Kids Health Info

Burns – medical treatment

  • See our fact sheet Burns – prevention and first aid if you are looking for what to do when your child has first received a burn.

    Once your child has been seen by a doctor for a burns assessment, they will be given treatment depending on what kind of burn they have and where it is. 

    Burns are classified by how deeply they injure or burn the skin: 

    • superficial (damage to the top layer of the skin only)
    • partial thickness (damage to the first and second layer of skin)
    • deep full thickness (damage to the skin layers and underlying tissue, including muscle and bone in very deep burns).

    It can be very difficult to tell how deep a burn is at first. It can take around 10 days for a burn area to fully develop. 

    Burns usually heal on their own with time, as long as they are looked after well. Proper burns management will also help minimise scarring. A physiotherapist and/or an occupational therapist can help with this. See our fact sheet Burns – rehabilitation

    Depending on how severe and deep the burn is, the new skin may take seven to 10 days to heal. However, sometimes burns don't heal and need skin grafting. See our fact sheet Split skin graft.

    Burns treatment 

    Treatment for burns involves applying special dressings, or in some cases (e.g. for burns on the face), Vaseline. The dryness, size, depth and location of the burn need to be taken into consideration when choosing the type of dressing.

    Dressings 

    Most burns are treated by placing slightly damp dressings over the wounds. Burns dressings used at The Royal Children's Hosptial (RCH) usually involve a closed dressing technique, where the wound is covered with a dressing and not left open to the air. This not only protects the wound, but also reduces stress on the child and their family. 

    • With a closed dressing, the wound does not need daily care – the dressing just needs to be checked to ensure that it stays on properly. 
    • Having the burn completely covered also means that you and your child don't have to look at the wound.

    The aim of the dressing is to keep the wound clean and to prevent infection. The RCH uses dressings that contain silver, which releases for up to seven days. Silver is an antimicrobial, which means it prevents the growth of microbes such as bacteria. Its antibacterial properties help with healing.

    Burns on the face and perineum 

    Burns on the face or perineum (the area between the anus and the scrotum or between the anus and the vulva) require different dressings than other parts of the body.

    • It is difficult to keep a dressing on the face if your child has a facial burn. However, the burn still needs something to keep it moist, free of infection and comfortable. Vaseline is used to do this. It is safe, gentle and soothing. 
    • Burns on the perineum may require dressings, creams or Vaseline to keep them clean and moist. 

    Care at home 

    If your child has been in hospital, they will be able to go home once they are eating and drinking enough, their pain is under control and their condition is stable. The burns do not have to be completely healed before your child is discharged from hospital.

    There are different ways to care for your child's burns at home, depending on whether they have dressings or they are undergoing treatment for a burn on the face or perineum.

    Caring for dressings 

    • Do not take the dressing off.
    • Keep the outside of the dressing dry. The dressing is damp underneath, but is dry on the outside. It is important not to contaminate the dressing by getting it wet or dirty. 
    • Do not give your child a bath – give them a sponge bath instead. 
    • Do not let your child play in the dirt or in a sandpit as these activities will contaminate the dressing. 
    • 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. 
    • If the dressing falls off, call the treating hospital or go to an emergency department to have the wound looked at and a new dressing put on. 

    Caring for burns on the face 

    You will need to wash your child's face and apply Vaseline twice each day. This reduces the risk of infection. If required, give your child some pain relief (e.g. paracetamol) before cleaning their face. Twice a day:

    • wash your hands thoroughly with warm soapy water and dry with a clean towel before washing your child's face
    • clean your child's face gently with water
    • apply the Vaseline to the face by using a big cotton swab, gauze or your clean hands. Apply a layer of Vaseline that's half a centimetre thick onto the burn. If you notice your child has rubbed the Vaseline off, just apply more. 

    The skin will start to form scabs as it heals. Once a scab has formed, stop using the Vaseline on that part and apply a moisturiser such as unperfumed sorbolene. Continue to use the Vaseline on the burnt areas that have not yet formed a scab.

    You can shower/bath your child as normal on the non-burnt skin. 

    Pain management

    Most children do not have much pain once the dressing or Vaseline has been applied. However, sometimes you may need to give your child some simple pain relief such as paracetamol. If your child's pain cannot be relieved after this, take them to the GP.

    Itching and irritation

    Your child may experience itch and irritation as their burns heal.

    • Overheating can make the itch worse. Keep your child cool by not overdressing them, especially when they are in bed.
    • Keep your child's fingernails trimmed. Scratching can damage the skin.
    • Some antihistamine medications may help with the itch. Talk to your GP or pharmacist.
    • Use sorbolene cream to moisten the skin that is not covered with dressings.

    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 a dietician, your GP or hospital staff for advice and examples of good foods to eat to promote healing.

    Follow-up 

    Your child may need to return to hospital or see a GP for review and dressing changes. The nurses or doctors will check how well the burnt skin is healing. Any areas that have not healed after about two weeks may need further medical intervention. This will be discussed with you when your child is reviewed.

    Dressing changes

    Burns dressing changes can be upsetting for both your child and you. Dressing changes can be, but are not always, painful.

    A combination of medications and techniques for distraction can help your child cope better with the procedure. Talk to staff about coping strategies for dressing changes and for ideas on how to talk to your child about their burns. Also see our fact sheet Reducing your child's discomfort during procedures.

    Before the appointment:

    • Half an hour before the dressing change, you should give your child some medicine such as paracetamol and/or ibuprofen to help with pain. If your child has been prescribed stronger pain medication, give them this.
    • If you can access the tape holding the dressing in place, apply olive oil to the tape edges to help remove the dressing. This can be done the night before your appointment. Do not do this if the dressing is under bandages.
    • Bring some comfort items your child may enjoy (e.g. a dummy, favourite comfort toy, book, smartphone or tablet).
    • It is a good idea to bring a snack and a drink, but do not give the food or drink to your child until after the dressing change. Sometimes children need to fast (have nothing to eat or drink) before the dressing change procedure so that they can be given sedation or strong pain medication. You'll be given instructions to follow if fasting is required.

    During the appointment:

    • Once old dressings have been removed, new dressings are moistened 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.
    • Sometimes a child may need extra help during a dressing change. Nitrous oxide (laughing gas) can be used, but only if your child has fasted beforehand.
    • Sometimes children need to go to theatre to have the dressing changed under a general anaesthetic.

    When to see a doctor

    See your GP or call your treating hospital if your child:

    • becomes unwell or does not seem their normal self
    • has a new or different discharge on the face
    • is in more pain
    • does not seem to be drinking enough fluids – babies will not be having their normal number of wet nappies, and older children will not be going to the toilet as much as they would normally
    • develops a temperature more than 38.5ºC.

    For more information

    Common questions our doctors are asked

    How should I bathe my child to prevent the dressings getting wet?

    This will depend on the type and location of the burn, as well as the dressing used. Some dressings include a waterproof cover, which will protect the wound from splashes of water. Children may sit in a shallow bath and be wiped down with wash-cloths. Discuss this with your child's doctor or nurse.

    When can my child return to school?

    Once feeling better, your child is able to return to school. An appropriate sturdy dressing should be applied, and your child’s teacher and school nurse should be made aware of the dressing and how to manage it, in the event of accidental removal, splash or other complication.


    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.