What is a burn?
A burn is caused by fire or heat and destroys the skin. When skin is destroyed it cannot help the body to protect against infection, prevent loss of body fluid, make vitamin D, or control body temperature.
How severe the burn is depends on:
- the depth of the burn or how many layers of skin are affected
- the size
- the part of the body affected
- the age of the child
- the cause
- the health status prior to the injury
Types of Burns:
There are many types of burns.
- A superficial burn (first degree) affects only the outer layer of skin (epidermis). The skin looks red and pink and may have blisters. These burns are painful.
- A partial thickness burn (second degree) affects both the outer layer of skin and the layer that lies underneath it (the dermis). The skin may have large blisters and the tissue is deep red, wet, and shiny. These burns are very painful.
- A full thickness burn (third degree) destroys all layers of the skin. This type of burn may be deep red, white, yellow, black, or brown. Surgery is often needed to remove dead tissue.
- A fourth degree burn affects all underlying skin and tissues and may cause charring.
- Both third and fourth degree burns may not be painful because the nerve fibers have been damaged.
Taking care of the burned skin
The wound must be cleansed to heal. Your child’s burn will be cleaned daily by the Physical Therapist in the tub room. In the evening, your child’s nurse will clean the burn by taking off the dressings, gently cleansing the area and then applying the topical ointments/creams and dressings.
If there is dead skin on the top of the wound it must be removed by debridement. Debridement is removal of dead tissue on the burn wound by scrubbing with gauze and sterile water in the tub room or by using surgical instruments in the Operating Room. Your child will be given pain and sedation medications for the cleaning in the tub room.
After cleaning a burn it is covered to help prevent infection. Some of the coverings used are:
- Accuzyme with Polyspori® powder- a cream that breaks down dead tissue. The Polysporin powder is used to fight infection.
- Aquacel® AG- an antimicrobial dressing placed over the burn when it is almost healed. It can be used on the donor site too.
- Bacitracin® - clear ointment used mostly for the face and superficial burns, and is left uncovered.
- Silvadene® - thick white cream usually covered with gauze.
- Sulfamylon® - thick white cream used for the ears and nose or sometimes partial-thickness burns.
- Xeroform® - gauze covered with Vaseline that is placed over burn areas and left on. This gauze is used mainly for burns that do not require grafting or burns that are almost healed.
Hydrotherapy or Tubbing
To care for your child’s wounds and help healing begin, a procedure called hydrotherapy may be used. Physical Therapists will provide the wound care during hydrotherapy and keep you informed of how the burn wound is healing. Hydrotherapy is done by scrubbing the wound areas with warm water and gauze to remove loose/dead tissue from the wound. By removing this old tissue, chance of infection is decreased and new tissue will be able to grow. Your child will be sedated by a pediatric intensive care physician for this treatment. This doctor will meet with you before the first hydrotherapy to talk with you about the medications and how your child will be monitored during the procedure.
Your child’s doctor may order evening dressing changes. This includes gently removing dressings, cleaning and redressing the burn wound. There will be no scrubbing at this time. Pain medications will be used to control your child’s discomfort.
While your child’s burns are healing, it is important to try to prevent infections. Infections might slow down the healing.
- People who are sick should not visit your child.
- IT IS VERY IMPORTANT TO WASH YOUR HANDS BEFORE AND AFTER CARING FOR YOUR CHILD.
- ANYONE coming to care for, or visit with, your child must wash his or her hands before and after touching your child.
Linens should be kept clean. Tubes and lines that are used for IV nutrition, blood draws, and draining urine will be taken out as soon as your child is well enough to manage without them. While the tubes and lines are in place, he/she will be closely monitored for signs of infection. Great care will be taken to keep your child clean.
Graft sites and donor sites
What is a skin graft?
A skin graft is a piece of the child's unburned skin taken to cover a burned area. Skin grafts can be thin or fairly thick. Skin grafts are done in the operating room. The burn that is covered with a skin graft is called a graft site.
What is a donor site?
The area where the piece of unburned skin was taken from to cover a burned area is called a donor site. Donor sites look like a scraped or a skinned knee. Your child's doctor will decide if he/she needs a skin graft. A skin graft can be done in the Operating Room when the surgeon removes the remaining dead tissue.
Graft Site Care
The dressing is left on the graft site for two to five days before it is changed so that the new skin will stay in place. For the first several days, graft sites need to be kept very still and protected from rubbing or pressure.
Donor Site Care
The donor site is kept covered the first 1-2 days with a white gauze dressing. The site needs to be kept dry. Under the gauze dressing, the donor site can be covered with any of the following:
- Xeroform® - yellow gauze that is trimmed with scissors as it dries or the edges peel up.
- Aquacel® AG- an antimicrobial dressing placed over the burn when it is almost healed. This can be used on the donor site too.
