to heal or if there will be scarring. Any burn that heals within 10-14 days is unlikely to scar and will probably not require an operation. However, if most or all of the skin in the area of the burn is destroyed, healing is slow, the risk of infection is increased, and there is likely to be scarring, so healing may be improved by an operation. In this operation, the dead skin is removed and the area is then covered with a thin layer of skin taken from another part of the body (a skin graft area). It may be up to 10-14 days after the injury before a decision about grafting can be made. If it is needed the operation will be fully explained to you.

Scarring

If the burn has taken longer than 2 to 3 weeks to heal or has required a skin graft, scarring is likely. With time, burns scars may become raised, red, itchy and painful and may cause limitation of movement if over a joint. Once the burn is healed, treatment of the scar is crucial, to reduce these problems and improve as much as possible the long term appearance of the affected skin. The doctors and physiotherapists will supervise scar treatment and management.

After care

• All new and healed burns are very sensitive to sunburn.
• Keep burn areas covered and apply Factor 30+ sunscreen.
• If the burn has healed quickly (meaning that it has not been very deep) it will become less sensitive after six to twelve months.
• New skin needs to be kept healthy by regular use of moisturising cream (use glycerine and sorbolene cream at least twice a day).
• Deep burns will need moisturiser more frequently, for a longer period of time.

• First aid - first stop the burning process, remove hot clothes and jewellery and apply tap water for 20 minutes
• Follow the treatment and advice of your doctor to achieve the best possible outcome in terms of appearance and function for your child
• With good care, most burns heal with minimal scarring