Burns in Children: How to Treat a Burn

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Guest: Ms. Jill Evans - RN, MSN

Host: Dr. Linda Austin – Psychiatry

Announcer: Welcome to an MUSC Health Podcast.

Dr. Linda Austin: I am Dr. Linda Austin, talking with Jill Evans, a nurse at MUSC and the Coordinator of the Pediatric Burn Center at the Medical University of South Carolina. Ms. Evans, let’s talk a bit about how one can treat minor burns in children at home and may be we should start by having you explain, how do you know when it’s time to take a child to the emergency room versus being able to just treat it at home.

Jill Evans: Well, there are guidelines set out by the American Burn Association for which burns really do need to be seen by a specialized burn center, or immediately by a primary care provider, or in an emergency room, and those are burns that happen in very young children or the very elderly, so really almost any burn unless it is very, very small, in a child younger than two, does need to be seen by a medical professional.

Dr. Linda Austin: And why is that, why is to kind of a cut off?

Jill Evans: Well, children under the age of 2 and the elderly, their skin is much thinner than those of older children and adults. So, it actually takes less heat at a shorter duration to cause a deeper burn and because their skin is thinner, burn that may initially appear to be more superficial may actually be a deeper burn in those two populations just because really kind of the physiology of their skin. Very young children are also more prone to having a lot of fluid loss through a wound. Anytime you have a wound, you usually have some normal drainage from that wound, but if it’s in a very small child, you can actually get quite a bit of fluid loss there and if there is associated sunburn or if the child has any kind of illness going on at all, they can very rapidly get dehydrated to the point where they would need more treatment than it could get at home.

Dr. Linda Austin: How about an older child, let’s say a school-aged child, are there guidelines that you can suggest about when a burn can be treated at home versus brought in to a professional?

Jill Evans: So, very small burn injuries and by that I mean those that are -- the way we measure burns is by how much of percentage of the body they cover. So, if it’s a one to two percent burn, one percent of your body is the palm of your hand. So, if it’s about the size of the palm of your hand and it’s on a flat surface of the body, so you had a small spill of a hot liquid may be to your arm or to your chest or to your leg, and it looks pink and may be doesn’t blister, those can oftentimes be cared for at home with cold compresses and oftentimes some ointment because those burns are really just similar in nature to a severe sunburn.

Dr. Linda Austin: What kind of ointment do you recommend?

Jill Evans: Usually initially, we will just use cooling, cool compresses and then any kind of really first-aid ointment that you have in the home. So, a triple antibiotic ointment or bacitracin ointment, those things that you probably already have in your home, but again it’s important for folks to know that even a small burn, even a burn that may be as less than one percent of the body, if it’s on an area of the body that may have difficulty healing even if it’s a pretty superficial burn and those areas of the body include the face, the hands, the feet, major joints, anything in kind of your periarea; those areas of the body tend to be a little bit more difficult to treat and they are more difficult to address. Even a pretty superficial burn that does not heal quickly can cause some problems with scaring or contractures down the road if they happen to the fingers or the toes. So generally, any burn that involves those areas of the body that I have just talked about the face, the hands, the feet, the eyes and ears, major joints so a burn that covers your knee or covers your elbow, those types of burns even if they are pretty small, really need to be seen at a specialized burn care facility.

Dr. Linda Austin: And then they will be addressed and treated appropriately, is that right?

Jill Evans: And then they will be addressed and treated appropriately and we can make sure that addressing, any needs that the patient may have as far as long term if we can address a burn to a hand that may be involves the fingers, we can do some relatively simple things early on that will prevent problems down the road.

Dr. Linda Austin: How about sunburns?

Jill Evans: Sunburn is usually not something that you need to go to a physician for, but there are exceptions. Exceptions are in the very, very young children. So, again children under the age of two and have a large body surface area sunburned, one that may be covers a good percentage of their body, and then also those sunburns that are bad enough that there is a lost of blistering and that the child -- dehydration is often associated with sunburn because the fact that you are out in the hot sun for a prolonged period of time getting the sunburn usually means that you are not taking fluids like you should, so again you can have some problems with dehydration. So, if those are over a good percentage of the body, again those should be seen.

Dr. Linda Austin: Jill Evans, thank you so much for taking with us today.

Jill Evans: Thank you.

Announcer: If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection at (843) 792-1414.

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