Burns are classified by the amount of damage done to the skin and other body tissue. Accidents happen whether at home or in public, and burn in children often leads to injury not only on their physical health, also mental and emotional being.
Dr Marzida Abd Latib, Consultant Plastic & Reconstructive Surgeon of Gleneagles Hospital Kuala Lumpur (GKL) here to explain about burn in children and what parents should do if this situation happen to them.
- What are the common burns in children
The aetiology of common burns in children changes with age. Younger children suffer more scalds, for example hot water, hot soup, hot oil, hot beverages.
Older children usually suffer more flame burns. Example flammable liquid causing a fire. Other notable causes of burn in children include:
- Contact with a hot object hot iron, hot stoves
- a child may come into contact with is through household cleaning and beauty products. E.g., drain cleaners, toilet bowl cleaners, dishwashing detergents, oven cleaners, metal cleaners, rust removers, and hair relaxers.
- Electrical burns
- Such as biting an electrical cord, placing an object into an electrical socket, contacting a low voltage wire or appliance indoors (low voltage household injury)
- contacting a high voltage wire outdoors) or being struck by lightning (high voltage injury)
- Sunburn is a specific type of burn caused by ultraviolet radiation from the sun (or from artificial ultraviolet sources, such as tanning beds).
- Will appear similar to thermal burns and can range from painless erythema to painful erythema with oedema and bullae, appearing in sun-exposed areas only
- Non-accidental injury (child abuse) should also be suspected from any suspicious lesions.
2. What are the different types of burns and symptoms?
However, burn wound constantly changes, which sometimes makes it difﬁcult to determine the depth of the injury in the ﬁrst 2-5 days and it is rarely homogenous throughout.
3. When should I take my child to the A&E for a burn injury?
Go to a hospital accident and emergency (A&E) department for:
- large or deep burns (2nd and 3rd degree burns) bigger than the affected person’s hand
- burns of any size that cause white or charred skin
- burns on special areas: the face, hands, arms, feet, legs or genitals
- burns with blisters
- all chemical and electrical burns
Also get medical help straight away if the child with the burn:
- has other injuries that need treatment
- is going into shock – signs include cold, clammy skin, sweating, rapid, shallow breathing, and weakness or dizziness
- is under the age of 5
- has a medical condition, such as heart, lung or liver disease, or diabetes
- any uncertainties at all
The level of care needed to treat a burn depends on many factors, including the location of the burn and the extent of the burn. If you’re not sure if your child’s burn is serious, check with your paediatrician.
4. Do’s and Don’ts of Burn First–Aid
- Stop burning process as soon as possible by:
- removing the person from the area
- extinguish flames with water, or smothering flames with a blanket, fire-extinguishing liquid
- Cooling the wound
- with tepid water to remove any residual heat and prevent progression of the thermal burn
- effective if applied within the first few minutes of the injury
- Remove any clothing or jewellery near the burnt area of skin, including babies’ nappies.
- Cover the burn with cling film, a clean bandage or cloth.
- Keep the child warm.
- Wrap using a blanket or layers of clothing, but avoid putting them on the injured area
- Take Paracetamol or Ibuprofen for pain.
- Sit upright as much as possible if the face or eyes are burnt
- Seek medical attention as soon as possible
- Do not start first aid before ensuring your own safety (switch off electrical current, wear gloves for chemicals, etc.)
- Do not apply home remedies/ointments until the patient has been placed under appropriate medical care.
- Do not apply soy sauce, toothpaste, turmeric powder, flour or greasy substances s like butter
- it might become infected
- it makes initial burn assessment difficult due to discloration
- Do not apply ice, ice water because it deepens the injury;
- Avoid prolonged cooling with water because it will lead to hypothermia
- Do not try to remove anything that is stuck to the burnt skin, as this could cause more damage.
- Do not intentionally open blisters.
5. How are burns managed or treated in children?
Outwardly, burns treatment for children is similar to that for adults, but there is significant physical, psychological, and social differences. Children have thinner skin, lose proportionately more fluid, are more prone to hypothermia, and mount a greater systemic inflammatory response.
Overall, it involves a multidisciplinary team including an emergency Physician, Paediatrician, Plastic & Reconstructive Surgeon, Anaesthetist, Nutritionist, Physiotherapist, & Rehabilitation Specialist, Child Councillor nurses and many more.
Depending on the extent and severity, a burned child maybe well taken care of in a tertiary hospital with Burn Unit set up which is usually headed by a Plastic & Reconstructive Surgeon.
Management of burns includes multiple phases: initial resuscitation, early burn management, rehabilitation and post-burn reconstruction as outlined below:
- Primary survey evaluation:
A, B, C, D, E (Airway, Breathing, Circulation, Disability (neurological status), Exposure/ environmental control.
