Handling Burn injuries in children!!

Burn in children can occur anytime, how do you handle it?

Burn injuries are common emergencies that often leave parents and caregivers confused on what to do!

Dr Ayobami Aranmolate, Consultant Burns and Plastic Surgeon at Grandville Medical and Laser, Lagos took up this topic in a Group Discussion on the Ask The Paediatrician Facebook Live Group Discussion recently.

It is always a very painful and agonizing time for the child and the parents anytime a child suffered from Burns.

It is very important to prevent burns from happening in the first instance. However, if it happens, we as parents must know what to do.

Most of the commonly used first-aids by many African parents are actually counterproductive and can worsen the burns injuries. The highlights of the Group Discussion on Burns by the Burns Surgeon is highlighted in this article.

Burn injuries are injuries or wounds that result from exposure of the skin to heat, electricity, radiation and chemicals.

In burns, the skin is partly or wholly damage by the heat or electricity.

The commonest is the home accident which can be caused by heat (fire) or  hot water in various scenarios such as

• Heat from hot water steam from our kettles.
• Hot food, hot water from the water bottle or flask.
• Children dragging boiling water and so on
• Others include children biting electric cables or eating battery which contains either acid or alkaline.

We can also burns have industrial burn injuries like in child labour especially in children who are forced to work in industrial areas or either as a survival option.

When burns occur, it is not only the skin that is burnt or damage but all the other structures that are under the skin. Likewise some cases may even burn all the way to the bone e.g. electrical burns injury. Electrical burns injuries are usually the most severe.

Thermal (heat) burn is the most common of the different forms of burn injuries often seen in children.

It can be sustained by touching or contact with anything that is hot either liquid or solid.

 

The contact time is usually very important apart from the temperature of the object. The higher the temperature the more severe the burn. The longer the contact time the higher the severity.

Melting metal in form of object roll cause more damage to the skin than water in liquid form.

Thermal burn is usually superficial burn meaning it doesn’t usually go deep down the skin and many at times they can be managed at home but it is advised that the discretion of management should be left to the Burns Surgeons as some superficial burns may actually be deeper than the way it looks.

What to do in event of burns accident?

• Call for help if you are in an enclosed area especially in fire accident.
• Pour copious amount of water on the area involved!!!Water helps the burn injury by cooling the skin which reduces the severity of the injury except in some rare cases of chemical burn injury
• Remove the child from the site of injury
• Remove the clothing if burning as quickly as possible
• Cold water should be poured preferable to the area of injuryThe same principle applies in chemical burn
• In electrical injury switch off the light from the source or disconnect the object
• Take the child to the hospital for assessment by the doctors especially if it is severe or major.

Types of burns that require immediate hospital  care

Though minor burns wounds can be managed at home, the following types of burn injuries must always be taken to the hospital!!! This is because such wounds have higher risks of complications if not properly managed. They are burns involving:

• the hand
• genitals or private part
• the face
• inhalation injury as a result of inhaling lot of smoke or fumes from the fire
• large surface areas of the body
• Chemical burns (from acid or alkali) no matter how small
• Electrical burns no matter how smallElectrical burn is worse because it has what we call ice berg phenomena because what you see outside is not a true representative of the severity of injury

What not to do in case of Burns?

There are some common, popular local practices of first-aids for burns injury that are actually not recommended as they can worsen the burns. In cases of burns,

• Do not  apply pap (ogi or corn meal)
• Avoid breaking and pouring egg on the burns wound
• Never pour urine on the wound
• Do not apply salt 
• Avoid applying crude oil

Remember, the first thing to do is to pour cold water on the burns and then take the child to the hospital if it falls in the category of those that must be taken to hospital. If small wound, after the cold water, you can use vaseline, honey or dermazine cream on the wound.

The first 24 hours is very important even though complications can still arise after the first 24hours but a lot of mistakes are made in the first 24hours.

Burn injuries don’t usually have infection until when things like urine,pap,eggs and so  on are poured on it! Burn wounds infections is one of the most serious complication of burns that can make it life-threatening!!!

In conclusion, we Paediatricians are more interested in prevention of  burns. As popularly known, prevention is better than cure!!!

Please AVOID BURNS BY ALL MEANS!!!  

• Keep children away from the kitchen.
• Be very alert when handling hot liquids – most burns accidents happen in split seconds.
• Avoid carrying hot water without pads or over a long distance!
• Avoid leaving hot liquids – water or tea on high tables where children will want to pull it down.
• Child-proof your homes to reduce domestic accidents from fire and hot liquids.

However, if burns still happen, do as advised. Pour lot of cold water and take the child to the hospital immediately!!!