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April 26, 2018 Thursday 11:16:33 AM IST
IT CAN HAPPEN IN A FLASH

The summer vacation is here and our children are most likely going the full hog in pursuit of some serious fun and frolic. A word of caution is, however, in order. For parents and caregivers must bear in mind that unintentional burn-related injuries are a leading cause of morbidity and mortality in children. Burn injuries rank third among injury-related deaths in children aged 1 to 9 years. In India, paediatric burns account for 17–25% of the total number of burn admissions!

 

Approximately 90% of burns are caused by household accidents. In children younger than three years, scalds account for most of the burns. Scald burns usually occur when a child accidentally topples a container with hot water, milk, curry, or cooking oil on herself. Scalds may also result from a hot bathtub immersion, especially if the child is all by herself. In older children, flame burns are more common.

 

Firecracker injuries and household fires are the common aetiological factors for these burns. Electrical burns also potentially harmful for children. Toddlers should be kept away from exposed electric sockets. Potent liquids used for cleaning floors and toilets attract children because of their radiant colours. Outside home, excessive exposure in the sun can sometimes result in sun burns.

 

Managing children with major burns isn’t easy. In fact, an understanding about the differences between burn management in children and adults is important. Children have nearly three times the body surface area (BSA) to body mass ratio of adults. Fluid losses are proportionately higher in children than in adults. Consequently, children have relatively greater fluid resuscitation requirements and more evaporative water loss than adults.

 

The large BSA to body mass ratio of the child also predisposes the child to hypothermia, which must be aggressively avoided. Children younger than two years have thinner layers of skin and insulating subcutaneous tissue than older children and adults. As a result, they lose more heat and water than adults do, and they lose it more rapidly.

 

In addition, because of the disproportionately thin skin, a burn that may initially appear to be of partial thickness in a child may instead be of full thickness in depth. Thus, the child’s thin skin may make the initial burn depth assessment difficult.

 

THE TYPES OF BURNS

 

Burns are often categorised as first, second, or third-degree, depending on how badly the skin is damaged.

 

First-degree burns, the mildest of the three, are limited to the top layer of skin. These burns produce redness, pain, and minor swelling. The skin is dry without blisters. Healing time is about 3 to 6 days; the superficial skin layer over the burn may peel off in 1 or 2 days.

 

Second-degree burns are more serious and involve the skin beneath the top layer. These burns produce blisters, severe pain, and redness. The blisters sometimes break open and the area is wet looking and appears in colours ranging from bright pink to cherry red. Healing time varies, depending on the severity of the burn. It can take up to 3 weeks or more.

 

Third-degree burns are the most serious and involve all the layers of the skin and underlying tissue. The surface appears dry and can look waxy white, leathery, brown, or charred. There may be little or no pain, or the area may feel numb at first because of nerve damage.

 

Healing time depends on the severity of the burn. Third-degree burns (called full-thickness burns) needs to be treated with skin grafts, in which healthy skin is taken from another part of the body and surgically placed over the burn wound to help the area heal.

 

FOR FIRST-DEGREE BURNS:

 

Remove the child from the heat source.

 

Remove clothing from the burned area immediately.

 

Run cool (not cold) water over the burnt area (if water isn’t available, any cold fluid can be used) or hold a clean, cold compress on the burn for approximately 3-5 minutes (do not use ice, as it may cause more destruction to the injured skin).

 

Remove all jewellery and clothing from around the burn area (in case there is any swelling after the injury), except for clothing that is stuck to the skin. If you are having difficulty removing the clothing, you may need to cut it off or wait until medical assistance arrives.

 

Do not apply butter, grease, powder, tooth paste, or any other local cream to the burn, as these can make the burn deeper and increase the risk of infection.

 

Do not break blisters.

 

For Flame Burns:

 

Extinguish the flames by having your child roll on the ground.

 

If fire extinguisher is not available, pour water to put out the fire.

