Thermal Burns in Children- Dr. Acky Friedman

A burn is a process of decay and necrosis of tissue due to heat. The burns may generate from dry heat (fire), wet heat (steamed water) or electrical burns.

Burns are classified, depending on the severity of tissue damage, into three levels.

1. First-degree burns – the most common burn is a result of excessive time in the sun. Usually, the area is red and turns white when pressed. The damage is mainly to the upper layer of the skin, the epidermis. Healing is spontaneous and takes up to a week.
2. Second-degree burns – a burn that penetrates the second layer of the skin, the dermis. Second-degree burns can be divided into two segments:
   • Second-degree surface burns – a burn that is followed by pain and sometimes blisters. This burn usually heals in about three weeks. It may or may not leave a scar.
   • Second-degree deep burns – usually white or an ivory color and may leave a scar. The healing time is much longer. With these burns, it is sometimes necessary to perform a skin graft to complete the healing process.
3. Third-degree burn – penetrates deep into the epidermis. Causes scars and usually requires an immediate skin graft and the use of pressure bandages.

In the process of the burn, there is a decay of skin cells and a release of chemicals that causes nerve irritation and pain. When new skin is grown and the injury begins to close, the healing process begins. However, when the burn is large or deep, there is a risk of infection, mostly caused by bacteria. In large burns, there is a degree of fluid loss from areas without skin, therefore dehydration becomes a concern. This is the reason that the two main complications that require attention in burns are infection and dehydration. There are long-term complications such as the shrinkage of the new tissue, resulting in a deformation of the injured area, sometimes to the point of limitation of motion (for example, if the burn damages the limbs).

In the burn area, and according to its severity, you may experience temporary or permanent changes in the sensation of heat, cold, humidity, touch and pain. There may also be changes in perspiration (if the sweat glands were injured). Consequently, if you’ve experience a burn, it is important to consider suitable clothing for your situation.

Treatment

First-degree burns – usually heal by themselves, naturally, while deep second-degree and third-degree burns require a skin graft and treatment on remaining scars. Sometimes, patients require supporting treatment at the hospital, such as taking fluids, painkillers and antibiotics.

For first-degree burns, it is usually sufficient to have local treatment and sometimes bandaging.

Prevention

Since infants are unaware of the dangers that can await them (stove, coffee mug, cigarette, etc.), it is recommended to keep such items out of their reach. For a crawling baby, the stove or a mug on a table could attract their attention. Note that babies have difficulty in removing themselves quickly enough from an burning situation, which can result in excessive burns, while an adult can quickly respond after the initial touch. Excessive sun exposure in babies can occur in as little as 30-45 minutes and cause burns, while adults normally endure this exposure time with no harm. This is not the place to discuss the importance of exposure to the sun, which activates Vitamin D, but it is important to note that there is no need for over-exposure.

Immediate Treatment

When there is a burn in which thermal damage has occurred, it is recommended to treat the area using ointments. Soaking the injured body part in cold water or using ice may ease the pain but will not heal the damage.

It is always recommended to get a dermatologist’s opinion concerning the burn and its severity, since if there is a risk for long-term complications, it is best to start treatment right away.