Burns

Burns are injuries to the skin caused by heat from flames, liquids, radiation, chemicals or electrical devices. The severity of a burn is determined by its depth, the age of the patient, the particular sites on the body burnt (hands, feet, face, genitals and joints are the most complicated) and the total surface area of the burns. While minor burns usually cause nothing more than temporary shock and mild discomfort, severe or widespread burns can be physically destructive, permanently debilitating and even fatal.

Types of burns

Burns can be classified by the depth of tissue they injure. The names for various types of burns have changed over the years.Superficial burn – previously known as first-degree burns, these are minor burns which affect only the outer layer of skin, the epidermis. They may become red, inflamed and painful, but generally heal within 10 days with no scarring.

Partial thickness – these burns (formerly second-degree) damage the middle layer of skin called the dermis. The dermis is much thicker than the epidermis so the severity of these burns can vary depending on their depth. Often red and/or white in colour with blisters, partial thickness burns can take several weeks to heal and often leave scarring.

Deep full thickness – burns which penetrate the entire width of the skin, down through the epidermis, dermis and hypodermis, are classified as full thickness, or third-degree. When the hypodermis is injured, other elements contained within this layer, such as hair follicles, sweat glands and nerve cells, are also destroyed. Skin which has incurred a full-thickness burn may be white or charred and surrounded with large blisters. These typically require skin grafts and usually leave considerable scarring.

Full thickness with injury to underlying tissue – sometimes this fourth classification (fourth-degree burn) is used to describe a burn which involves the loss of all three layers of the skin, plus underlying muscles, ligaments or bone. These types of burns are frequently life-threatening; they regularly cause permanent physical impairment or require amputation.

Basic first aid for minor burns

Basic first aid and at-home care is usually sufficient for treating children who receive a first degree burn on a small portion of their body.Basic first aid and at-home care is usually sufficient for treating children who receive a first degree burn on a small portion of their body:

• Stop the child’s skin from burning. This could mean removing the source of the burns (chemical, electrical or putting out a fire) or taking the child out of the situation.
• Soak the burnt area of skin or place it under cold running water immediately. Continue to cool the skin for 10-20 minutes; this stops the skin burning, minimises pain and reduces the resultant inflammation.
• Remove clothing and jewelry from the burn area whilst you are cooling it with water.
• Once cooled, cover gently with a dry, sterile bandage.
• If necessary, a child-appropriate medicine containing paracetamol (i.e Panadol or Dymadon) will help to relieve pain from minor burns. Be sure to read the label before using.
• If blisters form on the burnt skin, do not pop them, this will leave the wound susceptible to infection.
• If pain persists beyond a few hours or the skin appears to be becoming infected (oozes or becomes inflamed) consult your family doctor.

Things to avoid when treating burns

• Do not use ice as this can hinder the body’s repair of a burn.
• Do not apply lotions, ointments, butter or powder; rather than improving the injury these make burns worse. By trapping heat in, these substances make the skin burn for longer.
• Avoid rubbing burnt skin, since this makes it more likely to blister.

In an emergency: severe burns

In the event of a severe burn, call emergency services as soon as possibleIn the event of a severe burn (one which is third degree, encompasses more than 10% of the body or causes intense pain), call emergency services as soon as possible – 000 (Australia), 911 (US). While you await their attendance you can assist the child by taking the following measures:

• Put the burnt areas of the body under cold running water as soon as possible (this is beneficial even if it cannot be applied immediately).
• As you cool the skin, quickly remove clothing and jewelry from the burn. If material is stuck to the skin it is important to leave it in place.
• To prevent hypothermia, do your best to keep the child warm – wrap unburned areas of the body in a blanket and increase the temperature in the room to between 28 and 30 degrees celsius (82-86 degrees fahrenheit).
• Elevate the burnt body parts.

Medical treatment of severe burns

The amount of skin injured and the depth of a burn will affect how quickly it heals and whether infection or scarring is likely. Burns are usually treated with special dressings to encourage healing. Sometimes ‘wet dressings’ are used, these are slightly moist and contain silver – an antimicrobial agent – to reduce the risk of infection. It is vital that these dressings are kept clean, dry and in place. A medical professional will manage the checking or changing of dressings and provide the child with suitable pain relief.

It can take several days following a burn to ascertain the extent of the damage and for specialists to determine whether further treatment is necessary. Severe burns often require skin grafting, an operation which involves replacing burnt skin with healthy skin from another site on the body to help those areas heal better.

Long term care of burns

As burns heal, their scars can protrude, become red, sore or itchy and restrict movement. Physiotherapists are often employed to minimise the appearance of burn scars and manage their physical effects.

Along with plenty of fluids and rest, a nutritious, varied diet will help to optimise wound healing. A moisturising lotion, such as glycerine and sorbolene, should be applied to the burn scars a minimum of twice daily. This will enhance the healing process by nourishing the fresh skin, keeping it strong and supple.

Children should be discouraged from scratching their scars as this impairs the repair process and can inflict further damage. Your pharmacist or doctor may be able to recommend moisturisers or antihistamines to reduce the irritation of itchy skin. Sun exposure can further injure burns and burn scars, therefore it is important to keep them covered when spending time outdoors.

Preventing burns

Being aware of potential threats and discussing the risks of burns with your family will help with prevention.Ideally, we want to avoid children receiving burns in the first place. The following safety suggestions may help to prevent an incident from occurring:

• Keep flammable chemicals out of reach of children (preferably in a locked cupboard) and away from flames, sparks and heat.
• Do not allow young children to handle very hot food or drinks.
• Teach children how to avoid the hazards of household appliances such as heaters, ovens and irons.
• If older children are using hot appliances (i.e. sandwich press or hairdryer), show them how to do so safely.
• Ensure your home is fitted with fire blankets, extinguishers and working smoke detectors.
• Prepare a fire plan (including exit routes and meeting points) and practice a drill with your children.
• Make sure that the stove top is never left on unsupervised.
• Store matches and lighters in a safe place where children cannot access them.
• Show children the method of “Stop, Drop and Roll” to put out fire on their own clothes or body.
• Do not allow children near fireworks.
• When cooking with your child, ensure that they only undertake tasks they are capable of performing safely.
• Teach your child about the danger of scalds from hot water when bathing and cooking.
• Decrease the thermostat on your hot water to less than 49 degrees celsius (120 degrees fahrenheit).

References

The Children’s Hospital at Westmead 2011, ‘Burns and Scalds – Burn Care Advice’, retrieved 7 September 2011, < http://kidshealth.chw.edu.au/sites/kidshealth.chw.edu.au/files/fact-sheets/pdf/burns-and-scalds-burn-care-advice.pdf>.

Healthy Children 2010, ‘Treating and Preventing Burns’, retrieved 7 September 2011, <http://www.healthychildren.org/English/health-issues/injuries-emergencies/pages/Treating-and-Preventing-Burns.aspx>.

Healthy Children 2011, ‘First Aid for Burns’, retrieved 7 September 2011, <http://www.healthychildren.org/English/safety-prevention/all-around/Pages/First-Aid-For-Burns.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token>.

The Royal Children’s Hospital Melbourne 2010, ‘Burns-general treatment’, retrieved 7 September 2011, <http://www.rch.org.au/kidsinfo/factsheets.cfm?doc_id=11349>.