- The doctor may want a heat lamp applied to donor sites to help them dry.
Donor sites heal in 10-14 days. If a dressing is applied, it usually remains on until it comes off by itself. Lotion or cream (Eucerin®) is applied to the donor site after the dressing comes off. This skin often flakes off and looks dry.
Most children with burns have pain. The amount of pain depends on the degree of the burn. Severe pain can make your child's stay in the hospital very scary. Your child will be given pain medicine through the IV or by mouth before wound care and as needed. Many parents worry that their child may become addicted to pain medicine. This is very rare because children are given only small amounts of pain medicine for short time periods. If you have more questions about pain medicine, please ask your child's nurse or doctor.
If old enough, your child can help control the pain by rating it with a scoring tool. This will help the nurses know when and how much pain medicine to give to make your child more comfortable. The nurses and Child Life Specialist can help your child control the pain. Managing your child’s anxiety about procedures and treatments is an important part of managing his/her pain. A nurse and/or Child Life Specialist can help you find ways to comfort and distract your child to decrease his/her anxiety.
A child who has been burned needs a diet higher in calories and proteins to help him/her heal and grow (See Way to Grow: High Calorie/High Protein Diet). Your child may have an IV for extra fluids when he/she first comes to the hospital. When your child is more awake and is feeling better, he/she can start to eat.
Most children do not eat well when they are sick or when they are in the hospital. Some ideas to help your child eat include:
- Bring your child's favorite foods from home.
- Work with the nursing staff to adjust your child’s meal schedule to make up for time when he/she can not eat because of tubbing sedation.
- Serve your child small meals more often.
- Praise your child after eating, even if only a small amount was eaten.
- Offer your child high calorie shakes and snacks (ex: ice creams, puddings, custards). Avoid candy and soda, as they contain no nutritional value.
- Let older children fill out their own menu.
- Let your child eat with other children in the playroom.
- Serve drinks with fun straws in fun cups.
If your child eats poorly be sure to tell the nurse exactly what and how much your child eats and drinks. If your child does not eat enough to maintain his/her weight, it is possible that the burns will not heal properly. If this is a concern, the dietitian/nutritionist will see your child. The dietitian may recommend that your child receive supplemental calories and other nutrients through the use of tube feedings. If this is the case, a tube will be placed through your child’s nose and into his/her stomach. (See Way to Grow: Intermittent Nasogastric Feedings). High calorie liquids are given through the tube at night when your child is asleep so he/she can rest and get good nutrition. Once your child is eating enough, the tube feedings will be stopped.
Give your child a variety of foods that have good nutrients to help the skin heal. Vitamins A and C are important vitamins for the skin. Some foods that have Vitamin A and C are oranges, grapefruits, tomatoes, strawberries, broccoli, and carrots. Also, enriched cereals such as Product 19® and Total® have vitamins. Foods that give proteins such as meat, fish, eggs, peanut butter, chicken, and milk are important for skin healing, too. Remember raw fruits and vegetables are great snacks.
Pain, stress, anxiety, isolation, sleeplessness, low self-esteem and loneliness are all feelings experienced by the hospitalized child. Children often fear doctors, nurses and medical procedures. You will help your child manage and cope with this stressful situation by staying in the hospital with your child as much as possible. Brothers and sisters are also encouraged to visit after your child begins to heal. The Child Life Specialist will help your child and his/her brothers and sisters cope and adjust to the hospital and treatment.
Sometimes, children with burns behave in ways that concern us. It is common for children to feel angry, aggressive, depressed, and guilty or have nightmares. Body image, or how a child sees him/herself, is a major concern for the child with burns. These reactions are normal. Your Child Life Specialist will offer medical play sessions and guidance to help your child understand and cope with this overwhelming situation. Sometimes, professional counseling is helpful in dealing with the problems associated with burns.
The burn care treatment team is committed to meeting the psychological and social challenges that accompany burn treatment and recovery. Parents can help us provide the best psychological and medical care by working with the medical team to provide an individualized care plan. You will be asked to help with dressing changes, reporting pain levels, establishing comfort techniques, and helping us provide opportunities for socialization, play and education. It is also important to continue disciplining your child as you do at home. With love and support, your child needs to know what you expect. The Child Life Specialist will discuss your child’s behavior and help you develop a behavior management plan.
The Burn Team will be meeting with you on a regular basis. Do not be afraid to ask questions. It is often helpful to keep a notebook of questions and suggestions to discuss with the team each day.
Disclaimer:This information is not intended to substitute or replace the professional medical advice you receive from your child's physician. The content provided on this page is for informational purposes only, and was not designed to diagnose or treat a health problem or disease. Please consult your child's physician with any questions or concerns you may have regarding a medical condition.