How to Handle Burns in Kids from First Aid to Recovery

Gloria is a 27-year-old care worker. She is tall, elegant and well spoken. On her forearm, she bears a severe scar from a burn. Leading into burn awareness month, I asked her if she would be willing to share her story to educate people about prevention, treatment and long-term support. This is critical because it is estimated that over 1 million children suffer burns annually in South Africa. Gloria bravely agreed.

Gloria’s story

Gloria was 15 years old, living with her older sister. Her sister was at work, and she was at home helping with some ironing chores. She set the hot iron down on a small plate, but it tumbled. Instinct made her stretch out to catch it and the hot iron stuck to the inside of her arm, just below her elbow. She doesn’t recall much of what followed, except for the intense pain, fear and loneliness that she experienced. When her sister arrived home, she cleaned Gloria’s arm with warm, salty water and applied butter to the skin. For two weeks, Gloria wiped her skin with salted water and applied butter, but the pain never seemed to subside. When she noticed a terrible smell, she took herself off to the local hospital for treatment.

The outer skin was removed, revealing a large area of infection. She says the pain was unbearable. A three-month period of treatment commenced. She returned to the hospital every few days. She recalls the agony of those days as if it were yesterday.

Now, some 12 years later, Gloria’s eyes still well up with tears as she recounts the fear of being told that she may lose her arm due to the infection, the pain she endured and the ongoing questions from her peers about the scar. Today, people ask her why she doesn’t cover the scar with a tattoo. Her answer is simple – “My scar is a reminder to me of how quickly accidents can happen and what it takes to heal both physically and emotionally. This scar led me to become a care worker. I never want anyone to feel alone when they are suffering.”

From Gloria’s story, I would like to extract points for us to build a solid box.  Our box will contain the essentials of prevention, dos and don’ts and an understanding of the severity of these injuries. 

What is the difference between a burn and a scald?

Scalds are caused by wet heat, including hot liquids or steam. Dry heat burns arise from fire, hot metal (like an iron or stove), electricity, radiation or friction. Chemicals also cause severe burns. Ultimately, this kind of injury does damage to tissue.

The most common types of burns among young children are kitchen-related: hot drinks, microwaved foods or pulling on the cords of electrical appliances. The bathroom is another dangerous spot for scalds. Regardless of the cause, burns and scalds will be treated in the same way.

There are other burns caused by chemicals, electrical currents and radiation, but I will limit this blog to common childhood burns.

Prevention:

Accidents are part and parcel of growing up, but if we can spare a child the trauma of a burn or scald, then we should make every effort to do so. I am not going to go into the obvious safety tips, which can be found on many sites. These include:

1. Turn pot handles towards the back or centre of the stove.
2. Tuck cords of electrical appliances back and out of reach.
3. Use travel mugs with secure lids.
4. Install stove locks.

There are other safety recommendations that people are not always aware of, but are critical to prevent burns:

1. Set your geyser to 49°. Your geyser has a thermostat. If it is correctly set, then you don’t have to worry about your child climbing into dangerously hot water. We underestimate this danger. Statistics coming out of America show that burns from hot tap water result in about 1,500 hospital admissions and 100 deaths per year. It takes just 5 seconds for a child to burn in water at 60°C.
2. Avoid carrying hot liquids while carrying a child. A quick movement may cause you to spill the liquid. Coffee is usually about 79°C when it is first made. A two-second exposure to a hot liquid of 64°C causes a burn serious enough to require surgery.
3. Create a “no play zone”. Children must be taught to stay clear of the stove, oven or outdoor braai. 1m from each of these items will reduce the likelihood of an accident. My own granddaughter loves to see her reflection in the oven door, but without a 1m NO play zone, she may be tempted to touch the reflection, and this would be devastating.
4. Microwave safety. When food is heated in a microwave, steam builds up. An eager little helper may lift the lid and sustain a steam burn. I would advise that you avoid microwaving baby bottles. They heat unevenly and can create areas of great heat.

 An Accident Has occurred. What now?

The do’s

For the sake of quick decision making, remember the 6 C’s:

1. Clothing: Remove any clothing from the affected area. This will prevent the clothes from holding in the heat or restricting blood flow if swelling occurs. It will also allow you to assess the burn.
2. Cooling: Help stop further damage by cooling the injury with running, cool or lukewarm water. Do this for 10 to 20 minutes. Do not use ice. This can cause further injury to the tissue.
3. Cleaning: If there is dirt or debris on the site of the injury, dab with mild, soapy water.
4. Chemoprophylaxis: Apply a cooling cream or gauze. There are burn packs which you can purchase and keep in your emergency box. Aloe vera gel also works well to cool a burn.
5. Cover: Not everyone has bandages at hand, but cling wrap works well to cover a wound and prevent infection.
6. Comfort: The pain associated with a burn is extreme. Please give the recommended dose of paracetamol or ibuprofen as soon as possible.

The don’ts

1. Don’t remove clothing that is stuck to the skin.
2. Avoid breaking blisters as they serve as a protective barrier for the underlying skin. Breaking blisters also increases the risk of infection.
3. Don’t apply oily substances or pastes. There are lots of old wives’ tales about butter, oil, turmeric and toothpaste for burns. These substances trap the heat in the wound, contaminate the burn and increase the chances of infection.
4. Don’t use adhesive bandages, fluffy materials or cotton wool to cover the burn. These might stick to the wound and will be difficult to remove, causing further damage.

Conclusion

Burns happen in an instant, but the lifelong impact is very real. Complications of burns include slow healing, scarring, disfigurement and sometimes loss of function. We cannot underestimate the psychological effect of a burn. Just like Gloria, the trauma may remain real. Individuals who have been burned are at an increased risk for anxiety, depression and post-traumatic stress disorder. Family members also suffer as a result of the accident. Guilt is a real emotion in these situations.

Gloria’s story reminds us that life can change in a second. What is critical is our response. Be prepared. Make sure you have an emergency box and emergency numbers that anyone can access. Be sure to educate yourself and caregivers about first aid. Once you have attended to the immediate crisis, get a medical professional to assess your child and ensure that your child has the best outcome. 

References

1. https://publications.aap.org/pediatrics/article-abstract/25/5/886/40967/MANAGEMENT-OF-BURNS-IN-CHILDREN
2. https://publications.aap.org/aapnews/news/34614/Educating-families-on-risks-for-scald-burns-can
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC11090655/
4. https://kidshealth.org/en/parents/burns.html
5. https://www.sciencedirect.com/science/article/pii/S2468912224000245