- Secondary survey: head to toe examination after initial stabilization
- Burn wounds will be assessed in terms of depth and extent
- Intravenous fluid and urinary catheter inserted if required
- Pain management
- Any concern of non-accidental injury (child abuse) should also be addressed
- Wound management
- Treatment can be conservative which include cleaning, debridement, regular dressing change. Optimum wound care is instrumental toward recovery, as it protects the wound from further infection, provides comfort, and promotes healing
- There is no clear evidence on which dressing provides the best coverage; thus, the choice can be made based on cost, availability, frequency of dressing changes (i.e. dressing which minimizes amount of changes may be more suitable for children)
- Burn reconstruction surgery with early excision of burn wound and skin grafting is the mainstay of surgical burn treatment for wounds which are not expected to heal in 2-3 weeks’ time. This is usually required with extensive and deeper burn injury. This will help wound heals faster, better functional and aesthetic outcome as it reduces the risk of hypertrophic scarring and contractures. It also shortens the hospital stay which translates to lower overall medical cost. Nevertheless, skin donor site availability is a problem in major burns.
- Nutritional support & Physiotherapy
- high protein diet is important for wound healing. Encourage foods such as milk, meat, eggs, yogurt, cheese, beans and peanut butter.
- A nasogastric tube may also be inserted if required to facilitate feeding.
- Once wounds are healing and closed it is usually dry and itchy
- May begin to apply olive oil or moisturizer at least 4 times a day.
- Use a circular motion when rubbing the lotion into the skin.
- Scar massage helps the skin be more elastic, softer and less raised. It also helps with itching.
- Splinting the joints to prevent scar contracture.
- Pressure garment and silicone gel sheet are also added as scar management tool which results in improved texture and thickness of scars. If a pressure garment is recommended, it will be custom ordered by a physical or occupational therapist.
- Psychological management must not be overlooked.
6. What are the complications of deep or widespread burns in children?
They may cause multisystemic manifestations, including injuries to all major organs systems like renal failure, respiratory failure, sepsis and death.
Specialized burn centres, which care for these patients with multidisciplinary teams, may be the best places to treat children with major thermal injuries
Deep wounds may potentially lead to infection, hypertrophic scarring, and scar contracture, unstable scar and chronic pain. All may lead to functional and social disfigurement. Follow-up visits for therapy and for fitting pressure garments (to control scarring) can last for months and even years.
The child may need long term to follow up and secondary reconstruction procedures like contracture release, skin grafting or flap surgery. Some unstable chronic burn wounds may also have transformed into skin malignancy at a much later age.
The disfigurement and impaired function suffered by many burn victims may be lifelong, and returning to school and society with these handicaps can be extremely stressful, particularly for children.
Their behaviour and self-esteem may change tremendously. They may have a major psychological breakdowns if not detected early.
7. What steps parents can take to prevent the future risk of burns at home?
Parents can take small steps to reduce the likelihood of burns. Some useful tips:
To always test the water temperature first before soaking a baby or toddler in a tub. Remember: 140°F (60°C) water will cause partial-thickness burns in approximately 5 seconds, whereas water at 120°F (49°C) will cause partial-thickness burns in approximately 5 minutes
Never leave a toddler unattended as accident may happen in split seconds
Keep children out of the kitchen while cooking, using the oven or preparing hot milk and beverages
Place socket covers on unused plugs. Use safety cords, such as circuit breakers or ground fault interrupters. Cover or fix any exposed wires. Replace damaged electric cords. Never allow your child to touch wires.
Watch your child when he or she is playing with electric toys. Turn off and unplug electric toys or machines when not in use.
Do not use electric machines near water.
Keep electric machines out of your child’s reach.
Mind your hot cup of beverages on the table. Do not put it within the child’s reach or try avoiding the tablecloth when serving hot meals when there is a curious toddler around.
Put away chemical substances beyond the reach of children and never let them near you when you are using these substances.
A working fire alarm, aportable domestic fire extinguisher should be made available in all homes.
Closely supervise older children around candles, fires and grills.
Make sure you don’t leave matches and lighters where children can find them.
Also, don’t let children move logs in a burning fire, or throw on flammables such as straw or dry grass, which flare quickly, and especially not lighter fluid or gasoline.
Parents may also proactively educate their children in an age-appropriate manner on matters above. Teach the older children on first aid and important numbers to contact should such a mishap happens.
International Journal of Critical Illness and Injury Science | Vol. 2 | Issue 3 | Sep-Dec 2012 133
Krishnamoorthy, et al.: Pediatric burn injury review
Source: This article is written by Dr Marzida Abd Latib, Consultant Plastic & Reconstructive Surgeon of Gleneagles Hospital Kuala Lumpur (GKL)
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