Kids Health Info

Burns – rehabilitation

  • After a child has had a serious injury, such as a significant burn, they may need rehabilitation to help them recover and maximise their ability to participate in activities at home, school and the community. Rehabilitation for burns involves physiotherapy (often called physio), and in some cases, occupational therapy (OT).

    Children who have had a significant burn will usually start having physio early in their treatment. The main reasons for having physio are to:

    • keep the joints (e.g. elbows, knees) moving, and to help prevent them tightening up (called a 'joint contracture') from tight, damaged skin
    • keep the muscles working for normal movement
    • reduce scarring.

    Children who have burns to their hands or wrists will start OT early in their treatment as well. The main reasons for having OT are to:

    • best position the hand and wrist for healing, using dressings or splinting
    • minimise the impact of scars
    • keep joints and muscles moving in the hand.

    What to expect with burns rehabilitation

    While your child is an inpatient (staying in hospital), they will be seen by a physiotherapist, who will start your child on a physio program. They may also be seen by an occupational therapist if their burns are on the hand or wrist, to see how well your child functions in their ability to carry out daily tasks (e.g. eating, self-care or dressing).

    If your child has had skin grafts, any exercises will not be started until the grafts have started to heal. 

    Physiotherapy

    • Physiotherapists may use splints, pillows or custom-made wedges to position your child’s joints while they are in bed, to help prevent the joints from becoming stiff or contracting (tightening up). The physiotherapist will provide you with a program for the correct resting positions for your child and, together with the nursing staff, will assist you with following the program.
    • If your child has sustained an inhalation burn or remains resting in bed for a long time, the physiotherapist may teach your child deep breathing exercises or blowing games. These will help to prevent respiratory complications.
    • It is essential your child regularly stretches the affected joints. This is often done with splints and positioning in the beginning.
    • Bed exercises are important in the early days and weeks of recovery to keep your child's muscles working. The effects of pain and any surgery will be considered by the physiotherapist when planning exercises.
    • Your child will be helped to start moving and walking as soon as possible. This depends on which areas of the body have been burned.

    Occupational therapy

    Not all children will require OT – this will depend on the age of your child, the extent of their injury and if there has been a change in function.

    • An occupational therapist may see your child in hospital to prepare them for discharge home. The aim is to help your child gain independence in tasks such as toileting, dressing and attending school.
    • The occupational therapist may use thermoplastic splints or dressings to position your child’s hand and wrist while they are healing.
    • Active exercises may be provided to your child for their hand/wrist when they are healed to keep joints and muscles moving. This will assist with the return of hand function and strength.

    Scar management

    The physiotherapist and/or occupational therapist will assess your child's burns and scars and provide the best possible scar treatment. The aim is to have a scar that is as flat, supple (able to stretch) and as soft as possible.

    It can take one to two years for a scar to mature. This depends on:

    • how deep the burn is (deeper burns are more likely to leave a scar)
    • time taken for the burn to heal (the longer it takes to heal, the higher the risk of scarring)
    • skin colour
    • the part of the body (areas over joints are usually more likely to have problem scarring).

    Sometimes, scarring can become excessive (keloid). In these cases, there are special dressings that can be used to help reduce the development of keloid scars, including:

    • Tubigrip (a type of tube bandage) or compression garments made specially to fit your child
    • adhesive tape, which provides compression to prevent excessive scarring
    • compression garments or gloves.

    Care at home

    Your child's physiotherapist and/or occupational therapist will give you information and instructions for ongoing care at home. This may include exercises, positioning, stretches and bandages or garments to wear. Talk to the physiotherapist/ occupational therapist and ask about anything you are not sure of.

    Your child may need ongoing physio or OT appointments, which can be done as an outpatient. These appointments may take place at hospital or somewhere closer to your home.

    For more information

    Common questions our doctors are asked

    My child is very reluctant to do his exercises because he says they hurt. What can we do about this?

    Your child's physiotherapist is careful to recommend exercises that won't cause extra pain for your child. Pain relief may be required to prevent excessive discomfort, or you could focus on distraction techniques.

    When can my child return to sport and other physical activities?

    Skin that is recovering from a burn is particularly sensitive and prone to infection or break down. It is important to avoid participating in sports until the burn has healed adequately. You should discuss this with your child's doctor or physiotherapist as protective garments may be recommended.


    Developed by The Royal Children's Hospital Burns Unit. We acknowledge the input of RCH consumers and carers.

    Reviewed August 2018.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.


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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.