82860982The most common burn encountered is a scald caused by hot liquids or steam. Scalds usually occur in the kitchen or bathroom. Burns may also be caused by flames, chemicals, electricity, or radiation. Sunburn is the most frequent cause of a radiation burn. If your child has been sunburned.

The skin is the largest organ in the body, and its thickness varies greatly according to the location. The skin of the palms and soles may be up to 10 times thicker than that of the eyelids. The thinner the skin, the greater the sensitivity to heat. Burns may also be associated with other injuries, including smoke inhalation damage to the lungs.


skd188621sdcCAUTION

If your child has suffered a severe burn injury, seek medical care immediately.


CLASSIFICATION

The severity of a burn—and its consequences—depend on its size, depth, and location.

Size

The larger the burned area, the more severe the consequences. Even a superficial (first-degree) burn covering 10 percent of a child’s body can have serious consequences. (The palm of a person’s hand is equal to about 1 percent of his or her entire skin surface area.)

Depth

Heat burns can be classified into three degrees according to the depth of the burn. The degree of a burn is not always easy to determine, and the classification often has to be revised a day or two after the burn occurred.

First-Degree Burns

These are fortunately the most common and are characterized by superficial redness and pain. The skin will turn white when you press on it. The skin often peels within the next two to three days and is totally healed by one week. Sunburn is usually a first-degree burn.

Second-Degree, or Partial-Thickness, Burns

Second-degree burns are characterized by deeper redness, more severe pain, and swelling and blistering. Depending on their depth, these burns may take up to four weeks to heal. If these burns become infected, their classification may be revised to a third-degree, or full thickness, injury. Less severe scalds are usually second-degree burns and usually take 7 to 14 days to heal.

Third-Degree Burns

In third-degree burns, the burned area is leathery and either white or charred. The burned skin itself is not painful, but the surrounding area may be. These burns will require skin grafting.

Location

Burns of the face, hands, feet, and genital area have complications out of proportion to their size and should always be assessed by a medical professional.



preventPrevention

Most burns can be prevented by taking appropriate precautions, including the following :


  • For the prevention of sunburn, refer to Chapter 38.
  • Make sure your home has a number of functioning smoke detectors and use them. Newer photoelectric models cause fewer false alarms than the older smoke detectors, so consider switching to these newer models if you are tempted to disconnect your smoke detectors because of frequent false alarms. Replace the batteries in your smoke detectors every six months (some people do this in the spring and in the fall at the same time they adjust their clocks for the beginning and the end of daylight saving time).
  • Keep matches and cigarette lighters in a safe place. Do not leave lighted cigarettes and pipes around. Better still, give up smoking!
  • Be careful in the kitchen. Turn pot handles to the side or back of the stove. Preferably use the back burners of the stove.
  • Do not hold your child on your lap when drinking hot beverages.
  • Keep your hot water temperature between 120°and 125°F. Check the water temperature before putting your child in the bath.
  • Be especially careful when using curling irons. These are extremely hot and cause deep burns very quickly.
  • Don’t leave a hot iron on the ironing board. Both the iron and the board are too unstable.
  • Don’t leave burning candles within your toddler’s reach.
  • Keep caustic chemicals (strong alkalis and acids) in a safe place and in secure containers.
  • Put covers on electrical outlets.
  • If your car has been standing in the sun, check the temperature of your child’s car seat before putting her in it. Hot buckles can burn an infant’s sensitive skin.
  • Do not purchase your own fireworks. Attend public displays instead. Fireworks not only result in serious burns but are also a frequent cause of blindness


treatmentTreatment

The following treatment measures apply only to minor burns.

  • Remove your child from the heat source.
  • Remain calm.
  • Immerse the area in cold water. If this is not possible, cover the area with a cloth soaked in cold water. This will not only limit the burn size but also provide some pain relief.
  • Do not apply butter, oil, salves, or sprays to the burn. Benzocaine and other local anesthetic sprays may lead to sensitization, leading to allergic or irritant reactions.
  • Give your child an analgesic such as ibuprofen (Advil or Motrin) or acetaminophen (Tylenol).
  • After the initial cool water soaks, for fi rst-degree burns apply a skin care product such as aloe vera cream. For second-degree burns apply either aloe vera or an antibiotic ointment, and cover the burn with a nonstick dressing such as Telfa if you have it. Keep it in place with gauze and tape. An ideal cream for preventing infection is Silvadene, which is available only by prescription.
  • Do not pop the blisters.



medical-symboWhen to Seek Medical Attention

  • If the burn covers an area larger than the palm of your child’s hand.
  • For any burn of the face, hands, feet, or genital area.
  • If the burn is anything other than a first-degree burn. The degree of the burn may be difficult to assess. If you are unsure, seek medical care.
  • If the burn becomes infected. Signs of infection include the following :

-   Wound discharge that is green or yellow

-   Increasing pain at the burn site after a day or two

-   Increased swelling or redness of the skin surrounding the burn

-    A fever

  • If your child gets an electrical burn.
  • If your child has a second- or third-degree burn, he may require a tetanus shot.


FOLLOW-UP CARE

  • Burns other than fi rst-degree burns will require dressing changes once a day. Soak the burned area in cool water for 15 minutes, allow to air dry, and then apply an antibiotic ointment. Cover with a nonstick dressing such as Telfa, and keep it in place with gauze and tape. It is a good idea to give your child a suitable analgesic one hour before you change the dressing.
  • Be on the lookout for secondary infection (described above).
  • Once the burn has healed, soften the area by rubbing in vitamin E cream.
  • Be extra careful to avoid sunburn to the area for at least one year.


ELECTRICAL BURNS

Electrical burns may appear to be very minor at the surface, but serious deep tissue injury may have occurred. Internal injuries may also be present.

  1. Do not touch the victim until the current has been turned off or the source of the current has been removed with an implement that does not conduct electricity, such as a wooden broomstick.
  2. If the victim is unconscious, call 911 and begin CPR if necessary.
  3. If the victim is otherwise “OK,” treat the burn like other heat burns by immersing the burned part in cold water, if possible.
  4. Use pain medicine as necessary.
  5. Seek medical care.