Kids Health Info

Burns - general treatment

  • A burn is an injury to the skin caused when the skin has contact with hot fluid, flame or chemicals. Burns are classified by how deeply they injure or burn the skin:

    1. Superficial
    2. Partial thickness
    3. Deep full thickness

    Treatment for burns includes applying special 'wet dressings'. Good nutrition is also very important to help the body heal. Regular pain relief and physiotherapy may also be very helpful.

    Treatment

    Burns are treated by placing slightly wet dressings over the actual wounds. Most burns dressings used at The Royal Children's Hospital involve a 'closed dressing technique'. This means the wound is covered with a dressing and not left open to the air.

    The 'closed dressing technique' is used for protection and absorption and also reduces stress on the patient and their family. By having the dressing closed, the wound does not need daily care. It just needs checking that it stays on and is intact. The fact the wound is covered also means that neither the child nor their family have to look at the wound.

    The level of moisture, and the size, depth and area of the burn need to be taken into consideration when choosing the type of dressing. For example, burns dressings for the face and perineum (the area between the anus and the scrotum in the male and between the anus and the vulva in the female) are different to other parts of the body (see Kids Health Info factsheet: Burns on the face).

    The aim of the burn dressing is to keep the wound clean and dry and to prevent infection. Although the dressing is designed to keep the wound dry, a 'wet dressing' contains silver which releases for up to seven days. Silver is an antimicrobial - a substance that kills or prevents the growth of microbes such as bacteria. It is important not to have a bath or to play in the sandpit as these activities will contaminate the dressing.

    In the beginning, it can be very difficult to tell how deep a burn is.  It takes from 10-14 days or more for a burn area to fully develop. This does not mean that your child needs to stay in hospital for all of that time. Once your child is eating and drinking enough and their condition is stable, you may be able to take your child home. Your child will have their dressings on and will need to come back to either Specialist Clinics or Platypus Ward for dressing changes and to review the healing progress.  Sometimes children need to go to theatre to have the dressing changed under a general anaesthetic (GA).

    Dressing changes can be, but are not always, painful. However, the burns dressing changes can be emotionally and psychologically upsetting for both your child and you. As an inpatient, we try to minimise this with a combination of medications and techniques for play and distraction. This is where you, as a parent, can really help. See the Kids Health Info factsheet:  Reduce children's pain during tests and procedures.

    Please feel free to discuss any ideas you have to reduce your child's fear with the ward nurse. There is also a burns social worker on hand if you would like to talk about coping strategies for dressing changes as well as how to talk to your child about their burns.

    Burns usually heal on their own with time.  However, they sometimes don't heal and need skin grafting. Some burns can scar. The physiotherapist aims to reduce this as much as possible. (see the Kids Health Inof factsheet: Burns & physiotherapy).

    Nutrition

    Good nutrition is needed to help burns heal. Your child needs a diet high in protein and calories and plenty to drink. Talk to staff for advice and examples of good foods to eat.

    The Burns Team

    Children with burns are treated by a team of different specialists who work together to help your child get better. This team is called the Burns Team and includes:

    • doctors (consultant - senior doctor, registrar - middle doctor and resident - junior doctor)
    • nurses (ward, outpatients, theatre)
    • ward care coordinator (nurse who coordinates your child's care)
    • physiotherapist (works to maintain and restore mobility and range of movement and minimise scarring)
    • occupational therapist (services related to rehabilitation of hand injuries)
    • social worker (can assist with home, family or transport problems; help you work with welfare organisations such as Centrelink; provide counselling and coping mechanisms)
    • dietitian (makes sure your child gets the best food for healing - in hospital and at home)
    • education advisor (who acts as a liaison between hospital and school)
    • play therapist (provides educational play and distraction during distressing treatment)

    Your child may also see other experts as needed.

    At home care / care after procedure

    Keep the dressings on!

    • Acticoat is a dressing containing silver. Silver has antibacterial properties and helps with healing.
    • The dressing is moistened first, then put on your child's burn and taped securely into place.
    • The wound may 'sting' when the dressing is first put on. This should stop in about 15-20 minutes.
    • Keep the outside of the dressing dry. The dressing is wet underneath but is dry on the outside and it is important not to contaminate the dressing by getting it wet or dirty.
    • It is normal for dressings to ooze. A chemical reaction with the silver in the dressing can cause a green-grey coloured fluid to leak out onto the bandages. A moderate amount of leakage is normal, especially in the first two weeks.
    • Reinforce any oozy areas by wrapping another bandage over the existing one or just by adding some tape.
    • DO NOT TAKE THE DRESSING OFF!

    Pain management

    • Most children do not have much pain once the dressing is in place. However, sometimes you may need to give your child some simple pain relief such as paracetamol.
    • Your child can take some PainstopTM at night time before bed if needed. PainstopTM helps stop itch as well as pain.

    Itching / irritation

    • Overheating can make the itch worse. Keep your child cool by not overdressing them - especially in bed.
    • Keep your child's finger nails trimmed. Scratching can damage the skin.
    • Some antihistamine medications may help. Talk to your family doctor or pharmacist.
    • Use sorbolene cream to moisten the skin that is not covered with dressings.

    Follow-up

    See your family doctor or call the RCH (see below) if your child:

    • becomes unwell or does not seem their normal self
    • does not seem to be drinking enough fluids - your guide to this in little babies is not having their normal number of wet nappies, and in older children not going to the toilet as much as they would normally
    • develops a temperature more than 38.5º C

    If the dressing falls off

    • Call the burns outpatient nurse - (03) 9345 6564 or (03) 9345 5522 pager 6844.
    • After hours call Platypus ward - (03) 9345 5432.
    • Go to the RCH emergency department to have the wound looked at and a new dressing put on.

    For more information

    • Burns coordinator
      Mon - Fri 8.30am - 4.30pm
      T: (03) 9345 4343 or (03) 9345 5522 and ask for pager 5959.
    • Outpatient nurse
      Monday-Friday 8.30am - 4.30pm
      T: (03) 9345 6564 or (03) 9345 5522 and ask for pager 6844.
    • After hours contact Platypus ward 
    •  T: (03) 9345 5432
    • A social worker can provide counselling and other services that can be helpful when a child or family has a physical and/or emotional health problem or disability. For social work enquires please call (03) 9345 6111 during office hours or take a look at their website www.rch.org.au/socialwork/

    Other Kids Health Info factsheets:

     

    Developed by the RCH Burns Unit. Updated June 2015

We want your feedback!  

Please complete this short survey (takes 2 minutes) to help us further improve this resource, thank you. 


Disclaimer 
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.