 

Cover him or her with a blanket or jacket.

 

Remove smouldering clothing and any jewellery around the burnt area.

 

Call for medical assistance and take the child immediately to hospital.

 

For Electrical and Chemical Burns:

 

Make sure the child is not in contact with the electrical source before touching him or her, or you could also get an electric shock.

 

For chemical burns, flush the area with lots of running water for 5 minutes or more. If the burnt area is large, use a tub, shower, buckets of water, or a garden hose.

 

Chemical burns to the mouth or eyes require immediate medical evaluation after thorough flushing with water.

 

Electrical burns should be attended to, by a doctor; so, the child should be shifted to hospital without delay.

 

Although both chemical and electrical burns may not always be visible, they can be serious because of potential damage to internal organs. Symptoms may vary, depending on the type and severity of the burn and what caused it.

 

You can’t keep kids free from injuries all the time, but these simple precautions can reduce the chances of burns at home.

 

PREVENTING BURNS Kitchen/Dining Room

 

Position cookware handles towards the rear of the stove every time you cook.

 

Block access to the stove as much as possible.

 

Never let a child use a walker in the kitchen (in fact, health experts strongly discourage the use of walkers).

 

Avoid using tablecloths or large placemats. Young children can pull on them and overturn a hot drink or plate of steaming food.

 

Never drink hot beverages with a child sitting on your lap or carry hot liquids or dishes around kids. If you are walking about the kitchen carrying a vessel of hot liquid (like a pot of soup or cup of coffee), make sure you know where kids are so you don’t trip over them.

 

Never hold a baby or a small child while cooking.

 

Never warm baby bottles in the microwave oven. The liquid may heat unevenly, resulting in pockets of breast milk or formula that can scald a baby’s mouth.

 

Teach kids never to put anything into the fireplace when it is lit.

 

In General

 

Keep matches, lighters, chemicals, and lit candles out of kids’ reach.

 

Put child-safety covers on all electrical outlets.

 

Get rid of equipment and appliances with old or frayed cords and extension cords that look damaged.

 

Make sure older kids and teens are especially careful when using iron boxes.

 

Prevent house fires by making sure you have a smoke alarm at every level of your home.

 

Check this equipment every month and change the batteries at least twice a year.

 

If you smoke, don’t smoke inside the house, especially when you are tired or taking medicines that can make you drowsy.

 

Don’t use fireworks or sparklers inside homes.

 

Bathroom

 

Set the thermostat on your hot water heater to 120°F (49°C) or use the ‘low-medium setting’. A child can get scalded in 5 seconds in water if the temperature is 140°F (60°C). If you are unable to control the water temperature (if you live in an apartment, for example), get an anti-scald device, which is fairly inexpensive and can be installed easily.

 

Always test bath water with your elbow before putting your child in it.

 

Always turn the cold water on first and turn it off last when running water in the bathtub or sink.

 

Turn kids away from the faucet or fixtures so they are less likely to play with them and turn on the hot water.

 

Outside/In the Car

 

Use playground equipment with caution. If it’s very hot outside, use the equipment only in the morning, when it has had a chance to cool down during the night.

 

Before leaving your car outside on a hot day, conceal the seatbelt’s metal latch plates to prevent them from heating in the sun.

 

Do not let your child go near a two-wheeler especially when it has been just driven; the engine and the silencer will be very hot and cause bad burns.

 

Don’t forget to apply sunscreen when stepping out. Apply sunscreen 20-30 minutes before going out and reapply every 2 hours or more often if in water.

 

Try to keep infants under 6 months of age out of the sun.

 

The suffering caused by burns is ironically made more tragic as burns are eminently preventable. More preventive measures will help reduce burn-related deaths and disabilities. Foresight and care are all we need.


Dr. W. Ahamed Kabeer

The writer is a Consultant Paediatric Surgeon at Rajagiri Hospital, Kochi


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