Iowa Health Book: Emergency Medicine

Burns

Children's Hospital
300 Longwood Avenue
Boston, MA 02115

Burns caused by heat sources (hot water, fire, sun, stove burners, heaters, etc) result in injuries to the skin that are commonly labeled first degree, second degree and third degree. Other terms used are partial thickness and full thickness. All these terms refer to the severity or amount of tissue damage that has occurred.

First degree burns appear red and swollen. Second degree burns have blisters or look wet, in addition to being red, and swollen. Third degree burns are the most serious; they are deeper, look raw, charred or whitish. Even though third degree burns are deeper, they are less painful than first and second degree burns because the nerve endings have been destroyed. A child with multiple or large burns will often have a combination of first, second and third degree.

Caring For A Child With A Burn:

Your child's bandage must be changed on (date) by:

• Yourself at home
• Your Pediatrician or Nurse Practitioner (call for an appointment)
• Children's Hospital Emergency Department
• Surgical Nurse Clinic at Children's Hospital (Call 735-7641 for an appointment)
• Visiting Nurse at your home (visit will be arranged by us)

When changing the bandage at home, do the following:

1. Wash your hands with warm water and soap first.
2. Remove the old bandage. If the bandage is sticking to the wound then soak it in lukewarm water for several minutes.
3. Gently clean the area with lukewarm water and a mild, nonperfumed soap (Dove). Do not purposefully break blisters, they provide natural protection to the injured skin.
4. Gently pat the area dry with a soft, clean towel.
5. Apply to the burned area. Avoid touching the tube to the wound or reinserting a used applicator into the jar to prevent contamination of the remaining medication.
6. Apply a new, sterile bandage to the area as shown today.
7. Change the bandage daily or if it becomes wet. Keep the wound covered until the skin is well healed and there are no moist or open areas.

Pain: Burns are painful, especially in the first 24 to 48 hours. A prescription for a medication to relieve pain is usually given for severe or large burns. The pain of minor burns can be relieved by Acetaminophen (Tylenol, Tempra...). If using Acetaminophen, then give it every four hours and calculate the dose based on your child's weight rather than age for best effect. Changing a bandage in the first day or two is painful, try to give a dose of the prescription medicine or acetaminophen, 30 to 45 minutes prior to the change, to minimize discomfort. If your child's pain is not relieved by the prescription medication or acetaminophen, then contact your doctor for advice.

Elevate the Wound: If the wound involves an arm or a leg, then raise it up on pillows as often as possible and convenient for the first 24 to 48 hours to decrease the amount of swelling in the area.

Fluids: Give your child extra fluids to drink in the next 24 to 48 hours. Much water is lost through the skin when there is a burn.

Watch for Infection: The most common complication to occur after a burn is infection. Because the skin has been injured, it is open to contamination by bacteria. It is IMPORTANT to keep a burn covered with a clean, dry bandage until the wound is no longer open. Watch for signs of infection as the burn heals.

If you see any of the following signs, contact your doctor or return to the Emergency Department:

• the area becomes more red or swollen after the first 24 hours
• pain is increasing after the first day or two
• red streaks appear on the skin near the wound
• fever occurs without an another obvious cause . foul smelling, greenish pus drains from the area

All contents copyright © 1992-1997 the Author(s) and the University of Iowa. All rights reserved.
Last Modified: November 20, 1996