Ultimate guide to kids' burns: Types and treatment

At some point or another, your kid will likely get a burn. Which are OK to treat at home? Cover the burn or let it breathe? We sort through this hot topic.

paper illustration of burned skin
Photo: Erik Putz

toddler grabs the handle of a cooking pot on the stove. A baby is placed in too-hot bathwater. A preschooler knocks over a cup of coffee. A school-ager accidentally touches a hot curling iron or the glass door in front of a roaring fireplace. (We’re wincing at these scenarios, too.)

The typical home has a multitude of heat sources, so it’s no surprise that childhood burns are common. They’re almost always preventable, but accidents happen—so parents should know how to deal.

Types of burns
I
n North America, burns are described as first-degree, second-degree and third-degree depending on how deep they are.

First-degree burns are superficial burns affecting the skin’s top layer (epidermis). First-degree burns are red; if touched, they blanch to white, but quickly turn red again. They’re dry burns, not weepy, says Janice Heard, a Calgary paediatrician. You can treat first-degree burns at home unless they’re extensive. For example, if your child’s entire torso is sunburned, see a doctor, as there could be larger issues at play. “Kids can get dehydrated from having burns,” says Heard. “And for pain control, sometimes they need more than over-the-counter medication.”

Superficial second-degree burns are moist, red and very painful. They also form blisters (which you shouldn’t pop). Seek help if the burn is bigger than the surface of an adult’s palm.

Deep second-degree burns are serious, but they may cause less pain because nerves have been damaged. The burns may appear white or mottled red and white, and skin can slough off. Seek help immediately.

Third-degree burns are the most serious. They destroy the skin’s outer layers (epidermis and dermis) and affect nerve endings, capillaries and hair follicles. They can appear dry and leathery, and may be white, brown or charred. Get emergency medical help right away, no matter what the  size, as they may need skin grafting to heal.

First aid for burns
* Remove the heat source as quickly as possible and cool the burn by running cool or cold water over it or applying a cold compress (a cloth soaked in cold water) for 20 minutes. Never use ice or ice packs—they can cause further damage by freezing the skin.

* For large burns, cool the area but don’t immerse the child in a cold bath—this could cause hypothermia.

* You don’t need to cover first-degree or superficial second-degree burns unless they ooze. If that’s the case, or if the burn is painful for the first day or two, loosely tape a non-stick pad or gauze over it to block dirt, breezes and contact with clothing. To help control pain, give your child (six months or older) acetaminophen or ibuprofen, if needed, for the first 24 to 48 hours.

* Some people apply butter, baking powder or chilled oil to burns—but that’s not advised. Aloe vera, calamine and antibiotic creams aren’t recommended for burns, either. Use a clean dressing until you seek medical advice, says Heard. If you want to keep gauze from sticking to the burn, use petroleum jelly. “It’s clean, readily available, cheap and it doesn’t have anything added that might irritate skin and interfere with healing,” says Heard.

* If the child’s clothing caught on fire and the fabric is stuck to the wound, don’t pull it off. Cut around it as best you can and seek medical help.

* For severe burns—superficial second-degree burns larger than an adult’s palm, deep second-degree burns and third-degree burns—seek emergency services immediately. “On your way to medical care, cool the burn and wrap it in something clean,” says Heard.

* Electrical burns can be tricky to assess. “Even if the child seems well, electrical burns can affect internal organs, and you think they’re OK but they’re not,” says Heard. If your child has suffered an electrical burn, turn off the source of electricity before touching her, then call 911.

How to prevent scalding from the sink or bath
It’s super common for kids to get scalded from the hot water in sinks, showers and baths. To help prevent it, turn down the temperature of your hot water tank to 49C (120F). Most people keep their tanks at 60C (140F). “As adults, we can stand hot water, but we have thicker skin than kids,” says Heard. “A child can get scalded with something we find merely hot.” 

A version of this article appeared in our December 2016 issue with the headline “Burning questions,” p. 28-9.

Read more:
How to soothe a sunburn
First-Aid basics for parents
First-Aid checklist 

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