Burns are the second leading cause of death in children. The most frequent type of burn that accounts for 85% in children <4 years of age are scald burns. Scald burns are usually home injuries acquired accidentally by children like getting poured or spattered by hot water, hot liquids and foods.
Proper management of burn no matter how minor and superficial it is should not be underestimated. While most superficial burns generally heal in no time, there are also many instances that it can be complicated. If adequate initial first aid had not been given, the child could lose a lot of body water, leading to dehydration, and even worst- shock. More so, thoughtless handling of burn wound can lead to secondary infection, causing delayed healing, and sepsis.
The following should be observed in the initial management of minor burns:
1. Without delay, run cold tap water directly onto the burn for at least 20 minutes. Cooling is beneficial if started within 3 hours. It leads to reduction of fluid required for resuscitation, decreases burn depth, and significantly reduces pain and edema.
2. Never use ice or iced water (< 4 º C) in cooling the burnt area. This will only deepen the depth of the burn by causing vasoconstriction. Prolong cooling should also be avoided. Both ice water application and prolong cooling can lead to hypothermia which is a particular risk in young children..
3. While cooling the burnt area, keep the rest of the body warm by removing wet clothing, covering unbunt area, and increasing the ambient temperature to 25-30º C. Exposing the child’s whole body to water, such as in a bath, can cause hypothermia.
4. Do not apply cream, gel, alcohol-based solutions or anything on the burnt area. It is important to keep the burn site sterile in order to avoid infection.
5. The first 6 hours following injury are critical. Bring your child to the hospital no matter how minor the burn wound appears to be. Throughout transport, continue cooling by spraying fine mist or frequently changing soaked sterile dressings.
In the hospital, your child’s burn will be assessed as to percent body surface area coverage and depth. Burns in children which usually warrant hospitalization include the following: a) any burn in very young children, b) full thickness burn, c) circumferential burn, d) burns greater than 10% of the total body surface area, e) burn involving the face, hand, feet, and perineum, and f) inhalational burn injury.
In all cases of burn though, tetanus prophylaxis will be given to your child by your health care provider. Loose necrotic tissue will be removed by gentle scrubbing and a thin layer of antibiotic cream will be applied. The wound will then be dressed with petroleum gauze and dry gauze thick enough to prevent seepage to he outer layers.
At home, it is necessary to follow the following recommendations for daily care of the wound to ensure faster healing.
1. If possible, change the dressing twice daily or as often as necessary when the dressing becomes soaked with wound discharge.
2. On each dressing change, remove any loose tissue but do not attempt to remove the whitish granulation tissue that starts to grow on the wound. Granulation tissues are immature new growths that will soon seal in the wound.
3. Inspect the wound for discoloration, hemorrhage, and cellulitis. These are more reliable markers for secondary bacterial infection. Fever is not a useful sign. Consult your physician so the child will be given proper dose of antibiotic therapy.
4. Wound cleansing may be done with normal saline and soap. Air dry the wound, apply topical antibiotic (silver sulfadiazine) and cover with sterile gauze. Never use alcohol-based solution to the wound.
5. Malnutrition will prevent wound healing. Be sure to feed your child with foods high in energy and protein. Eggs and peanuts are good examples of high protein foods necessary for tissue regeneration and repair.
One should realize that failure to institute appropriate management of burn wounds can bring a lot of possible complications that may put your child in grave danger.