When should you be concerned about pediatric burns?

Grandmother was in charge, so the parents had complete peace of mind during their kid-free getaway weekend. Everything was well under control even when one of grandma's "charges" suffered a minor injury.

Granddaughter had been baking at a friend's house and after making a quick turn, burned her arm on a hot cookie sheet. With only a small blister and a patch of superficial redness resulting, it sounded like the teen was going to be fine as long as she and grandma continued good skin care and kept on the lookout for any unlikely-to-occur signs of infection.

Burns are frequently seen in pediatric practice and according to Dr. Katrina Mitchell and colleagues in the journal Contemporary Pediatrics, scald burns from hot foods or drinks or from hot bath or shower water are the most common burn injuries in young children under the age of 5. Older kids and teens tend to be burned by flames with common sources including matches, lighters, candles, and house fires.

The pediatric researchers explain that evaluating burn size and depth are important initial steps in burn care. Burns with skin loss to less than 10 percent of total body surface area are generally considered to have a low risk of mortality.

In the journal American Family Physician, Dr. Emillia Lloyd and colleagues caution that while most burns are not severe and can be managed in an outpatient setting, burns that cross major joints or that involve the face, hands, genital area, or feet cannot be classified as minor, easily treatable injuries.

Dr. Lloyd's team defines burn degree by depth of injury. First-degree or superficial burns such as sunburns affect only the top layer of skin, the epidermis. They are characteristically red, painful, and dry and heal in five to 10 days.

Superficial second-degree or superficial partial-thickness burns affect all of the top layer and part of the second skin layer, known as the dermis. These burns result in clear blisters and red, weeping skin and are expected to heal in two weeks without scarring, though scars and skin color changes can occur.

The AFP group describes deep second-degree or deep partial-thickness burns as white and non-blanching, with injury extending into the deeper dermis layers. These burns require a minimum of three weeks to heal and can result in scarring and tightening of the skin.

Third-degree or full-thickness burns penetrate through the epidermis, dermis and underlying subcutaneous fat, leaving an injured area that appears dark brown or tan with a "leathery" feel and no sensation when touched. Surgical skin grafting is often needed when attempting to repair these serious burns.

The most severe burns are classified as fourth-degree, with burn injury extending even further beneath the three skin layers to affect muscle, tendon, or bone.

For initial care of minor "thermal" burns, the family physician authors state that burn areas can be held under cool running water, but should not be immersed in ice water since this can lead to further tissue damage.

Parents should also remember that burns are painful and that oral pain relievers should be given to the injured child as quickly as possible.

Cleaning burns with sterile water can help remove any debris from wounds, but cleaning solutions such as povidone/iodine (Betadine) should not be used.

The AFP group notes that once superficial burns have been cleaned, topical products including aloe vera or antibiotic ointments such as Bacitracin can be applied. Topical corticosteroids are not recommended as they do not appear to decrease the inflammation often seen in minor burns.

Oral antihistamines such as cetirizine (Zyrtec) can also be safely used to decrease the itching often seen during the burn healing process. If the child is not up to date on shots and has suffered a burn greater than first-degree, a tetanus shots should also be administered.

And finally, what to do about those second-degree blisters?

Lloyd and colleagues advise that small blisters less than six millimeters in size be left alone. Large blisters with thin walls, blisters that are very likely to pop on their own, and blisters that prevent normal joint movement will need to be debrided (drained and "unroofed").

• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights

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