Burns: Care Advice

Disclaimer: This fact sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

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Each year almost 1,000 children aged 0-16 years are treated for a burn injury in NSW. Burns can be very serious. However, appropriate first aid will greatly reduce the likelihood of skin grafts, hospitalisation and scarring.

The treatment your child needs will depend on:

  • the size of the burn wound,
  • the body part involved,
  • the age of the child, and
  • the depth of the burn injury.

Special burn dressing products are used to support the wound healing. These dressings may be left in place for up to 7 days.   

If the burn wound/s is/are large, deep, very painful or involve particular areas of the body that make it difficult to manage at home, the child may be admitted to hospital so additional therapies can be accessed. Electrical burns will require admission to hospital.

Appropriate use of cool running water for 20 minutes, as a first aid treatment will significantly improve the outcome of the burn injury.

Dial 000 if your child:

  • is unconscious.
  • has difficulty breathing, or is suspected to have inhaled hot fluid or the steam from the hot fluid.
  • has 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

1.       Stop the burning process as soon as possible.

  • For Flame burns:

Put out the fire ("stop, drop, cover (face) and roll"). Do not run.

  • For Scalds from hot fluids:

Remove clothing as hot fluids soak into clothing and continue to burn the skin.

Remove jewellery, as if swelling occurs, jewellery can stop blood flow to the burnt area.

2.       First Aid

  • Apply cool running water over the surface of the burn for 20 minutes. Start as soon as possible after the accident.
  • Try to keep the child warm and avoid them shivering. Warm the room (or your car) to 28 - 30°C if possible.
  • Cover the burn loosely with a clean dressing or cling wrap.
  • Do not apply ice, iced water, creams, oil, toothpaste, butter or lotions (they are not helpful and may make the burn injury worse).
  • Burn creams do not cool the burn and must not be used instead of cool running water.
  • Cool water ‘misted’ over the burn from a spray bottle, may be used whilst transporting the child to medical help.  
  • Cool wet cloths are less effective in first aid treatment because they retain heat and need to be rinsed in cool tap water every minute.
  • If first aid is delayed, applying cool running water to the burn is still helpful within three hours of a burn.

Seek medical help if:

  • the burn is bigger than a 20c coin,
  • the burn is to the face, airway, hands or genitals,
  • the burn is deep, raw or blistered, or
  • you are unsure.

Pain relief

All burns are painful.

  • Cool water provides excellent pain relief if used early.
  • Medicine such as Panadol™, Dymadon™ or Tempra™ can give good pain relief.
  • If pain is not able to be managed at home with oral medication, the child needs immediate review by a doctor. Keep in mind that your child may cry for a number of reasons besides 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 in the burn wound can cause your child to become very sick.

Seek immediate medical advice if-    

  • the child seems unwell, or won’t eat or drink
  • the child has a temperature over 38.5 degrees Celsius
  • the wound has an offensive odour / the wound has a bad smell
  • the skin surrounding the wound becomes red and hot to the touch
  • the fluid seeping from the wound increases
  • there is pain coming from the site of the burn wound
  • the dressing is lifting, or completely falls off.

How to manage at home

  • Keep wound dressings clean and dry
  • 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

Encourage your child to eat healthy food. Wholesome nutrients help healing. High protein / high energy foods are recommended.

Activity

  • Your child should take part in normal play. Accidents which cause pain and require the child to go to hospital can make them feel insecure - so extra cuddles are needed. 

  • Children often feel guilty because they have caused so much trouble.

Burn injury management

  • Appropriate pain relief for the child.
  • A dressing is applied to protect the burn wound from further trauma and promote healing.
  • Burn wounds are usually reviewed and redressed every 3-7 days (it may take up to 14 days to determine how deep the burn is).
  • Burn wounds that have not healed within 14 days should be discussed with a burns specialist service to determine ongoing treatment.
  • A selection of wound dressings may be used as burn wound healing takes place.
  • Home care instructions for your child, together with contact phone numbers will be given to you prior to discharge.

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.
  • If much or all of the skin in the area of the burn is destroyed or healing is slow, there is likely to be scarring. Healing may be enabled 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). A decision about grafting may be made after 10-14 days post the initial injury. The operation will be fully explained to you by the attending Surgeon.

Scar management

If the burn injury has taken longer than 2 to 3 weeks to heal or has required a skin graft, scarring is likely. 

With time, burn’s scars may become raised, red, itchy and painful and may cause limitation of movement if over a joint.

Once the burn is healed, scar management treatment is started, to reduce potential limitations to mobility and improve the long term appearance of the affected skin.

The surgical team and physiotherapists will be involved in scar treatment and management.

After care

  • All new and healed burns are very sensitive to sunburn.
  • Keep burn areas covered.
  • Apply Factor 50+ 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.
  • The colour of a newly healed burn wound will be very red initially. It may take 2-3 months for the redness to fade and the area to return to a more normal skin colour.
  • New skin needs to be kept conditioned by regular use of moisturising cream. Use non perfumed moisturising cream at least twice a day. 
  • Deep burns will need moisturiser more frequently, for a longer period of time.

Remember:

  • First aid -
  1. Stop the burning process
  2. Remove hot clothes
  3. Remove jewellery
  4. Apply cool running 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.

Further information

Burns prevention: https://kidshealth.schn.health.nsw.gov.au/burns-prevention

E-learning module on first aid for burns:

https://kidshealth.schn.health.nsw.gov.au/cpr

 
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The Children's Hospital at Westmead
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Sydney Children's Hospital, Randwick
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Hunter New England Kids Health
www.hnekidshealth.nsw.gov.au

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