How to deal with child burns and scalds

Some burns can require immediate action dependent on the source of the burn. Electrical and chemical burns have the potential to be serious.

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For burns that are caused by a flame, immediately extinguish the flame. Many readers will remember the safety sequence “Stop, Drop and Roll.” Have your child stop what they are doing immediately, drop to the ground and roll. They should then be covered with a blanket or jacket and the burned clothing and jewelry removed. Call immediately for emergency assistance and follow the instructions below for a second- or third-degree burn.¹

When the cause of the burn is electrical or chemical, other actions are required. It is important to be sure that if the child’s burn was inflicted by an electrical source, the child is no longer in contact with the source to lower the risk of someone else receiving a shock.¹

If the burn was caused by a chemical source, it is important to flush the affected area for 5 minutes with running water in a sink, tub, shower, bucket or with a garden hose. It is important that you leave the child’s clothing in place until you begin flushing the area.¹

For small chemical burns, it is recommended that flushing continues for 10-20 minutes before a sterile bandage or gauze is applied and a health care provider is called.¹ If the chemical burn affects the mouth or eyes, flush thoroughly and seek immediate medical care.¹

In the US, poison control (800) 222-1222 should be called, followed by the emergency department, if a child ingests a chemical or potentially harmful object.¹

Not all burns are created equal, and below are outlines of the three types of burn and their treatment.

A first-degree burn affects only the outermost layer of the skin and produces symptoms such as redness, pain and mild swelling. This type of burn does not produce blisters and is dry.^1,2

Symptoms often resolve quickly within 3-6 days, and one may notice some skin peeling within the first 1-2 days of the incident.^1,2 Pain from a first-degree burn typically resolves quickly, lasting approximately 24-48 hours.²

Treatment of a burn varies based on its location and cause, as well as the child’s age, their tolerance of treatment and personal preference.² These burns are typically treated with a cold compress (not ice) or cool water over the burn for 3-5 minutes, lotions and topical creams such as aloe vera. Pain medication such as acetaminophen or ibuprofen can also be used as directed.^1,2

Although not required, the area can be covered with an adhesive bandage or gauze for 24 hours if it is less than the size of a quarter. However, the use of bandages in young children is not recommended due to the risk of choking.^1,2

To avoid worsening the burn or causing infection, do not use butter, grease, powder or any treatments other than the above methods.¹ Speak with your child’s doctor if you have concerns or for an evaluation if the burn is not healing as expected.

Second-degree burns, also known as partial thickness burns, are more extensive than first degree burns as they affect both the outer layer of the skin (the epidermis) and a portion of the layer beneath (the dermis).

These burns produce blisters, severe pain, redness and swelling. The blisters open, giving the burn a pinkish-red and wet appearance.^1,2

Second-degree burns may also exhibit an irregular white or discolored appearance.² Because these burns are more extensive than first-degree burns, the time for symptom resolution and healing varies and can be upward of 3 weeks.^1,2

As with other burn types, treatments vary based on the cause, location and extent of the burn, as well as the child’s age, health and medical history, tolerance for treatment and personal preference.² Second-degree burns do require immediate medical attention and treatment, however.¹

The child should remain in a lying position with the affected area elevated. Jewelry and clothing near the burn should be removed, blisters should be kept intact and the area should be kept in cool water for 3-5 minutes.¹ After applying cool water, cover the area with a clean and dry cloth.

As with a first-degree burn, to avoid worsening the burn or causing infection, do not use butter, grease, powder or any other treatments other than the treatments discussed in the section on first-degree burns.¹ Medical interventions may include antibiotic ointments, antibiotic medication, dressing changes and cleaning.²

Third-degree burns, also known as full thickness burns, affect the outer epidermis and the entire dermis under the top layer of the skin. While symptoms of a full thickness burn vary, they commonly exhibit skin that appears dry, leathery, black, white, brown or yellow, alongside the presence of swelling and lack of pain due to injury-related nerve damage.²

These burns require immediate medical attention and possible burn center evaluation as they will not heal well without treatment. With these burns, new skin will not regenerate due to the extent of skin and hair follicle damage. Patients will instead require a skin graft.²

The child should remain in a lying position with the affected area elevated. Jewelry and clothing near the burn should be removed, blisters should be kept intact and the area should be kept in cool water for 3-5 minutes. After applying cool water, cover the area with a clean and dry cloth.¹

As with a first-degree burn, to avoid worsening the burn or causing infection, do not use butter, grease, powder or any other treatments other than the treatments discussed in the section on first-degree burns.¹

As with other burn types, treatments vary based on the cause, location and extent of the burn, as well as the child’s age, health and medical history, tolerance for treatment and personal preference.²

Treatment may include the cleaning or debriding of the affected area, intravenous (IV) fluids, antibiotics (oral or IV), topical antibiotic creams, nutritional supplements, increased dietary protein, skin grafting, possible reconstructive surgery, administering a tetanus shot and remaining in a warm and humid environment.²

• There is a likely second- or third-degree burn
• Burns are larger than 2-3 inches or cover more than 10% of the body. In these cases, it is not recommended to use wet compresses or ice as these will increase the risk of hypothermia. Instead, use clean, soft cloths or towels to cover the burned area
• Fire, electricity or chemicals were the cause of the burn
• The burn involves the face, scalp, hands, joint surfaces or genitals
• There is the presence of swelling, pus, worsening redness or red streaking of the affected area.

Here are some simple precautions that can be taken to minimize the risk of burns:¹

• Use child covers in all electrical outlets
• Keep all flammable and toxic items out of a child’s reach
• Use flame-retardant sleepwear
• When using a vaporizer, use on the cool setting
• Make sure electrical cords are not damaged
• Exhibit caution when using irons, flat irons, and curling irons near children
• Have working smoke alarms in the bedrooms and on each level of the home; replace units that are more than 10 years old
• Do not smoke in the house, use fireworks or sparklers
• Be sure to set your water heater thermostat to 120°F (49°C), or use the “low-medium setting;” you can also use an anti-scald device
• Test your child’s bathwater with your elbow before letting them get in and be sure to turn on the cold water first and last when using the sink, shower or tub faucets
• When cooking, turn pot handles inward and not facing the front of the stove where children can pull them down – do not let children use walkers in the kitchen to avoid accidents
• Avoid tablecloths or large placemats as children can pull them off tables easily
• Do not hold your child while cooking, drinking or eating hot items
• Do not heat baby bottles in the microwave
• Use protective screens for fireplaces, radiators and other sources of heat
• Use sunscreen when outside to prevent sunburn and be careful when playing with hot metal or plastic play toys
• Vinyl and metal components of car seats and strollers can injure children so be sure to keep out of hot direct sunlight.

Be sure to speak with your health care provider with any questions regarding your child’s burn or preventive methods.