Dr. Sears Guide to Treating Burns
As you are fixing your hair in the morning, you set the curling iron down on the counter. Your one-year-old has been watching you, fascinated by this strange object. You turn your back for a second, and he eagerly grabs onto the hot iron.This is a very common situation that happens to even the most careful and watchful parents. Below is the Dr. Sears guide to treating burns.
TREATING BURNS: THE VERY FIRST STEPS
The very first step is to stop the heat.
- Do this by submerging the burned area in cold water as fast as you can. If the burn is on the part of the body, you cannot submerge, then immediately pour cold water over the area several times or rinse the area under a faucet or shower. Remove any clothing that is covering the area, then pour some more water over the burn. Be careful not to pull a still-hot shirt over the head as this may burn the face. Getting cold water onto the area as fast as possible is the single most important factor in minimizing the burn damage.
Do not use ice.
- This can cause cold damage to the skin, which may make the burn worse.
The next step is to continue the cold water for at least 20 minutes.
- Submerging is best when treating burns, but if you cannot, run it under cold water or apply cold water-soaked washcloths repeatedly.
- Do not put any butter, grease, or powder on the burn.
Most children will protest holding the burn under cold water.
- Your child might kick and scream while you’re holding the burn area underwater. You will have to restrain and reassure them. It’s much better to have a child cry for 20 minutes than to have a worsened burn.
AFTER THE INITIAL 20 MINUTES OF COLD WATER, WHAT DO I DO NEXT?
- Pain relief. Give your child a dose of ibuprofen (Motrin or Advil). This will both help the pain and decrease the inflammation.
- Calm yourself and your child.
- Assess the burn. There are three degrees of burn.
- First degree burns. This is simply redness, with no blistering. This type of burn never leaves a scar if properly treated.
- Second-degree burns. This is redness with blistering of the skin and is usually the most painful type of burn. With proper treatment, this type of burn rarely leaves a scar. NEVER pop the blisters.
- Third-degree burns. This occurs when many layers of skin are actually burned away. Normally there is no blister because the top layers of skin are gone. This burn usually leaves a scar, even with proper treatment.
SHOULD I PAGE THE DOCTOR OR SHOULD I RUSH TO THE ER?
Not all burns require immediate medical evaluation, and some do not need to be seen by a doctor at all. Here is a guide to help you decide the next appropriate step.
Any burn over a large part of the body, regardless of the degree, should receive medical attention promptly in an ER. Examples include burns of the entire back or chest and abdomen, or burns involving most or all of an extremity.
These almost always warrant a call to your doctor right away, unless it involves a very small area, such as the size of a quarter or smaller.
Again, this is just redness, no blisters will form, and no skin is burned away. This does not require urgent care and usually doesn’t require a doctor’s visit. Depending upon your observations, you may call your doctor during office hours and speak with a nurse just to be sure no follow-up is needed. Some first-degree burns will begin to blister as long as 24 hours later. This means it has changed into a second-degree burn.
The key here is that blisters will form. If there is no blister, and the skin is not burned away, then it is first-degree. A second-degree burn does warrant an urgent page to your doctor after hours or a visit to the office right away.
If it appears that many layers of skin have been burned away to the extent that there is not enough skin left to form a blister, then take your child into an emergency room immediately. Even during the day, while your doctor’s office is open, it still may be better to go to an ER if you are certain it is a third-degree burn.
HOW DO I TREAT THE BURN?
First degree burns
For treating burns that are first degree, you do not need a prescription cream. You also do not need to use an antibiotic cream. One of the best treatments for first degree burns is aloe vera. Buy a bottle of 100% aloe gel and apply it several times a day. Be sure to buy 100% aloe. Some bottles will say, “made with pure aloe,” but only contain 10% aloe. Read the ingredients. Basically, it should only read aloe on the label. You can also use the juice from the leaf of an aloe plant if you have one.
Treating burns that are second degree is more complex. You should check with your doctor about how to treat your child’s second-degree burns. Here are some general guidelines that we recommend. Twice a day, do the following:
Rinse the area with comfortable temperature water. Use a sink or bathtub faucet. The stream of water will remove germs, dead skin, and debris.
Apply prescription burn cream called Silvadene (the generic equivalent is silver sulfadiazine). This is an antibiotic cream with excellent healing properties and is an important part of the burn treatment because it’s very effective at preventing infection. You need to apply it aseptically; buy a package of sterile tongue depressors to use. Use a lot of cream, as if you were icing a cake. When you change the bandage, if all the cream is worn off or soaked in, then you didn’t use enough. Silvadene contains silver, and you will notice a dark “tarnish” discoloration on the bandages.
Cover with a bandage. Your doctor may recommend a specific type of bandage. Typically a non-stick pad is placed over the cream (one brand name is Telfa), then a gauze is taped or wrapped around the area.
Stretch. If the burn is on an area of the body that stretches or pulls a lot (such as the palm of the hand or palm side of the fingers), the burned skin is at risk of healing too tight. This is called a contracture. In this area, it is very important to stretch this skin around ten times a day for one minute.
Cutaway the blister – after the blister pops on its own. Your doctor may cut the dead blistered skin away. This will help prevent infection and will promote healing. If your child has a large blister that pops after several days, then go back to see their doctor. He or she may want to cut it away.
Watch for infection. Call or see your doctor if you detect any foul-smelling greenish discharge from the burn or see an expanding area of redness around the burn.
Because of the seriousness and potential for scarring from this type of burn, it is recommended that you go to a burn center or ER for treating burns of this degree, and then continue your follow-up care with a burn surgeon. We cannot put any general recommendations here for this type of burn.
WHEN TREATING BURNS, HOW LONG DO I USE THE BURN CREAM OR ALOE AND BANDAGES?
If you are just treating burns that are first-degree with aloe, you probably only need to use it for a few days. It doesn’t hurt to use it longer.
If you are treating a second-degree burn, you should ask your doctor when to stop the treatment. In general, as the burned skin peels off, new red skin (which usually bleeds a tiny bit) will be visible underneath. This red skin will slowly lighten into pink skin color. You can generally stop using the cream at this time. You can also stop covering it with a bandage at this time.
Burned skin is extremely sensitive to becoming permanently discolored by the sun. Once the burn is healed, you should apply sunscreen or cover the area with clothing or a hat. Continue this extra sun protection for 6 months.
To learn more about your children’s health, see The Portable Pediatrician