As we head into this holiday season, we are reminded that with the warm, open hearths and hot seasonal beverages that await us, comes the opportunity to talk to parents and families about pediatric burns and their prevention.
Pediatric burns are the third leading cause of accidental death amongst children. In 2005, an estimated 120,000 children under 15 years of age received care in the emergency department (ED) for a burn. In children under the age of 5, more than half of these burns were due to scald injuries. During a recent shift in the ED, a 3-year-old boy was brought in by his parents after accidentally knocking over a pot of coffee while twirling a baton. He suffered first and second degree burns over 18% of his body, from hot coffee spilling onto his back and leg, and was transferred to a pediatric burn center for further care.
What is considered a burn?
Burns are broken down into the depth of skin and soft tissue involved and by injury pattern:
· Superficial burns (1st degree) – the skin is pink or red and painful; think sunburn.
· Partial thickness (2nd degree) – the skin is red, painful and with blister formation OR white, pale and less painful (since the nerve fibers have been destroyed); think curling iron or kitchen oven.
· Full thickness (3rd degree) – the skin is white, waxy, leathery without bleeding, and painless; think house fire.
· 4th degree burn – there is destruction of underlying tissue including tendons, nerves, muscle and bones; think electrocution.
Types of burns
· Thermal - a scald burn resulting from contact with fire, hot objects, or hot fluids. Imagine a toddler pulling down a piping hot cup of cocoa and spilling it on themselves!
· Electrical- a burn resulting from flow of an electrical current, carrying temperatures as high as 5000°C. Entry and exit points do occur but most burned tissue remains invisible at surface levels. Imagine a newly crawling baby discovering Christmas lights and chewing on the cord!
· Chemical- injury caused by an alkali (e.g. ammonia, caustic potash, sodium hydroxide) or acid (e.g. hydrochloric, sulphuric). The severity of burn depends on the chemical and type of tissue involved. Imagine a child spraying cinnamon air-freshener into his brother’s eyes.
Why are burns in an infant or child more serious than in an adult?
(1) Body surface area (% BSA) –children have different proportions of surface area as compared to adults (e.g. larger heads) so they can quickly suffer fluid loss.
(2) Location...location...location! All burns in kids need immediate medical evaluation. Burns to the face, hands, feet, genitalia, and areas that cross joints are considered high-risk locations. If not immediately treated, children can suffer poor cosmetic outcomes and growth complications.
What can you do to prevent burns in your child?
There are several things that YOU as a parent can do to protect your child, many of which begin in your own home:
· Reset your water heater – Hot water scald burns cause more deaths and hospitalizations than any other hot liquid burns. Most home water heaters are set at 140-150 ℉. Water at this temperature will result in a 3rd degree burn within 2 seconds. Reset your water heater to 120 degrees. And as a reminder, never leave a child unattended in the bath tub.
· Do not leave handles within reach – You would be surprised how far your little one can reach. Many scald burn injuries are the result of a child pulling a pot off the stove or a cup of coffee from the countertop.
· Hide matches and lighters - Most child play-related home fires begin with matches or lighters in a room where children are left unattended. Keep matches and lighters away from children and when necessary, use child-resistant lighters.
· Smoke alarms - Children under the age of five are at greatest risk of suffering fire-related injuries and twice as likely to die in a fire. It is critical to ensure that the smoke alarms in your home are working and checked regularly.
Treating burns in your child
If your child does suffer from a burn, appropriate wound care and further evaluation is key. Contrary to popular belief, ice should never be applied to a burn. Instead, the area that is burned should be immediately cooled with room temperature water for 10 to 20 minutes after the injury. This helps to prevent ongoing damage to the skin and soft tissue.
When available, the wound should be covered with a wet, sterile dressing. Otherwise, the burn should remain uncovered - do not apply butter or any other topical ointment until further evaluation by a medical professional. Elevate the burned extremity to minimize swelling and seek medical attention. This is extremely important to avoid infection and minimize any long term complications from wound healing.
Remember, the best approach is prevention. Re-set your water heater, turn pot handles in, never leave your child unattended in the kitchen or bath, and make certain your smoke detectors are working and you change your batteries once a year.
Written by 3MD | THREE MOMMY DOCTORS
National Center for Injury Preventions and Control www.cdc.gov/ncipc/wisqars/ (Accessed on April 12, 2007).
D'Souza AL, Nelson NG, McKenzie LB. Pediatric burn injuries treated in US emergency departments between 1990 and 2006. Pediatrics. 2009;124(5):1424. PMID: 19805456
Drago DA. Kitchen scalds and thermal burns in children five years and younger.Pediatrics. 2005;115(1):10. PMID: 15629975
Peoples J. Pediatric Burn Care. http://peds.stanford.edu/Tools/pdfs/pediatric_burn_care_peoples.pdf
Hartford CE, Kealey CP. Care of outpatient burns. In: Total Burn Care, 3rd ed, Herndon DN (Ed), Elsevier, Philadelphia 2007.
Reed, JL and WJ Pomerantz. Emergency management of pediatric burns. Pediatric Emergency Care. 21 (2): Feb, 2005: 118-129.
Wiktor, A. Richards, D. Treatment of minor thermal burns. In: UpToDate, Post (2015), UpToDate, Waltham, MA. (Accessed on September 25, 2015).