What is the management for a scald burn on a child's skin?

From the Guidelines

The immediate management for a scald burn on a child's skin involves first removing the child from the heat source and cooling the burn with cool (not cold) running water for 10-20 minutes, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. This approach is supported by the highest quality and most recent evidence, which emphasizes the importance of immediate cooling to reduce tissue damage and promote healing. Key steps in managing a scald burn in a child include:

• Removing any clothing or jewelry near the burned area unless it's stuck to the skin
• Cooling the burn with cool running water for 10-20 minutes, as this has been shown to decrease the need for subsequent care in patients with thermal burns 1
• Covering the burn with a clean, non-stick bandage or sterile gauze wrapped loosely to avoid pressure on the burned skin, which helps prevent infection and promotes healing 1
• Giving over-the-counter pain medications, such as acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours), as appropriate for the child's age, to manage pain 1 It is also crucial to avoid applying ice, butter, toothpaste, or home remedies, as these can worsen tissue damage, and to avoid breaking any blisters that form. Seeking immediate medical attention is necessary for burns that are larger than 3 inches in diameter, affect the face, hands, feet, genitals, or major joints, appear deep (affecting multiple skin layers), or if the child is under 5 years old, as these cases require specialized care to prevent long-term damage and promote optimal recovery 1.

From the FDA Drug Label

Uses first aid to help prevent infection and for the temporary relief of pain or discomfort in minor: cuts scrapes burns Directions adults and children 2 years of age and older: clean the affected area apply a small amount of this product (an amount equal to the surface area of the tip of a finger) on the area 1 to 3 times daily may be covered with a sterile bandage children under 2 years of age: ask a doctor

The management for a scald burn on a child's skin includes:

• Cleaning the affected area
• Applying a small amount of topical product, such as bacitracin, to the area 1 to 3 times daily for children 2 years of age and older
• The area may be covered with a sterile bandage
• For children under 2 years of age, it is recommended to ask a doctor for guidance on management 2 2

From the Research

Management of Scald Burns in Children

The management of scald burns in children involves several key steps to promote healing, minimize scarring, and prevent infection.

• Initial first aid measures include removing hot clothes and jewelry, applying cool water for 10-20 minutes, and covering the burn with a plastic film or clean cloth 3.
• Assessment of the burn wound is crucial to determine the optimal setting for management, with patients having full-thickness burns, circumferential burns, or burns on the face, hands, feet, genitals, or perineum requiring referral to a burn subspecialist 4.
• Topical antimicrobial agents, such as silver sulfadiazine, are commonly used to prevent infection and promote healing 5, 4.
• Pain management is also an essential aspect of burn care, with acetaminophen being the first-line treatment for minor burns and opioids used for more severe burns 4.
• The goal of treatment is to allow the patient to heal with as little scarring as possible, with strategies such as optimizing reepithelialization and skin grafting used to achieve this goal 6.

Treatment Strategies

Different treatment strategies are needed for various types and depths of burns, including:

• Superficial burns: optimizing reepithelialization to reduce scarring 6
• Deeper burns: skin grafting, including the use of "sheet" autograft skin 6
• Exposed bone or tendon: requiring specialized treatment strategies 6

Importance of Education

Education on proper burn first aid and treatment is crucial for parents and caregivers to provide adequate care for children with scald burns 3.

• A simple mnemonic, such as STOP (Strip clothes, turn on the tap for 10 min, organise help, put on plastic film), can be used to assist parental education on burn first aid 3.