Burns and scalds in children: first aid in the first twenty minutes

Friday evening, the end of my shift. A breathless mother walks into the pharmacy with a boy of about three who is crying at the top of his voice: he grabbed the handle of a pot and got burned by hot soup. Her question was which burn ointment to buy. My answer surprises her: none for now. The first step is at the tap, twenty minutes under cool running water, and the ointment is applied only after that. In the first minutes after such an injury the pharmacy can offer nothing more valuable than plain water.

Burns are among the most common home accidents in small children, and around 3500 children with burns pass through Bulgarian hospitals every year. According to burn specialists, between half and 80% of the injured receive improper first aid or none at all. I am writing this article so that this does not happen to your child: what to do in the first minutes, what never to do, when to dial 112 and what follows in the days after.

A child's skin is thinner than yours and heat penetrates it more deeply in less time. A liquid that is merely hot for an adult can leave a second-degree burn on a small child. Remember: with children the notion of a light burn does not exist. Because their body is small, even a small-looking injury covers a large percentage of their skin. This leads to lightning-fast fluid loss and a rapid risk of complications. That is why with children there is no minor burn to be waved away.

The highest risk is in children under five, and among hospitalised children under four about 65% of cases are scalds from hot liquids and another 20% are contact burns from hot surfaces. To judge how great the danger is, use an easy-to-grasp measure: the child's whole palm is about 1% of their body. If you see a burn larger than that palm, do not waste time with home remedies, call a doctor at once.

Cool the spot under cool running water for at least 20 minutes, as soon as possible after the injury. The water should be cool but not ice cold, and the stream gentle so it does not injure further. Twenty minutes feel like an eternity when your child is screaming, but they are what stops the heat that keeps burning the tissue even after the contact has ended: less depth of the burn, less pain, a smaller scar. It is useful to know that cooling still helps up to three hours after the incident, so even a late reaction is better than a missed one.

While you are pouring water, remove the clothing, nappy and jewellery around the affected spot before the swelling sets in. If something is stuck to the skin, do not pull it: cut away as much as you can around the stuck part and leave the stuck part for the team in the emergency department or the ambulance crew. Cover the body to preserve its warmth: small children lose heat quickly, so while cooling wrap the child in a blanket without covering the burned spot. If you are waiting for an ambulance, keep cooling until it arrives.

The hydrogel compresses from the medicine cabinet are only a temporary option until you reach running water. For a larger area a shower with a gentle stream also works, aimed at the burned spot rather than the whole body.

Grandma's recipes in this topic do a worse service than the injury itself. Ice constricts the blood vessels and adds cold damage to the heat damage. Butter, ointments and grease seal the heat into the skin, and in hospital they will have to be removed painfully. Toothpaste gives only a menthol illusion of coolness without really cooling. Yoghurt, egg white and potatoes are not a dressing either, but a risk of infection.

Blisters are not popped: the fluid under them is sterile and their cap protects the wound more reliably than any dressing. Adhesive tapes, plasters and cotton wool stick to the wound and tear the new skin when removed. The rule is simple: nothing sticky, nothing greasy, nothing from the fridge. Only water, then cling film.

After the twenty minutes cover the spot with a layer of kitchen cling film: placed over the burned area, without wrapping it around a limb, because the swelling continues. For a hand a clean plastic bag does the same job. The film does not stick, keeps the wound clean, calms the pain because it stops air from reaching it, and lets the doctor examine without removing anything.

Call 112 immediately for: a burn larger than the child's palm; skin that has turned white, waxy or charred; blisters over a large area; an affected face, neck, hands, feet, genitals or creases over joints; a chemical or electrical burn, however small it looks; inhaled smoke, a hoarse voice or difficulty breathing; a temperature above 38 degrees after the injury; any burn in a child under two years. If in doubt, call anyway: the dispatcher on the line will assess.

While you wait for the crew, do not stop the cooling, do not give the child food or drink in case of a severe injury and do not leave them alone. Your calm is contagious: a child who sees frightened adults is stressed twice as much.

With chemical burns, and some of the most common such burns involve household cleaning products at home, first clean the substance off with a dry cloth, then pour cool running water generously for at least 20 minutes and keep the product packaging to show the doctors. Do not try to neutralise an acid with an alkali or the other way round: the reaction itself releases heat and worsens the injury.

With an electric shock, switch off the power supply before touching the child. Electricity leaves a small entry point on the skin but injures in depth, so every electrical burn is for the hospital, even when it looks almost unharmed from the outside.

Mild reddening without blisters passes in about two weeks. To relieve the pain, use paracetamol or ibuprofen, calculating the dose according to the child's weight, but remember that aspirin is absolutely forbidden under the age of 16. The wound must be kept clean and covered with a non-adhesive dressing from the pharmacy, with household cling film used only in the first hours after the incident. Stay alert for signs of infection: if the redness spreads, pus appears, the pain increases or the child runs a temperature, take them to a doctor immediately. During healing the skin becomes dry and itchy, and a moisturising cream (emollient) from the pharmacy soothes it. Since the new skin is very sensitive and darkens easily, protect it with sunscreen during the first year. Sunburn is a separate topic with its own rules and has its own article.

Most accidents with children at home happen within seconds, but almost all can be avoided. The rules are simple: do not hold hot coffee or any hot drink with a child on your lap, do not leave cups near the edge of tables and put away the tablecloths that little hands can pull. When cooking, turn the pot handles inward. Set your water heater to a maximum of 50-55 degrees and always test the bath water with an elbow or a thermometer before the child gets in. Science proves these measures work. The global medical review Cochrane tells of the Norwegian town of Harstad, where ten years of persistent prevention cut childhood burns by more than 50%. One minute of prevention saves months of pain and scars for life. In an emergency call 112 first. And if you have questions after that, I will be waiting for you in the chat. I answer personally and free of charge, for informational purposes, without diagnosis and without changing therapy.

This article was written by Donka Arabadzhova, Master of Pharmacy, and confirmed by the following sources: NHS, Burns and scalds: first aid, 20 minutes of cooling, cling film, when to seek emergency help; NHS Healthier Together: burns in children, the red flags and the palm rule for 1% of body surface; HSE Ireland: first aid for burns and scalds in babies and children; Mayo Clinic: Burns, first aid; Cochrane Review: community-based interventions for the prevention of burns and scalds in children; Johns Hopkins Medicine: Burns in Children, statistics on scalds and contact burns under age 4; Interview with Prof. Maya Argirova, head of the Burns Department at Pirogov: around 3500 children with burns per year in Bulgaria (in Bulgarian); Pirogov specialists: 50-80% of burn patients receive inadequate or no first aid (in Bulgarian).